局灶性皮质发育不良合并难治性癫痫患者头部MRI融合PET-CT进行术前评估的价值

Diagnostic and therapeutic value of brain PET-MRI fusion image in cerebral cortical dysplasia manifested as refractory epilepsy

目的探讨颅脑PET-MRI融合图像在表现为局灶性皮质发育不良(focal cortical dysplasia,FCD)的应用价值,并总结患者治疗后的预后,为广大癫痫患者寻求一个更合理的诊治方案。方法回顾性分析2017年1月～2018年8月我院神经内外科、儿科收治的23例表现为难治性癫痫的FCD患者临床表现、影像学特点、视频脑电图特点以及手术疗效。结果表现为难治性癫痫的FCD患者的发作类型多种多样,但以局灶性发作继发全面性发作为主;病灶多见于颞叶15例、额叶6例、顶叶2例; 20例患者癫痫序列MRI及视频脑电发现病灶,3例患者行癫痫序列磁共振及视频脑电未能确定明确的致痫灶,完善PET-MRI融合成像发现致痫灶,病变部位主要在额叶,因此对于头部MRI阴性的患者,则主要通过PET-MRI发现病灶;视频脑电图(EEG)痫样放电部位与PET-MRI融合成像发现的病灶部位有较高一致性,且放电及发作形式对于FCD分型没有明显的相关性; 23例患者术后癫痫发作次数明显减少,有的未再发作。结论表现为难治性癫痫的FCD患者可通过PET-MRI融合成像结合视频脑电脑电进行术前评估,找准致痫灶,手术切除癫痫灶的治疗可取得良好的预后。

Objective To investigate the application value of brain PET-MRI fusion image in focal cortical dysplasia( FCD). And to summarize the prognosis of patients after treatment,and to seek a more reasonable diagnosis and treatment plan for the majority of patients with epilepsy. Methods A retrospective analysis of the clinical manifestations,imaging breakthroughs,video EEG features and surgical outcomes of 23 patients with refractory epilepsy who underwent neurosurgery and pediatric treatment from January 2017 to August 2018 in our hospital. Results The types of seizures in patients with refractory epilepsy were various,but the primary seizures were mainly caused by focal seizures;The lesions were more common in 15 cases of temporal lobe,6 cases of frontal lobe and 2 cases of parietal lobe;Patients with epilepsy sequence MRI and video EEG found lesions,3 patients with epilepsy sequence magnetic resonance and video EEG failed to determine a clear epileptogenic focus,perfect PET-MRI fusion imaging found epileptic focal. Therefore the patients with negative MRI in the brain,the lesions are were mainly detected by PET-MRI;the EEG epileptiform discharge site and the PET-MRI fusion imaging have had higher consistency,discharge and seizures. There was no significant correlation between form and FCD classification;The twenty three patients had significantly fewer seizures after surgery,and some did not recur. Conclusion FCD patients with refractory epilepsy can be preoperatively evaluated by PET-MRI fusion imaging combined with video brain computerization. The treatment of epileptogenic foci and surgical resection of epileptic foci can achieve a good prognosis.