伴海马硬化的内侧颞叶癫^(18)F-FDG PET定量分析

Metabolic characteristics of mesial temporal lobe epilepsy with hippocampal sclerosis based on quantitative analysis of ^(18)F-FDG PET

研究背景伴海马硬化的内侧颞叶癫是最常见的部分性癫类型,涉及复杂的神经网络。18F-脱氧葡萄糖(18F-FDG)PET有助于揭示癫的脑代谢特征。本研究基于18F-FDG PET定量分析探讨伴海马硬化的内侧颞叶癫的代谢特征模式。方法共23例伴海马硬化的内侧颞叶癫患者和性别、年龄相匹配的正常对照者行头部MRI和18F-FDG PET检查,将PET图像配准至国际标准空间,并根据自动解剖分区模板将皮质和皮质下核团分割为90个兴趣区,计算全脑、双侧大脑半球和各兴趣区标准化摄取(SUV)值。结果伴海马硬化的内侧颞叶癫患者全脑校正SUV值低于正常对照者(1.13±0.06对1.20±0.10;t=-3.245,P=0.002),伴海马硬化的内侧颞叶癫患者左侧大脑半球校正SUV值低于右侧大脑半球(1.10±0.06对1.15±0.06;t=-2.710,P=0.010)。与正常对照者相比,伴海马硬化的内侧颞叶癫患者有15个兴趣区代谢降低,分别位于左侧颞叶,包括海马、海马旁回、杏仁核、颞极上部、颞极中部、颞下回、颞横回、梭状回,以及左侧颞叶外结构,包括额下回岛盖、Rolandic岛盖、岛叶、扣带回中部、尾状核、壳核、丘脑。结论18F-FDG PET定量分析可以从代谢角度揭示伴海马硬化的内侧颞叶癫的代谢特征模式,有助于加深对伴海马硬化的内侧颞叶癫病理生理学机制的理解,也为进一步研究此类患者功能改变和癫发作进程提供参考和框架。

Background Mesial temporal lobe epilepsy with hippocampal sclerosis（m TLE-HS） isthe most common type of focal epilepsy involving complex networks.^18 F-fluoro-2-deoxy-D-glucose（^18 F-FDG）PET provides unique brain metabolic information for epilepsy. This study aims to explore the spatialmetabolic characteristics of m TLE-HS based on a quantitative analysis of ^18 F-FDG PET. Methods A totalof 23 patients with m TLE-HS and 26 sex-and age-matched healthy controls were enrolled in this study.All of them were performed head MRI and18 F-FDG PET scanning. PET images were registered to standardtemplate and further divided into 90 regions of interest（ROIs） based on anatomical automatic labeling（AAL）. Normalized standard uptake value（SUV） in whole brain, bilateral cerebral hemispheres and eachROI were calculated. Results The normalized SUV of whole brain in m TLE-HS patients was significantlylower than healthy controls（1.13 ± 0.06 vs. 1.20 ± 0.10; t =-3.245, P = 0.002）. The normalized SUV of lefthemisphere was significantly lower than right hemisphere（1.10 ± 0.06 vs. 1.15 ± 0.06; t =-2.710, P = 0.010）in m TLE-HS patients. Compared with controls, the normalized SUV in 15 ROIs of m TLE-HS patients wereidentified with hypometabolism significantly, which were located in left temporal lobe（hippocampus,parahippocampal gyrus, amygdala, superior temporal pole, middle temporal pole, inferior temporal gyrus and fusiform gyrus, transverse temporal gyrus） and left extratemporal cortex（inferior frontal operculum, Rolandicoperculum, insular lobe, median cingulate gyrus, caudate nucleus, putamen and thalamus）. Conclusions This study revealed the spatial metabolic characteristics of m TLE-HS based on a quantitative analysis of18 F-FDG PET from the metabolic perspective, deepened the understanding on pathophysiological mechanisms ofm TLE-HS, and provided a framework for further analyzing the functional change and seizure progression ofm TLE-HS.