目的探讨18F-FDGPET/CT脑3D显像在癫发作期和发作间期致灶定位中的应用价值。方法癫患者60例均行24h头皮脑电图、MRI、18F-FDGPET/CT脑显像。25例行皮质脑电图(ECoG)或深部脑电图(DEEG)。PET/CT图像经过目测和半定量的方法进行分析。结果(1)60例中，18F-FDGPET/CT脑显像阳性者57例，检出率95%，其中患者处于发作间期56例，PET/CT表现为低代谢灶者53例，发作期4例，PET/CT上均表现为高代谢灶。(2)PET/CT显示80%为单发灶(48/60)，15%为2个以上病灶(9/60)。单发灶中，66.7%位于颞叶(32/48)，另33.3%位于颞叶外皮质(顶叶6例，额叶10例)。(3)PET/CT与皮质脑电图(ECoG)或深部脑电图(DEEG)符合率为96%(24/25)。(4)32例颞叶癫行前颞叶切除术，术后随访结果EngelⅠ～Ⅱ级者30例。非颞叶癫16例，行致灶皮质切除术，12例达EngelⅠ～Ⅱ级。3例未检出致灶，9例DEEG定位双侧致灶未行手术治疗。结论对于颅内有病灶癫及明确的颞叶癫患者，PET/CT与EEG以及MRI检查结果具有高度一致性;对于没有病灶及非颞叶癫患者，PET/CT是一种无创、敏感、有效的定位癫源灶的方法。
Abstract
Objective To assess the value of 18F-fluorodeoxyglucose (FDG)PET/CT in localizing the epileptic foci in attack period or interphase. Methods All 60 patients underwent 18F-FDG PET/CT.The images were analyzed by visual inspection and semiquantitative methods. The scalp electroencephalogram( EEG )was examined in all patients, among whom electrocorticogram(ECoG)or depth electroencephalogram (DEEG) was examined in 25 cases. Results (1) Of 56 patients who in epileptic interictal time, PET/CT images show hypometabolic foci in 53case. Of 4 patients who in epileptic ictal time, PET/CT show hypermetabolic foci.(2) PET /CT detected 80% solitary lesion and 15% multiple lesion.Among 48 solitary lesion,32 were located in temporal lobe. (3) Compared with ECoG or DEEG,the accuracy of PET/CT to localize epileptic foci was 96%. (4) 32 cases of mesial temporal lobe epilepsy underwent the anterior temporal lobectomy,and 30 reached Engel Ⅰ-Ⅱ. 16 cases of extratemporal epilepsy underwent the resection of epileptogenic foci, and 12 cases reached Engel IⅠ-Ⅱ postoperatively.Conclusions The results of 18F-FDG PET/CT are highly accordant with that of EEG and MRI in mesial temporal lobe epilepsy.For extratemporal epilepsy,PET/CT is a noninvasive, sensitive and effective method to locate possible sites and extent of epileptogenic sources.
关键词
癫 /
体层摄影术 /
发射型计算机 /
脱氧葡萄糖
Key words
epilepsy /
tomography, emission-computed /
tomography, X-ray computed /
deoxyglucose
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参考文献
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