发作间期^(18)F-FDG联合^(13)N-NH_3·H_2OPET脑显像在颞叶内侧癫痫术前定位中的价值

The value of interictal ^(18)F-FDG combined with ^(13)N-NH_3·H_2O PET imaging in localizing epileptogenic zone in presurgical mesial temporal lobe epilepsy

目的:探讨发作间期18F-FDG联合13N-NH3.H2O PET脑显像在颞叶内侧癫痫术前定位中的价值。方法:收集行头部MRI、18F-FDG及13N-NH3.H2O PET/CT检查并经术中深部脑电图(DEEG)及皮层脑电图(ECoG)证实的颞叶内侧癫痫患者17例。所有PET图像采用感兴趣区(ROI)分析,对18F-FDG及13N-NH3.H2O PET显像结果进行比较。结果:18F-FDG PET显像对癫痫灶准确定侧12例(70.6%),准确定位5例(29.4%);13N-NH3.H2O PET显像准确定侧9例(52.9%),准确定位4例(23.5%)。两种显像方法对癫痫灶定侧性能具有中度一致性(Kappa=0.638,P=0.005),定侧准确性经McNemar检验,差异无统计学意义(P>0.05)。综合分析两种显像结果对癫痫灶准确定位8例(47.1%)。结论:发作间期18F-FDG PET显像对颞叶内侧癫痫有较高的定侧准确性,13N-NH3.H2O PET显像亦可以有效定侧颞叶癫痫。联合两种显像剂显像,优势互补,定位准确性明显提高,且癫痫灶低代谢、高灌注的表现使诊断特异性增加,更有助于颞叶癫痫灶的准确定位。

Objective：The aim of this study was to evaluate the value of interictal 18F-FDG and 13N-NH3.H2O PET imaging in localizing the epileptic foci in patients with mesial temporal lobe epilepsy（MTLE）.Methods：Preoperative MRI,18F-FDG and 13N-NH3.H2O PET data in 17 MTLE patients confirmed by electrocorticogram（ECoG） and depth electroencephalogram（DEEG） were retrospectively analysed.The PET images were visually assessed with ROI-based analysis.The 18F-FDG and 13N-NH3.H2O PET images were compared.Results：According to the ROI-based analysis,the FDG uptake and the CBF（cerebral blood flow） correctly determined the side of the epileptic temporal lobe in twelve cases（70.6%） and nine cases（52.9%） respectively,correctly determined the side of the epileptic focus on the mesial temporal structure in five cases（29.4%） and four cases（23.5%）,respectively.The diagnostic performance of the two agents were in moderate concordance by Kappa test（Kappa= 0.638,P=0.005）.And there was no statistically significant difference in the localization accuracy between the two agents.FDG uptake combined CBF correctly determined the side of the epileptic focus on the mesial temporal structure in eight cases（47.1%）.Conclusion：Positron emission tomography measurement of FDG uptake was most sensitive in detecting the side of the epileptic temporal lobe,CBF PET also can lateralize the epileptic temporal lobe effectively.When combine FDG uptake with CBF imaging,the specificity may be improved.