^(18)F-FDG PET显像对致痫灶的定位诊断价值  

The Value of ^(18)F-FDG PET Imaging in the Localization of Epileptic Foci

作　　者：王全师[1] 吴湖炳[2] 胡海涛[1] 漆松涛[2] 杨开军[3] 

机构地区：[1]西安交通大学医学院解剖教研室,陕西西安710061 [2]第一军医大学附属南方医院PET中心 [3]第一军医大学附属南方医院神经外科

出　　处：《实用放射学杂志》2003年第12期1130-1132,共3页Journal of Practical Radiology

摘　　要：目的　探讨 18F -脱氧葡萄糖 (FDG)PET显像对癫痫灶的定位诊断价值。方法　难治性癫痫患者 2 2例 ,男 15例 ,女 7例 ,平均年龄 19.0岁 ,平均病程 8.2年。所有患者均进行常规 18F -FDGPET显像 ,结合脑电图 (EEG)及MRI、CT对 2 1例患者进行开颅手术 ,术中在皮层脑电图 (EcoG)监测下行致痫灶切除术 ,并送病理学检查 ;另 1例进行立体定向杏仁、海马损毁术。所有患者术后随访疗效。结果　 2 2例癫痫患者中 ,2 1例 18F -FDGPET显像阳性 (95 .5 % ) ,2 0例表现为发作间期低代谢灶 ,1例为发作期高代谢灶 ;EEG检查阳性 17例 (77.3 % ) ,其中 8例无定位意义 ;CT、MRI阳性者 5例 (2 2 .7% ) ;18F -FDGPET定位的致痫灶与EcoG一致的有 18例 (85 .7% ) ,不完全一致的 2例 ,不一致的 1例 ;18F -FDGPET显像阳性 19例中 ,18例手术病理异常 (94.7% ) ,PET阴性的 1例手术病理为正常脑组织 ;开颅手术治疗后 ,癫痫发作完全消失者 9例 (4 2 .9% ) ,癫痫发作次数减少 5 0 %以上者 9例 (4 2 .9% ) ,发作次数无明显变化 3例 (14 .3 % ) ;另 1例进行立体定向杏仁海马损毁术的患者癫痫发作次数无明显变化。结论　18F -FDGPET显像对致痫灶的定位诊断灵敏、准确 。Objective To assess the value of 18 F-FDG PET imaging in the localization of epileptic foci.Methods 18 F-FDG PET were performed in 22 patients with medically intractable epilepsy (15 males,7 females,mean years:19.0 years,mean duration:8.2 years). The open skull operations were undergone in 21 patients according to the results of 18 F-FDG PET, combining with scalp EEG and CT or/and MRI. 1 patient was refered for stereotactic operation. During operation,EcoG was detected for identifying the site of epileptogenic focus and lobectomy was performed . All specimens were examninated with the pathological tests. All patients were followed up for the curative effects. Results PET showed abnormalities in 21 patients(95.5%). Among them,single or multiple focal hypometabolisms were found in 20 patients and focal hypermetabolism in 1 patient. The scalp EEGs showed abnormalities in 17 patients(77.3%),but 8 of them did not showed clear latreralizing manifestations.The abnormalities were found on MR or/and CT in only 5 cases (22.7%).The epileptogenic foci detected by PET were consistent well with EcoG in 18cases(85.7%), consistent approximately in 2 cases and not consistent in 1 cases .Among 19 patients with abnormal PET findings , the pathological abnormalities were found in 18 cases (94.7%).No pathological abnormality was found in the patients with nomal PET imaing. After the open skull operations, 9 patients (42.9%) becomed seizure free . 9 patients (42.9%) had more than 50% seizure reduction and 3 patients (14.3%)showed no improvement. The patient treated with stereotactic operation also showed no significant improvement.Conclusion 18 F-FDG PET imaging is a sensitive and accurate modality to localizate the epileptic foci and has important clinical value in surgical therapy.

关 键 词：^18F-FDGPET显像 致痫灶 定位诊断价值 癫痫 体层摄影术 发射型计算机 正电子 脱氧葡萄糖 

分 类 号：R749.17[医药卫生—神经病学与精神病学] R814.4[医药卫生—临床医学]