^(18)F-FDG PET脑显像在难治性颞叶癫痫定侧诊断中的价值研究

The Diagnostic Value of ^(18)F-FDG PET Brain Imaging in the Localization of Intractable Temporal Lobe Epilepsy

目的探讨^(18)F-FDG PET脑显像对难治性颞叶癫痫(TLE)致痫灶定侧的诊断价值。方法对20名健康志愿者及78例资料完整的难治性TLE患者进行回顾性分析,以病理结果为金标准,评价^(18)F-FDG PET-CT脑代谢显像在难治性TLE上的临床应用价值。结果利用视觉分析法与不对称指数(AI)分析法均发现76例患者呈阳性表现(阳性率97.43%),两种方法分别准确检出65及67例,但两组间无统计学显著差异(χ~2=0.197,P=0.657)。2例患者双侧颞叶代谢未见明显减低,无法判定致痫灶。经统计学分析,健康对照组双侧颞叶SUV_(mean)比较差异无统计学意义(t=-0.566,P=0.578);TLE组患侧SUV_(mean)低于健侧,差异有统计学意义(t=-16.217,P<0.001);TLE组患侧SUV_(mean)明显低于健康对照组两侧颞叶SUV_(mean),差异有显著统计学意义(F=195.463,P<0.001)。利用SUV_(mean)作为致痫灶定侧指标行ROC曲线分析,当SUV值为6.065时,其对海马硬化诊断的敏感度为27.3%,特异度为99.9%,曲线下面积0.586。结论^(18)F-FDG PET脑显像在难治性TLE定测诊断上有较大临床应用价值。视觉分析与AI分析法无显著差异,但相比之下AI分析法更加客观、影响因素少。单独应用单侧SUV_(mean)作为诊断指标灵敏度低,其价值不及AI分析法。

Objective To evaluate the diagnostic value of^（18）F-FDG PET brain imaging in localization of temporal lobe epileptic focus. Methods 20 healthy volunteers and 78 patients diagnosed as TLE were all underwent^（18）F-FDG PET-CT brain imaging. Using pathological results as the gold standard,the diagnostic value of^（18）F-FDG PET brain imaging was studied. Results^（18）F-FDG PET images were analyzed by visual analysis method and Asymmetry index method to determine the side of epileptic foci. Abnormal images were found in 76 patients using the two methods respectively with positive rate as 97. 43%. 65 and 67 cases were correct diagnosed by the two methods respectively,but there was no significant difference between the two groups（ χ~2= 0. 197,P = 0. 657）. There was no obvious decrease in bilateral temporal lobe metabolism in 2 patients,so we couldn＇t determine the localization of epilepsy foci. After statistical analysis,there was no statistically significant difference in SUV_（mean） between the bilateral temporal lobe of the healthy control group（ t =- 16. 217,P〈0. 001）. In the TLE group,there was statistically significant difference between the SUV_（mean） of epilepsy foci and the healthy side（ t =- 0. 566,P = 0. 578）. The SUV_（mean） of epilepsy foci in the TLE group was significantly lower than that of the healthy control group（ F = 195. 463,P〈0. 001）. Using SUV_（mean） as the index of the focal epileptic foci,we can get the ROC curve analysis. When SUV_（mean） was 6. 605,the sensitivity was 27. 3%,the specificity was 99. 9%,and the area under the curve was 6. 065. Conclusion In summary,^（18）F-FDG PET brain imaging has great clinical value in the diagnosis of refractory TLE. There was no significant difference between the visual analysis method and Asymmetry index method,the AI analysis method was more objective and had less influence factors than the visual analysis method. If SUV_（mean） was used as a diagnostic indicator alone,its sensitivity was relatively low and it＇s value was less than AI analysis.