三重融合PET/MRI在局灶性脑皮质发育不良导致的癫痫病灶定位中的初步应用

Triple fusion PET/MRI in location of epileptogenic focus in patients with focal cortical dysplasia

目的探讨三重融合PET/MRI在局灶性脑皮质发育不良(FCD)导致的癫痫病灶定位中的应用价值。方法选择中日友好医院神经内科自2016年12月至2017年6月收治的3例难治性局灶性癫痫患者进入研究,应用Freesurfer、FSL等影像学处理软件对患者原始MRI、PET影像进行处理,通过提取、配准等步骤实现异机的PET/MRI融合,并在其上突出显示灰-白质分界线,获得三重融合的PET/MRI图像,以观察代谢减低区域,明确病灶定位。结果应用三重融合,病例1可见右侧扣带回灰-白质分界勾画的脑回区域内有明显的代谢减低,病例2可见右侧额上回局部信号略增高的部位(MRI FLAIR序列)为代谢减低区域,病例3可见右侧扣带回局部代谢减低区域。3例患者术前评估均显示上述区域为癫痫病灶,行手术切除后随访2年,患者均无临床发作,抗癫痫药物逐渐减停。3例患者术后病理诊断均为FCD。结论三重融合PET/MRI方式可有效协助诊断FCD,特别是其他影像学方式难以诊断的FCD,在癫痫患者术前评估中具有一定的应用价值。

Objective To explore the value of triple fusion positron emission tomography(PET)/MRI in location of epileptogenic focus in patients with focal cortical dysplasia(FCD).Methods Three patients with refractory partial epilepsy,admitted to our hospital from December 2016 to June 2017,were chosen in our study.The raw MRI and PET images of these patients were processed using Freesurfer and FSL image processing softwares.After extraction and coregistration,precise PET/MRI fusion images were obtained;and the grey-white matter dividing line was highlighted on this fusion image to form triple-fusion images to observe the hypometabolic area and clarify the location.Results Triple-fusion images of these 3 patients were acquired.In patient 1,a marked decrease in metabolism was noted in the gyrus region delineated by the gray-white matter boundary in the right cingulate gyrus.In patient 2,the area with slightly increased local signal in the right superior frontal gyrus(MRI FLAIR sequence)was the area with reduced metabolism.In patient 3,an area of local decreased metabolism was noted in the right cingulate gyrus.The preoperative evaluation of all 3 patients showed that the above areas were epileptic foci;the patients were followed up for 2 years after surgical resection,no clinical seizures occurred in all patients,and antiepileptic drugs were gradually stopped.All 3 patients were diagnosed as having FCD by postoperative pathology.Conclusion Triple fusion PET/MRI is a powerful way to assist FCD diagnosis,especially for those FCD cases which are difficult to be diagnosed by other imaging methods,and has a potential clinical application value in epilepsy patients.