基于PET/MRI影像联合脑功能分析在检出癫痫患者致痫灶中的价值探讨

The value of PET/MRI imaging and brain function analysis in the detection of epileptogenic foci in epilepsy patients

目的 探讨基于PET/MRI影像联合脑功能分析在检出癫痫患者致痫灶中的价值。方法 选取本院2017年10月—2020年10月收治的110例癫痫患者,均进行头颅正电子发射计算机断层显像(PET)/磁共振成像(MRI)检查,检查前注射脱氧葡萄糖(FDG)休息30 min后行PET,再行MRI,并进行视频脑电图(VEEG)检查。对PET/MRI影像结果采用视觉分析、半定量分析及脑功能分析判断可能病灶,以术后病理结果作为金标准,分析PET/MRI影像及脑功能分析在检出癫痫患者致痫灶的诊断价值。结果 以术后病理结果作为“金标准”,结果显示,110例癫痫患者病理结果为脑皮质发育不良60.00%(66/110)、海马硬化34.55%(38/110)、节细胞胶质瘤5.45%(6/110)。致痫灶定位于额叶8.18%(9/110)、枕叶9.09%(10/110)、颞叶82.73%(91/110)。110例癫痫患者PET/MRI显像视觉分析与软件定量分析结果显示,69例(62.73%)患者PET/MRI视觉分析与软件定量分析结果一致;31例(28.18%)患者PET/MRI显像结果为阴性,其中包括疑似病灶9例(8.18%)。软件分析显示,病灶位置定位于顶叶6例(5.45%),颞叶25例(22.73%),PET显像显示癫痫灶或位于双侧颞叶6例(5.45%);脑功能分析结果显示,阳性34例(30.91%),阴性76例(69.09%),其中单侧病变30例(27.27%),双侧病变4例(3.64%)。MIMneuro软件分析,PET/MRI对诊断单侧病变具有统计学意义,与脑电图结果一致。PET/MRI影像及脑功能联合对检出癫痫患者致痫灶诊断的灵敏度显著高于单一PET/MRI成像像(t=26.564,P<0.05),高于单一脑功能分析(t=7.875,P=0.004),差异有统计学意义(P<0.05)。当Z-sorce=-1.81时,预测术后癫痫灶复发的灵敏度和特异度为81.46%、77.23%。结论 PET/MRI影像联合脑功能分析可显著提高癫痫患者致痫灶定位的准确性,为手术切除提高可靠指导,进而有效控制癫痫发作,具有较高临床应用价值。

Objective To explore the value of PET/MRI imaging and brain function analysis in detecting epileptogenic foci in epilepsy patients.Methods A total of 110 patients with epilepsy who were admitted to our hospital from October 2017 to October 2020 were selected and underwent cranial PET/MRI examination.Deoxyglucose(FDG)was injected before the examination,and then PET(positron emission tomography)was performed after a 30-min rest.),followed by magnetic resonance imaging(MRI)and video electroencephalography(VEEG).Visual analysis,semi-quantitative analysis and brain function analysis were used for PET/MRI image results to determine possible lesions,and postoperative pathological results were used as the gold standard to analyze the diagnostic value of PET/MRI images and brain function analysis in detecting epileptogenic foci in epilepsy patients.Result Taking postoperative pathological results as the"gold standard",the results showed that the pathological results of 110 epilepsy patients were 60.00%(66/110)cerebral cortical dysplasia,34.55%(38/110)hippocampal sclerosis,and 5.45%(6/110)ganglioglioma.The epileptogenic foci were located in 8.18%(9/110)of the frontal lobe,9.09%(10/110)of the epileptogenic foci were located in the occipital lobe,and 82.73%(91/110)were located in the temporal lobe.The results of PET/MRI visual analysis and software quantitative analysis of 110 epilepsy patients showed that 69(62.73%)patients had consistent PET/MRI visual analysis and software quantitative analysis results;31(28.18%)patients had PET/MRI imaging results were negative,including 9 cases(8.18%)of suspected lesions.Software analysis showed that the lesions were located in the parietal lobe in 6 cases(5.45%),and in 25 cases(22.73%)in the temporal lobe.PET imaging showed that the epilepsy focus was located in the bilateral temporal lobe in 6 cases(5.45%).The results of brain function analysis shown that 34 cases(30.91%)were positive and 76 cases(69.09%)were negative,including 30 cases(27.27%)with unilateral lesions and 4 cases(3.64%)with bilateral lesions.MIMneuro software analysis showed that PET/MRI had statistical significance in the diagnosis of unilateral lesions,which was consistent with the EEG results.The combined sensitivity of PET/MRI imaging and brain function in detecting epileptogenic foci in epilepsy patients was significantly higher than that of single PET/MRI imaging(t=26.564,P=0.000),and higher than that of single brain function analysis(t=7.875,P=0.004),the difference was statistically significant(P<0.05).When Z-sorce=1.81,the sensitivity and specificity of predicting postoperative epilepsy foci recurrence were 81.46%and 77.23%.Conclusion PET/MRI images and brain function analysis can significantly improve the accuracy of epileptogenic foci location in epilepsy patients,provide reliable guidance for surgical resection,and effectively control epileptic seizures,which has high clinical application value.