PET-CT脑3D显像在癫痫定位中的临床应用价值

Clinical value of PET-CT 3D mode brain image in the localizition of epileptic foci

目的:研究18F-FDG PET脑3D显像对致痫灶定位的应用价值。方法:癫痫患者13例,继发性癫痫4例,原发性癫痫9例。皆行18F-FDG脑三维PET显像,通过目测和半定量方法分析图像。所有患者均行EEG检查,其中2例行皮层脑电图(EcoG)或深部脑电图(DEEG);12例行脑MRI或CT检查。结果:PET阳性表现为低代谢灶者检出率为92.3℅(12/13例),明显高于EEG和脑MRI/CT(分别为92.3℅、69.2℅和33.3℅,χ2分别为14.3和35.0,P均<0.01)。单病灶检出率PET明显高于EEG(分别为61.5℅和38.4℅,χ2=23.1,P<0.01)。与皮层脑电图(EcoG)或深部脑电图(DEEG)相比较,PET对致痫灶的检出灵敏度为95℅,定位准确性为89℅。结论18F-FDG PET在致痫灶的检出及定位方面有较高的灵敏度和准确性;在引导癫痫外科手术及放射定向治疗方面有较好的实用价值。

Objective To assess the value of ^18F-FDG PET cerebral 3D mode in the localization of epileptic foci.Method 13 cases with epilepsy included 9 cases of primary epilepsy and 4 cases of secondary epilepsy.The brain scan with 3D mode was performed on all the patients and the images were analyzed by eyes and semi-quantitative method by two experienced nuclear medicine physicians.The scalp electroencephalogram（EEG）was performed on all the patients,and electrocorticogram（EcoG） or depth electroencephalogram（DEEG） were performed on 2 cases to verify the PET results,MRI and/or CT examination were obtained in 12 cases.Results 92.3% was abnormal displaying hypometabolic foci on PET imaging（12/13）.PET was more sensitive than EEG and MRI/CT detecting the lesions（92.3℅,69.2℅ and 33.3℅,respectively,χ^2=14.3 and 35.0,P〈0.01）.Solitary lesion detection rate of PET was 61.5%,which was higher than EEG（61.5% vs.38.4℅,χ^2 =23.1,P〈0.01）.Compared with golden standard of EcoG or DEEG,the sensitivity and specificity of PET localizing the epileptic foci were 95℅ and 89℅.Conclusion ^18F-FDG PET is a sensitive and accurate image modality in the localization of epileptic foci and is useful to direct surgical treatment and orientate radiation therapy.