PET和脑磁图综合定位对难治性癫癎低剂量立体定向放射外科治疗远期效果的影响

Effect of combined localization by positron emission tomography and magnetoencephalography on long-term efficacy of low dose radiosurgery for intractable epilepsy

目的为探讨正电子发射断层扫描(PET)和脑磁图综合定位对难治性癫癎低剂量放射外科治疗远期效果的影响。方法回顾性分析采用放射外科治疗的8例难治性癫癎病人的临床资料,治疗前均行MRI、视频脑电图(VEEG)、18F-脱氧葡萄糖正电子发射断层扫描(18F-FDG PET)显像、脑磁图检查。放射外科治疗以脑磁图定位区为中心靶点,体积大于脑磁图显示范围,但局限于PET低代谢区内。中心剂量为11-13.25 Gy。结果随访8例,时间8-10年。Engel分级:Ⅰ级4例,Ⅱ级2例,Ⅲ级2例。2例行脑磁图复查未检出致癎灶,1例行PET复查见原低代谢区无明显变化。结论 PET和脑磁图综合定位可明显增加致癎灶定位准确性,从而提高放射外科疗效。

Objective To investigate the effect of localization of positron emission tomography（PET） and magnetoencephalography（MEG） to localize the epileptic foci on the long-term efficacy of low dose stereotactic radiosurgery for intractable epilepsy.Methods Clinical data of 8 patients with intractable epilepsy were analyzed retrospectively who underwent radiosurgery.All the patients were examined by MRI,video electroencephalogram（VEEG）, 18 F-fluorodeoxyglucose PET（ 18 F-FDG PET） and MEG before surgery.The foci localized by MEG were set as central target of radiosurgery and the volume was larger than the regions by MEG but within the low metabolic areas detected by PET.The central dose of radiosurgery was 11 to 13.25 Gy.Results All the patients were followed up for 8 to 10 years.The results were class Ⅰ in 4 patients,class Ⅱ in 2 and class Ⅲ in 2 according to Engel classification.Two patients were reexamined by MEG and no epileptic foci were found.One patient was reexamined by PET and no obvious change of the original low metabolic areas was found.Conclusions PET combined with MEG can increase the accuracy of localization of epileptic foci and improve the outcome of radiosurgery.