发作间期动脉自旋标记成像在癫痫术前评估中的作用  

The role of interictal arterial spin labeling imaging in the preoperative evaluation of epilepsy

作　　者：史洁[1] 王思瑜 王海祥[1] 贺晶[1] 宋宪成[1] 张冰清[1] 孙朝晖[1] 刘一鸥[1] 李佳[1] 周文静[1] Shi Jie;Wang Siyu;Wang Haixiang;He Jing;Song Xiancheng;Zhang Bingqing;Sun Zhaohui;Liu Yiou;Li Jia;Zhou Wenjing(Department of Neurosurgery,Yuquan Hospital,Tsinghua University,Beijing 100040,China)

机构地区：[1]清华大学玉泉医院神经外科,北京100040

出　　处：《中华神经外科杂志》2023年第9期903-908,共6页Chinese Journal of Neurosurgery

摘　　要：目的评估发作间期动脉自旋标记成像(ASL)在药物难治性局灶性癫痫术前评估中的作用。方法回顾性分析2022年1—9月在清华大学玉泉医院神经外科行术前评估的药物难治性局灶性癫痫患者的临床资料。共纳入29例患者,其中26例为儿童患者。术前根据临床资料、视频脑电图(VEEG)、头颅结构像MRI、正电子发射断层显像(PET)-CT等评估致痫区。所有患者均行发作间期ASL检查,采用视觉阅片对ASL扫描获得的脑血流(CBF)影像进行定性分析,确定是否存在灌注异常及分布模式,分析异常灌注部位与多学科会诊和立体脑电图(SEEG)确认的致痫区的一致性。结果29例患者中,术前评估28例(97%)致痫区明确,其中25例行手术治疗;1例(3%)不明确,行内科治疗。29例患者中,26例(90%)存在CBF影像异常,其中19例(66%)为局部低灌注,5例(17%)为局部高灌注,2例(7%)为局部低灌注与高灌注共存,3例(10%)无灌注异常区域。23例(79%)ASL结果与术前评估基本一致,2例(7%)部分一致,4例(14%)不一致。4例存在发作间期近持续局灶性癫痫样放电的患者中,3例存在局部高灌注;25例无近持续间期放电的患者中,4例存在局部高灌注,差异有统计学意义(P=0.034)。19例CBF影像显示局灶低灌注的患者中,18例与术前评估致痫区基本一致,1例部分一致;7例CBF影像显示存在高灌注的患者中,5例与术前评估的致痫区基本一致,1例部分一致,1例不一致;CBF影像呈低灌注者与术前评估致痫区的一致率与呈高灌注者与术前评估致痫区的一致率比较,差异无统计学意义(P=0.167)。行手术治疗的25例患者中,22例(88%)CBF影像显示的灌注异常部位与手术切除或损毁部位一致。所有患者的中位随访时间为10个月(1~12个月),手术治疗的25例中,术后均无癫痫发作。结论发作间期ASL有助于识别致痫区,在术前评估中具有一定的定位价值。Objective To evaluate the role of arterial spin labelling(ASL)imaging in the preoperative evaluation of drug-resistant focal epilepsy.Methods A retrospective analysis was conducted on the clinical data of patients with drug-resistant focal epilepsy who underwent preoperative evaluation in Neurosurgery Department of Yuquan Hospital,Tsinghua University from January 2022 to September 2022.A total of 29 patients were included,of which 26 were children.The epileptogenic zone(EZ)was evaluated preoperatively based on clinical data,video electroencephalography(VEEG),brain structural MRI,and positron emission tomography(PET)-CT.All patients underwent interictal ASL examination,and qualitative analysis of cerebral blood flow(CBF)images obtained by ASL was performed by visual reading to determine whether there was abnormal perfusion and distribution patterns.The consistency between abnormal perfusion sites and EZ confirmed by multidisciplinary meetings and SEEG results was analyzed.Results Among 29 patients,EZ was identified in 28(97%)patients,and 25 of them underwent surgical treatment.EZ of 1(3%)patient was not clear and received medication.Of the 29 patients,26(90%)had abnormal CBF imaging,including 19(66%)with local hypoperfusion,5(17%)with local hyperperfusion and 2(7%)with both local hypoperfusion and hyperperfusion areas,and 3(10%)with negative results.Local hyperperfusion was found in 3 of the 4 patients with interictal near-continuous focal epileptiform discharges,while among the 25 patients without near-continuous epileptiform discharges,4 patients had local hyperperfusion,and the difference was statistically significant(P=0.034).Of the 19 patients with focal hypoperfusion on CBF imaging,18 cases showed consistency between hypoperfusion site with the EZ determined by presurgical evaluation and 1 showed partial consistent.Of the 7 patients with hyperperfusion on CBF imaging,5 showed consistency between hyperperfusion site with the EZ determined by presurgical evaluation,1 showed partial consistent,and 1 showed inco

关 键 词：癫痫 术前评估 致痫区 动脉自旋标记 

分 类 号：R742.1[医药卫生—神经病学与精神病学]