18F-FDG PET/CT结合MRI在癫（癎）外科治疗中的应用

18F-FDG PET/CT associated with MRI in epilepsy surgery

目的 探讨18F-脱氧葡萄糖（FDG）PET/CT结合MRI定位致（癎）灶,指导癫（癎）外科治疗的意义.方法 67例癫（癎）外科治疗患者术前均行18F-FDG PET/CT和MRI检查,根据术前评估以及术中皮质脑电图监测结果进行致（癎）灶切除术.术后长期随访,根据Engel分级将患者分为癫（癎）发作完全控制组（Engel Ⅰ）和癫（癎）发作未完全控制组（Engel Ⅱ～Ⅳ）,采用x2检验或Fisher精确检验对数据进行分析.结果 67例中48例患者术后癫（癎）发作完全控制（Engel Ⅰ,71.6%）,11例Engel Ⅱ,5例Engel Ⅲ,3例Engel Ⅳ.18F-FDG PET/CT定位定侧结果与MRI检查结果一致或基本一致者63例,其中71.4%（45/63）术后癫（癎）发作完全控制;18F-FDG PET/CT与MRI检查结果不一致者4例,其中3例术后癫（癎）发作完全控制,2组差异无统计学意义（Fisher精确检验,P＞0.05）.63例中MRI与18F-FDG PET/CT均发现局限性异常者为41例,其中80.5%（33/41）术后癫（癎）发作完全控制;MRI发现局限性病变,但18F-FDG PET/CT呈更广泛性代谢异常者20例,其中55.0%（11/20）术后癫（癎）发作完全控制,2组差异有统计学意义（x2=4.34,P＜0.05）.结论 18F-FDG PET/CT结合MRI可为致（癎）灶定位及预后评估提供重要信息.

Objective To evaluate retrospectively the role of 18 F-fluorodeoxyglucose （FDG） PET/CT associated with MRI in the localization of epileptogenic foci. Methods Sixty-seven patients with medically resistant epilepsy were included from 2003 to 2008. All underwent 18F-FDG PET/CT and MRI for presurgical evaluation as well as post-surgical evaluation 12 to 65 months after operation. Based on postoperative seizure occurrence, patients were divided into two groups. One group was free of seizures （ Engel classification Ⅰ, Group 1） and the other was with postoperative seizure occurrence of any type （ Engel classification Ⅱ-Ⅳ, Group 2）. X2-test or Fisher＇s exact test was used for the statistical analysis. Results About 71.6% （48/67） patients were defined as group 1, and 19 patients were group 2 （ 11 were Engel Ⅱ , 5 were Engel Ⅲ, and 3 were Engel Ⅳ ）. In Group 1, no statistically significant difference was found between concordant （45/63） and discordant findings （3/4） with regard to 18F-FDG PET/CT and MRI images （Fisher＇s exact test, P 〉0.05）. For 41 patients that showed focal abnormality both on MRI and 18F-FDG PET/CT, 80.5% （33/41） were found in group 1. For 20 patients that showed focal lesions on MRI while with multi-focal or generalized abnormal metabolism on 18F-FDG PET/CT, 11 （55.0%） were in group 1 and9 （45.0%） were group 2. There was no significant difference （33/41 vs 11/20, X2 =4.34, P 〈0.05 ）. Conclusion 18F-FDG PET/CT associated with MRI may offer more helpful information for pre-surgical evaluation and prediction of prognosis of epileptic patients.