^(18)F-FDG PET/CT在癫痫病灶定位诊断中的应用

Application of ^(18)F-FDG PET/CT in localization of epileptogenic foci

目的:观察氟18脱氧葡萄糖(^(18)F-FDG)正电子发射体层摄影(PET)/计算机体层摄影(CT)在癫痫病灶定位诊断中的应用价值。方法:回顾性搜集2019年1月-2022年1月诊治的62例癫痫患者临床资料,手术切除治疗前均接受核磁共振(MRI)、^(18)F-FDG PET/CT检查,以手术结果为参考标准,评估不同检查方案对癫痫阳性检出率、癫痫致痫灶定位诊断的价值。据癫痫患者治疗后疗效不同分为预后良好组、预后不良组,比较两组FDG PET/CT检查显示的脑代谢异常差异。结果:^(18)F-FDG PET/CT联合MRI阳性检出率98.39%,较术前^(18)F-FDG PET/CT检查的87.10%、术前MRI检查的72.58%明显高(P<0.05)。^(18)F-FDG PET/CT联合MRI对癫痫病灶类别(单发病灶)诊断的准确率较术前^(18)F-FDG PET/CT检查、术前MRI检查的明显高(χ^(2)=5.899、5.309,P<0.017)。术前^(18)F-FDG PET/CT检查对癫痫病灶定位诊断的符合率较术前MRI检查的略高,差异无统计学意义(χ^(2)=4.060,P>0.017),但较^(18)F-FDG PET/CT联合MRI的明显低(χ^(2)=15.676,P<0.017)。62例癫痫患者预后良好患者37例(37/62),预后不良患者25例(25/62),预后良好组^(18)F-FDG PET/CT联合MRI检查显示的病灶分布与预后不良组比较差异有统计学意义(P<0.05)。结论:^(18)F-FDG PET/CT联合MRI检查可明显提高对癫痫病灶的定位诊断价值,对指导癫痫患者手术选择和评估治疗疗效有积极意义。

Objective:To observe the application value of fluorine-18 fluorodeoxyglucose(^(18)F-FDG)positron emission tomography(PET)/computed tomography(CT)in localization of epileptogenic foci.Methods:The clinical data of 62 patients with epilepsy admitted to the hospital from January 2019 to January 2022 were retrospectively collected.All patients underwent magnetic resonance imaging(MRI)and ^(18)F-FDG PET/CT examinations before surgical excision.Surgical results were taken as the standard to evaluate the value of different examination methods in detection and localization of epileptogenic foci.The patients were divided into good prognosis group and poor prognosis group according to the curative effect.Cerebral metabolism abnormalities on ^(18)F-FDG PET/CT were compared between the groups.Results:The positive detection rate of ^(18)F-FDG PET/CT combined with MRI(98.39%)was significantly higher than that of preoperative ^(18)F-FDG PET/CT(87.10%)or preoperative MRI(72.58%)(P<0.05).The diagnostic accuracy of ^(18)F-FDG PET/CT combined with MRI for single focus was significantly higher than that of preoperative ^(18)F-FDG PET/CT or preoperative MRI(χ^(2)=5.899,5.309,P<0.017).The coincidence rate of preoperative ^(18)F-FDG PET/CT in locating epileptogenic foci was slightly higher than that of preoperative MRI(χ^(2)=4.060,P>0.017),but significantly lower than that of ^(18)F-FDG PET/CT combined with MRI(χ^(2)=15.676,P<0.017).Of the 62 patients with epilepsy,37(59.68%)had good prognosis and 25(40.32%)had poor prognosis after treatment.There were statistically significant differences between the good prognosis group and the poor prognosis group in focus distribution on ^(18)F-FDG PET/CT combined with MRI(P<0.05).Conclusion:^(18)F-FDG PET/CT combined with MRI can significantly improve the localization of epileptogenic foci,which is of positive significance for surgery selection and efficacy evaluation.