顽固性癫患者的PET、EEG和MRI对比研究

Comparative study of PET imaging with EEG and MRI in patients with intractable epilepsy

目的 :比较顽固性癫患者的正电子发射计算机断层扫描 (PET)、脑电图 (EEG)、磁共振成像 (MRI)结果 ,探讨脱氧葡萄糖 (18F FDG)PET对致灶进行定位的可行性和应用价值。方法 :10 2例顽固性癫患者 (男 6 4例 ,女 38例 ,平均年龄 2 2 1岁 )进行18F FDGPET脑显像 ,发作期显像 5例 ,发作间期显像 97例 ,全部病例均行EEG检查 ,4 8例作过MRI检查 ,分析比较PET、EEG和MRI定位致灶的有效性。结果 :PET发作期显像主要为局部高代谢 ,发作间期显像为 1个或多个低代谢灶 ,阳性检出率为92 4 % ,定侧定位率 5 2 9% ,PET对致灶的检出率和定侧定位率均明显高于EEG和MRI(P <0 0 1) ;EEG与PET检出的符合率为 4 1 2 % ,MRI与PET检出的符合率 4 1 7%。结论 :癫患者18F FDGPET脑显像是一种敏感而安全的定位顽固性癫致灶的有效方法 ,明显优于EEG和MRI,但PET所示异常低代谢区是否均为致灶尚存在质疑 ,联合EEG和MRI可提高灶检出阳性率及定位准确性。

Objective:To compare the results of PET,EEG and MRI in patients with intractable epilepsy,and to explore the application value and feasiblity of 18 F FDG PET in the localization of epileptogenic focus.Methods:Brain imaging of 18 F FDG PET was determined in 102 patients (M64,F38,average age 22.1) with intractable epilepsy,five patients were imaged by PET during ictal and 97 were imaged during interictal phase. All the patients received the examination of EEG and some of MRI. The efficacy of 18 F FDG PET for the localization of epileptogenic foci was compared with that of EEG and MRI.Results:102 patients showed interictal one or more hypometabolism and ictal focal hypermetabolism. The positive rate of detection epileptic focus was 92.4% and accurate lateralization and localization rate was 52.9%,significantly higher than those by EEG and MRI (p<0 01) The finding of epileptogenic foci by EEG in concordance with PET was 41.2%,MRI in concordance with PET was 41.7%.Conclusions:PET imaging might be a sensitive and safe method for effective localization of epileptogenic focus. It might have significant advantages over EEG and MRI in detecting and localizing epileptogenic focus. However,it might be still doubtful that abnormal metabolism areas by PET do all belong to epileptogenic foci. A combination of PET,EEG and MRI might increase the positive rate and accuracy for localization.