难治性颞叶癫痫定位诊断的SPECT与质子MR波谱对照研究

Comparison of the localization diagnosis between SPECT and ~1H-MRS in temporal lobe epilepsy

目的:探讨单光子发射计算机断层(SPECT)和质子磁共振波谱(1H-MRS)两种分子影像学技术对难治性颞叶癫痫定位诊断的临床价值。方法:选择经手术病理证实的单侧TLE患者29例。所有患者术前均行发作间期SPECT脑血流灌注显像、常规MRI扫描和1H-MRS成像。将两种分子影像学检查技术,发作间期脑血流灌注显像和1H-MRS,对颞叶癫痫致痫灶的定位诊断结果进行对比分析。结果:29例单侧TLE患者,常规MRI发现异常18例,其中海马硬化16例,定位率62.07%。SPECT异常21例,定位率72.41%,其中,MRI阴性病例中27.27%(3/11)的患者SPECT为阳性1。H-MRS发现异常18例,定位率62.07%,但MRI阴性病例中36.36%(4/11)的患者MRS为阳性。结论:SPECT对TLE功能异常脑区敏感,尤其是颞叶新皮质的异常1。H-MRS对早期海马硬化比MRI敏感。此两种分子影像学技术都能有效定位颞叶致痫灶,相互不可替代。

Objective：To evaluate the value of localization diagnosis of single photon emission computed tomography（SPECT） and proton magnetic resonance spectroscopy（1H-MRS） in the patients with temporal lobe epilepsy（TLE）.Methods：Twenty-nine selected patients with unilateral TLE verified by operation and pathology were studied.All of them had performed interictal SPECT cerebral blood flow perfusion imaging,routine magnetic resonance imaging（MRI） and 1H-MRS before the operation.The value of the localization diagnosis in epilepsy focus of these two molecular imaging methods,interictal cerebral blood flow perfusion imaging and 1H-MRS were compared.Results：According to these twenty-nine cases with unilateral TLE focus,eighteen cases had abnormalities on MRI,including sixteen cases of hippocampal sclerosis,the accuracy rate of the localization was 62.07%.Twenty-one cases had abnormalities on SPECT,the accuracy rate reached to 72.41%.And 27.27%（3/11） of cases with negative MRI showed positive SPECT.Eighteen cases had abnormalities on 1H-MRS,the accuracy rate was 62.07%.But 36.36%（4/11） of cases with negative MRI showed positive 1H-MRS.Conclusion：SPECT is a sensitive method to detect abnormal cerebral region of TLE,especially useful to neocortical TLE.1H-MRS is more sensitive than MRI in detecting early hippocampal sclerosis.SPECT and 1H-MRS are effective and non-alternative molecular imaging methods for localization diagnosis in epileptogenic focus of TLE.