^(18)F-FDG PET/CT脑显像在癫发作期及发作间期致灶定位中的应用价值

Value of ^(18)F-FDG PET /CT in localizing epileptic foci in attack period or interphase

目的探讨18F-FDG PET/CT脑3D显像在癫发作期和发作间期致灶定位中的应用价值。方法癫患者60例均行24 h头皮脑电图、MRI、18F-FDG PET/CT脑显像。25例行皮质脑电图(ECoG)或深部脑电图(DEEG)。PET/CT图像经过目测和半定量的方法进行分析。结果 (1)60例中,18F-FDG PET/CT脑显像阳性者57例,检出率95%,其中患者处于发作间期56例,PET/CT表现为低代谢灶者53例,发作期4例,PET/CT上均表现为高代谢灶。(2)PET/CT显示80%为单发灶(48/60),15%为2个以上病灶(9/60)。单发灶中,66.7%位于颞叶(32/48),另33.3%位于颞叶外皮质(顶叶6例,额叶10例)。(3)PET/CT与皮质脑电图(ECoG)或深部脑电图(DEEG)符合率为96%(24/25)。(4)32例颞叶癫行前颞叶切除术,术后随访结果 EngeⅠl～Ⅱ级者30例。非颞叶癫16例,行致灶皮质切除术,12例达EngeⅠl～Ⅱ级。3例未检出致灶,9例DEEG定位双侧致灶未行手术治疗。结论对于颅内有病灶癫及明确的颞叶癫患者,PET/CT与EEG以及MRI检查结果具有高度一致性;对于没有病灶及非颞叶癫患者,PET/CT是一种无创、敏感、有效的定位癫源灶的方法。

Objective To assess the value of 18F -fluorodeoxyglucose （FDG）PET/CT in localizing the epileptic foci in attack period or interphase. Methods All 60 patients underwent lS F - FDG PET/CT. The images were analyzed by visual inspection and semiquantitative methods. The scalp electroencephalogram （ EEG ） was examined in all patients, among whom electrocorticogram （ECoG） or depth electroencephalogram （DEEG） was examined in 25 cases. Results （ 1 ） Of 56 patients who in epileptic interictal time, PET/CT images show hypometabolic foci in 53case. Of 4 patients who in epileptic ictal time, PET/CT show hypermetabolic foci. （2） PET/CT detected 80% solitary lesion and 15% multiple lesion. Among 48 solitary lesion,32 were located in temporal lobe. （3） Compared with ECoG or DEEG, the accuracy of PET/CT to localize epileptic foci was 96%. （4） 32 cases of mesial temporal lobe epilepsy underwent the anterior temporal lobectomy,and 30 reached Engel I - II. 16 cases of extratemporal epilepsy underwent the resection of epileptogenic loci, and 12 cases reached Engel I Ⅰ - Ⅱ postoperatively. Conclusions The results of 18F - FDG PET/CT are highly accordant with that of EEG and MRI in mesial temporal lobe epilepsy. For extratemporal epilepsy ,PET/CT is a noninvasive, sensitive and effective method to locate possible sites and extent of eoilentouenic sources.