SPECT脑血流灌注显像对癫疒间灶的诊断价值

The diagnostic value of SPECT brain blood perfusion imaging for epileptic foci

目的探讨SPECT脑血流灌注显像(rCBF)对癫疒间灶的检出及定位价值。方法72例临床确诊的癫疒间患者行发作间期rCBF检查,并同CT、MRI影像检查结果进行比较,对其中7例拟行立体放射(伽玛刀)治疗的患者行发作期rCBF检查,立体放射治疗后随访疗效。结果①癫间疒患者rCBF、CT、MRI检查阳性率分别为83.3%(60/72)、38.9%(21/54)和52.6%(20/38),rCBF阳性率明显高于CT和MRI(P<0.01)。②7例患者发作间期rCBF影像中见14个低血流灌注区,发作期见9个相对高灌注或明显高灌注区,将两期吻合的8个异常灌注区确定为癫疒间灶。③7例患者行立体放射治疗后,根据Engels疗效分级,Ⅰ级1例,Ⅱ级4例,Ⅲ级1例,Ⅳ级1例,6例有效。结论rCBF检查是一种检测癫疒间的敏感技术,发作期与发作间期rCBF检查结合可较准确地定位癫疒间灶。

Objective To investigate the diagnostic value of SPECT brain blood peffusion imaging for epileptic foci. Methods 72 patients with epilepsy were examined by interictal SPECT regional cerebral blood flow （rCBF） imaging. The resuits were compared with those of CT and MRI. The 7 patients, who underwent γ knife treatment, were followed up to assess the seizure control. Results OThe positive rates in interictal stage of rCBF, CT and MRI were 83.3% （60/72）, 38.9% （21/ 54） and 52.6% （20/38） respectively, with that of rCBF higher than CT and MRI in detecting epileptic foci. ②In 7 of the patients, 14 hypopeffusion zones were found in the interictal rCBF image, and 9 hyperperfusin zones in the ictal rCBF image. By combining the results of intefictal and ictal rCBF imagings, 8 epileptic foci were identified. ③ The 7 patients with epileptic foci localized by rCBF underwent γ knife procedure. According to Engel＇s classification, the operative effects in 6 of the 7 patients were grade Ⅱ - Ⅲ, with an efficacy of γ knife treatment being 6/7. Conclusion SPECT rCBF is a sensitive method to study epilepsy. Combining the results of interictal and ictal rCBF imagings helps accurately localize epileptic foci.