发作间期PET和SPECT检查对颞叶癫痫定位诊断价值

Clinical value of interictal PET and SPECT for detection of temporal epileptic foci

目的：探讨发作间期１８Ｆ－脱氧葡萄糖（ＦＤＧ）正电子发射断层扫描（ＰＥＴ）和９９ｍＴｃ－己撑半脱氨酸（ＥＣＤ）单光子发射断层扫描对顽固性颞叶癫痫（ＴＬＥ）的定位诊断价值。方法：５３例脑电图（ＥＥＧ）定位明确的顽固性ＴＬＥ患者分别行发作间期１８Ｆ－ＦＤＧＰＥＴ和９９ｍＴｃ－ＥＣＤＳＰＥＣＴ检查。其中２１例磁共振（ＭＲＩ）显示有结构性病变并与ＥＥＧ定位结果一致。结果：ＭＲＩ异常组均在ＰＥＴ和ＳＰＥＣＴ相应部位出现低代谢和低灌注表现。ＭＲＩ正常组，ＰＥＴ定位准确性为８４．５％，显著高于ＳＰＥＣＴ的５６．３％（Ｐ＜０．０５）。结论：对于无结构性病变的颞叶癫痫，发作间期ＰＥＴ检查有较高的定位诊断价值。

Objective:To examine the clinical value of interictal FFDG PET and TcECD SPECT for detection of temporal lobe epileptic foci. Methods: We performed interictal FFDG PET images and brain perfusion TcECD SPECT IN 53 patients with medically intratable temporal lobe epilepsy. Localization of the epileptic foci in the patients was determined by a combination of clinical seizure characteristics and interictal and ictal scalp EEG, 21 patients had structural abnormalities detected on MRI. Results:In 21 patients had focal lesions the sensitivities of PET and SPECT were 100%. In 27 of 32 patients (84.5%) without structure abnormal, PET images showed focal hypometabolism in the area corresponding with the result of EEG. SPECT images, however, demonstrated hypoperfused lesions which corresponded with EEG in only 18(56.3%). Conclusion:FFDG PET is a valuable tool for accurate localization of epileptic foci, and cerebral perfusion SPECT is of limited clinical value.