联合应用SPECT、EEG、MRI定位癫痫致痫灶53例分析

Clinical analysis of epileptogenic zone location combining SPECT,EEG and MRI in 53 patients

目的探讨单光子发射计算机断层(SPECT)脑血流灌注显像联合动态脑电图和(或)视频脑电图、磁共振成像(MRI)检查在定位癫痫致痫灶中的意义。方法对53例癫痫患者于发作间期进行99mTc-ECD局部脑血流灌注显像,并与同期动态脑电图和(或)视频脑电图、MRI检查、术中皮层脑电图检查结果进行对比分析。结果SPECT脑血流灌注显像诊断癫痫的阳性率为88.68%,与脑电图(EEG)检查的阳性率(86.79%)一致,但二者均明显高于MRI检查阳性率(33.96%),且STECT联合EEG检查,阳性率可提升至98.11%(52/53),明显高于SPECT或EEG单独检查的阳性率;在定位致痫灶过程中,SPECT脑血流显像与EEG在致痫灶的定位上具有良好的吻合性,其符合率(包括定位一致及基本一致者)为60.37%,明显高于SPECT与MRI检查的符合率(35.85%)及EEG与MRI的符合率(32.07%);经术中皮层脑电图检查证实SPECT定位致痫灶的准确率达83.33%,若与EEG、MRI联合分析则其定位准确率提升至95.8%(23/24)。结论SPECT脑血流灌注显像不仅能灵敏地检出癫痫灶,且能较准确地定位诊断癫痫灶,与EEG和MRI的联合应用可大大提高其诊断的灵敏度和定位的准确性。

Objective To explore the diagnostic value of combining 99m Tc-ECD brain blood perfusion imaging(SPECT imaging),EEG and MRI in locating epileptogenic zone.Methods SPECT imaging was performed in 53 patients with interval epilepsy,and were compared with AEEG/video-EEG,MRI,cortical EEG intraoperation.Results The positive rate of epileptic focus of SPECT imaging,EEG,SPECT imaging combined with EEG was 88.68 %, 86.79 %,98.11%respectively,which were higher than that of MRI(33.96%).The localization accordance rate of epileptic foci with SPECT imaging and EEG was 60.37%,which was higher than that of SPECT imaging and MRI( 35.85 %),or EEG and MRI(32.07%).The localization accurate rate of epileptic foci of SPECT imaging,combination SPECT imaging,EEG and MRI was 83.33%,95.8%respectively,which was confirmed with cortical EEG intraoperation.Conclusion SPECT imaging can detect epileptic focus sensitively,also localize epileptic focus effectively.Combining SPECT imaging,EEG and MRI can obviously increase the detect sensitivity and localization accuracy of epileptic focus.