摘要
目的:分析难治性癫痫患者正电子发射断层扫描(PET)、视频脑电图监测(VEEG)、颅内脑电图(Intracran ialEEG)以及MR I结果,探讨18脱氧葡萄糖(FDG)PET及MR I对致痫灶进行定位的应用价值.方法:难治性癫痫患者65(男44,女21)例,平均年龄(30.1±18.5)岁,均行VEEG,发作间期PET及MR I检查,42例进行了手术治疗,其中13例行颅内电极埋藏术,所有患者均术后1 mo复查MR I,定期电话随访,根据Engel疗效分级评估手术疗效,比较PET,MR I和VEEG在对致痫灶的术前定位准确性并分析它们之间的关系.结果:①58例癫痫患者发作间期脑皮层为低代谢表现,3例癫痫患者发作间期脑皮层为高代谢表现,4例癫痫患者发作间期脑组织代谢未见明显异常.②FDG PET病变定侧率高于VEEG,FDG PET低代谢灶检出率高于MR I.③42例手术患者中,属于Engels疗效分级Ⅰ级的30例手术切除部位定为准确的致痫灶,颅内EEG,FDG PET,VEEG与MR I定侧定位准确性分别为96.7%,90.0%,76.7%,53.3%,经2χ检验,颅内EEG,PET与MR I有显著性差异(P<0.05).④MR I阳性患者比MR I阴性患者的手术效果好;单侧颞叶低代谢手术效果好;颞叶癫痫手术效果优于颞叶外癫痫;PET示局灶性脑组织代谢减低者,手术效果优于伴有其他部位皮层代谢改变者.结论:发作间期FDG PET对癫痫灶定位的灵敏度和准确性优于MR I和头皮EEG,头皮EEG,MR I及FDG PET相结合可帮助临床医生确定病灶部位、选择手术适应证和预测疗效.
AIM： To compare the results of ictal PET, scalp Video EEG （VEEG）, intracranial EEG and MRI in patients with intractable epilepsy and to explore the application value of 18F-FDG PET and MRI in the localization of epileptogenic focus. METHODS： Brain imaging of 18F-FDG PET, MRI and EEG was obtained in 65 patients [ male 44, female 21 , age averaging （30. 1 ± 18. 5 ） years] with intractable epilepsy. Forty-two patients received surgical treatment and intracranial electrodes were placed in 13 patients. All the patients who had undergone surgery had MRI examination 1 month after surgery. Seizure control was also evaluated according to Engel＇s classification of surgical outcome. The efficacy of PET for the localization of epileptogenic focus was compared with that of VEEG, MRI and intracranial EEG. RESULTS：①Fifty-eight patients showed interictal focal hypometabolism, 3 patients with continuous seizure showed ietal hypermetabolism and 4 patients were normal. ② FDG PET localized the seizure foci in patients whose VEEG showed bilateral or no definite epileptoform discharge. FDG PET image demonstrated more metabolic changes than structural changes shown by MRI.③According to Engel＇s classification, 71.4% （30/42） were classified as grade Ⅰ, whose lesions were confirmed to be epileptogenic foci. The localization accuracy of intracranial EEG, FDG PET, VEEG and MRI for seizure foci was 96.7% , 90.0%, 76.7% and 53.3% , with significant difference when calculated by X^2 test （P 〈0.05 ）. ④ Surgical outcome of the patients with abnormal MRI image was better than that with normal MRI image. The effect of surgical removal of the hypometabolic focus in one temporal lobe was better than that in bilateral lobe. Patients with epileptogenic foei in temporal lobe had a better outcome than thosewith foci in other lobes. In the patients with other hypometabolic lesions besides major lesion, the removal of the major lesion was not as effective as that in the patients only with major lesions. CONCLUSION： The sensitivity and accuracy of the FDG PET imaging in localizing the seizure focus are significantly higher than those of MRI and VEEG. The FDG PET metabolic images combined with MRI and scalp VEEG can help the neurosurgeons to localize the epileptogenic focus, confirm the operative indications and predict the surgical outcomes.
出处
《第四军医大学学报》
北大核心
2006年第2期151-154,共4页
Journal of the Fourth Military Medical University
关键词
癫痫
体层摄影术
发射计算机
磁共振波谱学
视频脑电描记术
颅内脑电描记术
epilepsy
tomography, emission-computed
magnetic resonance spectroscopy
video electroencephalography
intracranial electroencephalography
