^(18)F-FDG PET脑显像在癫痫图型、病灶定位及预后预测中的价值

Clinical evaluation of ^(18) F-FDG PET cerebral imaging in patternization,focus localization and prognosis prediction of epilepsy

目的 分析各种癫痫患者的18F 脱氧葡萄糖 (FDG)PET图像与致痫灶的关系 ,以期术前较准确地定位、选择手术适应证和预测疗效。方法 73例癫痫患者 (男 5 1例 ,女 2 2例 ,平均年龄2 3 .3岁 )行FDGPET脑显像 ,并与同期脑电图和MRI结果进行比较。 40例进行了手术疗效随访 ,其中 8例术后复查了FDGPET ,并比较FDGPET、视频脑电图 (VEEG)、MRI对致痫灶术前定位的准确性及脑代谢改变的不同图型与手术疗效的关系。结果 ① 72例癫痫患者发作间期皮层局灶为低代谢表现 ,仅 1例部分癫痫持续状态者表现出发作期的高代谢。②FDGPET病变定侧率高于VEEG ,低代谢灶检出率高于MRI。③ 40例手术患者中 ,属于Engels疗效分级I、II级的 30例手术切除部位应为确定的致痫灶 ,FDGPET、VEEG与MRI定侧定位准确性分别为 93 .3% ,73 3% ,5 3 3 % ,经 χ2 检验 ,差异有显著性 (P <0 .0 5 )。④单侧颞叶低代谢手术效果好 ;对部分双侧颞叶低代谢者 ,切除其代谢减低更严重的一侧 ,发作也会改善 ;颞叶外癫痫手术效果不如颞叶癫痫好 ;病灶局限者 ,手术效果优于伴有其他部位皮层代谢改变者 ;单侧多脑叶代谢改变者 ,半大脑切除术效果好 ;双侧大脑多脑叶弥漫性病变者 ,手术效果差。

Objective 1.To find out the relationship between FDG PET image pattern and epileptogenic focus localization.2.To help surgeons in patient selection, operative planning and therapy prediction. Methods73 patients(51 M,22 F,av.23.3 y) with epilepsy were studied with FDG PET cerebral imaging.40 patients who underwent surgery were followed up (av.6 months,2～12 months) for assessment of seizure control.The efficacy of FDG PET for the localization of epileptogenic foci was compared with that of VEEG,MRI and invasive EEG.Relationship between the cerebral FDG metabolic pattern and surgical outcome were also evaluated. Results 1.72 patients showed interictal focal hypometabolism.1 patient with continuous seizure showed ictal hypermetabolism.2.FDG PET could localize the seizure foci in patients whose EEG showed bilateral or no definite epileptoform discharge.FDG PET image demonstrated more metabolic changes than structural changes shown by MRI.3.According to Engel's classification of operative effect,75%(30/40) was classified as grade Ⅰ or Ⅱ,7.5%(3/40) as grade Ⅲ and 17.5%(7/40) as grade Ⅳ.The lesions removed in grade Ⅰ or Ⅱ patients were confirmed to be epileptogenic foci.The localization accuracy of FDG PET,VEEG and MRI for seizure foci were 93.3%(28/30),73.3%(22/30) and 53.3%(16/30) respectively.4.(1)The effect of surgical removal of the hypometabolic focus in one temporal lobe was better than that in bilateral lobes,but some of the patients suffered from bilateral temporal changes might also be benefited by removing the more severe lobe.(2)In case of patients with other hypometabolic lesions except major lesion,removal of the major lesion was not as effective as the patients with single lesion.(3)Patients with multiple lesions in one side of cerebrum,the result of half brain removal was good.(4)The prognosis of patients with bilateral multiple diffuse lesions was poor. Conclusions [WT5”,6BZ]The sensitivity and accuracy of the FDG PET imaging in localizing the seizure focus are significantly higher than those of VEEG and MRI.The patternization of the FDG PET metabolic images can help the surgeon to select patient,planning of operation and predict therapy.