发作间期颞叶癫痫的18F-FDG PET 显像研究

目的：采用诊断试验评价方法评估发作间期^18F-FDG PET显像对颞叶癫痫定性和病业定位的诊断价值，探讨其外科治疗的意义。方法：26例CT或MRI检查正常，经临床及脑电图诊断的颞叶癫痫患者在同期进行发作间期^18F-FDG PET脑显像，图像通过目测和半定量的方法进行分析，PET显示的低代谢区行皮层脑电图（EcoG）或深部脑电图（DEEG）描记以评估^18F-FDG PET检测癫痫灶的特异性，17例定位明确的单侧颞叶癫痫行前颞叶切除术，术手进行随访。2例PET未检出癫痫灶，7例DEEG定位双侧病灶未行手术治疗。结果：26例颞叶癫痫中，发现^18F-FDG PET对癫痫灶检出的灵敏度为92%（24/26），特异度为87%(21/24)。结论：从颞叶癫痫的定性定位诊断来看，发作间期^18F-FDG PET脑显像对癫痫灶的检出率较高，但^18F-FDG PET显示的低代谢区与癫痫灶的位置并非完全重叠，尚需要其他的诊断措施加以肯定，^18F-FDG PET和皮层脑电图或深部脑电图对癫痫病灶定位的一致性是手术成功的关键。     

VEEG在难治性癫痫术前致痫灶定位中的价值

目的 探讨视频脑电图(VEEG)、单光子发射计算断层扫描(SPECT)、正电子发射断层扫描(PET)技术在术前进行致痫灶定位中的价值.方法 175例手术治疗的难治性癫痫患者,术前全部行VEEG检查,59例行VEEG +蝶骨电极记录,46例行PET致痫灶定位,61例行SPECT定位.并与术中皮层脑电图(ECoG)的结果进行比较.结果 术前VEEG定位、VEEG+蝶骨电极记录、PET检查及SPECT检查与术中ECoG致痫灶定位符合率分别为67.42%、74.57%、54.84%和52.45%.结论 VEEG在致痫灶定位中有重要的价值;对于颞叶内侧深部癫痫而言,术前以VEEG +蝶骨电极记录定位更为准确.     

发作间期癫痫灶的~(18)F-FDG PET/CT显像研究

目的 探讨~(18)F-FDG PET/CT对发作间期癫痫灶定性定位诊断价值.方法 病人空腹4-6 h以上,空腹血糖3.9～6.1 mmol/L,肘静脉注射显像剂~(18)F-FDG0.12 mCi/kg体质量,平静休息40 min后行脑部PET3D及CT断层显像,层厚3.75 mm,PET图像行衰减校正及迭代法重建多层面,多幅显示,连续两个层面以上肉眼可辨的放射性改变(低代谢、高代谢区)为癫痫灶.同时根据癫痫灶对放射性示踪剂的摄取进行半定量测定.对于多发癫痫灶采用痫灶部位及对侧同一部位SUVmax与小脑SUVmax相比.每个病人开颅后根据术前脑电、PET/CT结果行颅内电极(条状脑皮质电极、脑深部电极)监测癫痫灶的脑电情况,证实~(18)F-FDG PET/CT结果.结果 38例患者中37例检出癫痫灶,术中脑电证实癫痫灶部位较准确,1例颞叶癫痫未检出.单痫灶较多痫灶准确.结论 ~(18)F-FDG PET/CT是一种无创伤性、高度灵敏、较有效的癫痫灶定位方法.     

皮层脑电图监测在顽固性癫痫手术中的应用(附155例报告)

目的总结皮层脑电图在顽固性癫痫手术中的应用经验并评价手术疗效。方法 155例顽固性癫痫患者,术前行MRI、视频脑电图、单光子发射计算机断层成像与脑磁图检查,明确致痫灶,在皮层脑电图监测下手术。54例颞叶癫痫患者行颞叶前部与海马杏仁核显微切除术,47例颅内病灶患者行病灶与癫痫灶切除术,35例行癫痫灶切除术,19例致痫灶位于功能区的患者行皮层电凝及软脑膜下横纤维切断术。结果术后随访1~2年,按Engel分级:Ⅰ级88例,Ⅱ级46例,Ⅲ级13例,Ⅳ级8例。术后患者神经功能保持良好,未出现明显后遗症。结论在术前多种方法联合定位癫痫灶的基础上,应用皮层脑电图可以提高顽固性癫痫患者的手术疗效。     

18F-2-氟代脱氧葡萄糖PET/MRI显像结合神经功能定量分析在癫痫术前定位中的应用价值研究

目的评估~(18)F-2-氟代脱氧葡萄糖(~(18)F-FDG) PET/MRI结合神经功能定量分析软件在癫痫术前定位的临床价值。方法回顾性分析经手术治疗的60例难治性癫痫患者一体化~(18)F-FDG PET/MRI结果,以术后病理为依据,比较视觉分析与神经功能分析软件的自动定量分析结果的一致性。结果 35例癫痫患者60%中(21/35)病理结果为脑皮质发育不良,34.2%(12/35)为海马硬化,5.7%(2/35)为节细胞胶质瘤。8.5%(3/35)致痫灶定位于额叶,8.5%(3/35)定位于枕叶,余82.8%(29/35)均定位于颞叶。视觉分析与软件定量分析结果中有22例定位一致,一致率62.8%。其中2例患者~(18)F-FDG PET显像提示病变位于双侧颞叶,MIMneuro软件分析示仅一侧病变有诊断意义,且与视频EEG一致。10例患者~(18)F-FDG PET肉眼分析为阴性或疑似病灶,软件分析结果为阳性,其中8例定位于颞叶,2例定位于顶叶。1例患者视觉分析、软件定量均为阴性,手术定于基于术前视频EEG及术中皮质EEG。视觉分析与定量分析敏感性差异有统计学意义(80%vs. 97.1%,P=0.038)。结论神经功能分析法基于患者皮质葡萄糖代谢的统计学差异的定量分析,其对致痫灶检出的效能大于常规视觉分析,且量化分析结果有助于提高诊断者的信心,有利于难治性癫痫患者术前精准定位。     

隐源性癫痫致痫灶最常见好发部位及相关病理特征

目的 回顾性分析隐源性癫痫致痫灶最常见的好发部位及手术切除标本的病理改变,探讨隐源性癫痫致痫灶的发病机制.方法 通过向26例头部CT、MRI等影像学检查无特异性表现的患者颅内可疑脑区植入皮层电极及深部电极,行长程视频脑电监测,记录发作间期及发作期脑电图变化,确定癫痫病灶起始区,手术切除致痫灶并送病理,术后定期随访.结果 26例均可以明确致痫灶,其中癫痫发作单独起源于颞叶新皮层及颞叶内侧的13例,占本组病例的50％;送检标本病理结果显示胶质细胞增生、皮层分层紊乱25例,占本组病例的96.15％,其中伴有海马硬化14例.术后随访1年以上,Engel Ⅰ级15例,Engel Ⅱ级8例,Engel Ⅲ级2例,Engel Ⅳ级1例.无严重并发症及手术死亡病例.结论 颞叶新皮层及颞叶内侧是隐源性癫痫致痫灶最常见的好发部位,皮层发育不良是隐源性癫痫手术切除标本中常见的病理改变,其中海马硬化是颞叶内侧常见的病理改变.颞叶新皮层及颞叶内侧病理改变不仅经常相伴出现,而且病理改变轻微.通过外科干预,效果较满意.按Engel分级,位于颞叶新皮层及颞叶内侧的病例手术疗效较其他好,Engel's分级均在Ⅱ级以上.     

表现为难治性癫痫的低级别脑胶质瘤的手术治疗(附28例临床分析)

目的探讨表现为难治性癫痫的低级别脑胶质瘤的临床特点,手术治疗策略。方法回顾性分析28例表现为难治性癫痫经病理检查证实为低级别胶质瘤(LGG)患者的临床表现、影像学(CT/MRI/PET)资料、脑电图(EEG/VEEG/ECoG)资料和手术方法。所有病例术前均行动态脑电图(EEG)检查明确致痫灶完成定位诊断,术中行皮质脑电(ECoG)监测,再次验证致痫灶,同时快速冰冻确诊肿瘤性质,完成定性诊断。全部患者在显微镜下先行致痫灶(肿瘤)切除术,并根据致痫灶部位的不同,加行皮质热灼,功能区行软膜下横切、颞叶病灶行患侧海马切除术。结果随访6~40个月,平均24个月癫痫症状消失(EagleI级)26例,癫痫发作次数明显减少(EagleII级)2例,肿瘤均无复发。结论表现为难治性癫痫的脑肿瘤多为低级别脑胶质瘤;术前动态EEG明确致痫灶,术中ECoG监测下切除脑肿瘤及致痫灶是控制癫痫发作的有效方法。     

颞叶新皮层癫痫的外科治疗（附42例病例分析）

目的研究颞叶新皮层癫痫外科治疗的临床相关问题。方法42例病人术前均经128导视频EEG及MRI检查,MRI阴性者进一步行SPECT检查;对于术前无创检查难以确定致痫灶者行硬膜下电极埋藏纪录;术中利用ECoG进一步明确致痫灶的范围后进行个体化治疗。结果①本组资料中,术前MRI的病理灶定位与128导视频EEG的致痫灶定侧高度一致(P<0.05);②MRI阳性的35例中有25例致痫灶位于病灶附近,MRI阴性7例者的SPECT与术中ECoG结果完全一致;③参照Engel标准,本组病例平均随访3.6±1.1年,总有效率为88.10%,其中Ⅰ级占71.43%,Ⅱ级占16.67%;④致痫灶处理的手术方式与预后密切相关(P<0.05)。结论①颞叶新皮层癫痫的术前定位应综合考虑方可决定手术方案;②明确致痫灶仅限于颞叶新皮层时,手术不必涉及到颞叶内侧面结构,以防增加病人的致残率。     

发作间期18F-FDG PET在难治性癫痫手术定位中的价值

许多学者认为脑PET显像不仅能诊断癫痫,且能对癫痫灶准确定位,为癫痫的手术、立体定向和放射外科治疗提供了定位依据[1].本研究分析了12例难治性癫痫患者术前18F-FDG PET脑显像与术中皮层脑电图(ECoG)检查、术后病理结果的关系,以探讨术前18F-FDG PET脑显像对癫痫灶定位的价值.     

非侵袭性检查定位致痫灶在癫痫外科治疗中的作用

目的 评价非侵袭性检查方法定位致痫灶在癫痫外科治疗中的作用。方法 对30例难治性癫痫病人行EEG、MRI、PET检查,根据3项检查结果选择外科治疗方法（开颅手术,X－刀治疗,立体定向手术）。开颅手术,术中行皮层脑电图（ECoG)检查。结果 致痫灶位于颞叶22例,颞叶外6例,额颞区2例。方法 开颅手术16例,X－刀治疗10例,立体定向手术4例。术后除2例发作无明显改善外,28例病人发作均明显减少或消失。结论 大部分难治性癫痫病人,尤其是颞叶癫痫,开颅致痫灶切除、放射外科、立体定向手术可以根据EEG、MRI、PET检查来定位,避免术前侵袭性EEG（如植入深部电极等）检查的危险性。     

18F－FDGPET／CT显像对颞叶癫痫灶定位的价值

目的探讨以18氟-2-脱氧葡萄糖为显影剂的正电子发射断层扫描／计算机断层成像（18F-FDGPET／CT）对颞叶癫痫（TLE）灶的定位价值。方法本研究回顾分析被确诊为TLE的24例患者的临床资料,将术前18F-FDGPET／CT、MRI、视频脑电图（VEEG）与术中颅内电极脑电图和术后病理学检查结果进行对比研究。结果24例TLE患者中,18F-FDGPET／CT准确定位致痫灶21例,MRI准确定位10例,VEEG准确定位10例。18F-FDGPET／CT对TLE致痫灶的敏感性为87．5％（21／24）,其中对内侧颢叶癫痫（MTLE）致痫灶为88．9％（16／18）,对外侧颞叶癫痫（LTLE）致痫灶为83．3％（5／6）。MRI对TLE致痫灶的敏感性为41．7％（10／24）,其中对MTLE致痫灶为55．5％（10／18）,对LTLE致痫灶为0。VEEG对TLE致痫灶的敏感性为41．7％（10／24）,其中对MTLE致痫灶为50．5％（9／18）,对LTLE致痫灶为16．7（1／6）。18F-FDGPET／CT对TLE（包括MTLE和LTME）致痫灶的敏感性均显著高于MRI和VEEG（P〈0．05）,而MRI和VEEG对TLE致痫灶的敏感性无显著差异（P〉0．05）。结论18F-FDGPET／CT对于TLE致痫灶定位具有独特的优势。     

PET with 11C-deuterium-deprenyl and18F-FDG in focal epilepsy

OBJECTIVES: This study compares positron emission tomography (PET) using 11C-deuterium-deprenyl (DED) with PET using 18F-fluorodeoxyglucose(18F-FDG) for examining epileptogenic regions in patients with focal epilepsy. MATERIAL AND METHODS: Twenty-three patients undergoing evaluation for epilepsy surgery were subjected to PET with DED. Fourteen patients had mesial temporal lobe epilepsy (TLE) and 9 patients had seizures of neocortical origin. In addition, 6 healthy control subjects were examined. Pixel-by-pixel analysis was used to generate graphical images of tracer distribution volume (intercept) and the accumulation rate (slope). Asymmetries with respect to relative intercept and slope were compared in patients with temporal lobe epilepsy (TLE), in patients with extra-temporal lobe epilepsy (exTLE), and in the control subjects. The results were compared with 18F-FDG-PET. RESULTS: Among the patients with TLE, significant differences between the epileptogenic and the contralateral lobe were found with DED intercept and FDG-uptake. No significant differences were found with DED slope. The exTLE and the control groups showed no significant differences between sides or lobes. CONCLUSIONS: This study indicates that PET with 11C-deuterium-deprenyl is a useful method for identifying TLE and is equivalent to PET with 18F-FDG in this sense. The method has little localizing value in seizures originating from neocortical structures.     

PET/CT在非病灶性癫(癎)外科评估中的作用

目的 探索PET/ CT 在癫(癎)外科评估中的作用,更好地利用PET/ CT 以提高癫(癎)外科的治疗水平.方法 总结分析已经进行手术治疗的难治性局灶性癫(癎)46 例.所有病例在术前都经PET/ CT 检查(发作间期),并随访6 ～24 个月.结果 颞叶癫(癎)24 例PET/ CT 阳性,与头皮EEG 结果、MRI 及颅内电极检查结果有高度的一致性;24 例均行颞前叶海马切除术,结果Engel I-II 级者22 例.非颞叶癫(癎)22 例,行致(癎)皮层切除术,15 例达Engel Ⅰ-Ⅱ级.结论 对于颞叶癫(癎)PET/ CT 检查能协助判断侧别.对于非颞叶癫(癎),它可以帮助确定癫(癎)源的范围,指导颅内电极的植入.     

局灶性难治性颞叶癫痫全脑葡萄糖代谢特点

目的 探讨局灶性难治性颞叶癫痫全脑葡萄糖代谢特点。方法 回顾性分析2017年1~12月行发作间期18FDG-PET/CT检查的23例局灶性难治性颞叶癫痫的影像学资料。将PET图像导入MIM neuro软件,软件自动分析癫痫病人葡萄糖代谢水平与正常人群葡萄糖代谢的差异,各脑区差异结果以Z-Score值显示,分析颞叶癫痫病人全脑葡萄糖代谢特点。结果 术后病理为脑皮质发育不良22例,节细胞胶质瘤1例;病灶位于左侧颞叶16例,右侧颞叶7例。除颞叶呈葡萄糖低代谢改变外,还存在同侧海马、海马旁回、岛叶、杏仁核、颞叶岛盖以及双侧小脑半球葡萄糖代谢不同程度减低;对侧颞叶、额叶、顶叶、顶上小叶以及角回葡萄糖代谢不同程度增高。结论 颞叶癫痫具有一定葡萄糖代谢特点,其特定的葡萄糖代谢特点有助于更加精准的癫痫术前定位及其病理特征的分析。     

Usefulness of PET scan in a child with mesial frontal lobe epilepsy.

Positron emission tomography (PET) scan with 18F-fluorodeoxyglucose (18F-FDG) was performed in a 14-year-old boy who had seizures suspected to have originated in mesial frontal lobe. The seizures occurred in clusters and were characterised by a change in the facial expression at seizure onset and complex motor manifestations consisting of kicking, swaying and screaming. Ictal EEG showed rhythmic alpha-waves in the left frontal area association with the ictus. Cerebral CT, MRI and SPECT revealed nothing of significance, but the PET brain scans showed frontal and parietal hypometabolism, which was most prominent in the left mesial frontal lobe. The present case suggests that FDG-PET scanning may be useful for the diagnosis of the mesial frontal epilepsy, when other imaging studies fail to show abnormalities.     

Mesial temporal lobe epilepsy with lateral temporal lobe abnormalities in magnetoencephalography and glucose metabolism.

Magnetoencephalography (MEG) and positron emission tomography (PET) revealed abnormal findings in the lateral temporal lobe of a 22 year old female with mesial temporal lobe epilepsy. Electroencephalography identified the epileptogenic focus in the left mesial temporal lobe and standard anterior temporal lobectomy resulted in a good surgical outcome. These discrepancies can be explained by the presence of anatomical and functional pathways between the mesial and lateral temporal structures, or pathophysiological abnormalities in both the mesial and lateral temporal lobes. Careful evaluation is necessary for analysis of MEG and PET findings in patients with temporal lobe epilepsy.     

Relationship between bilateral temporal hypometabolism and EEG findings for mesial temporal lobe epilepsy: analysis of 18F-FDG PET using SPM.

PURPOSE: To investigate the clinical significance of bilateral temporal hypometabolism (BTH) for patients with mesial temporal lobe epilepsy (MTLE) by using statistical parametric mapping (SPM). METHODS: Interictal 18F-FDG PET scans were performed for 29 patients with surgically treated MTLE. Clinical data, interictal epileptiform discharges (IEDs), ictal scalp EEG and intracarotid amobarbital test (IAT) were analyzed. To assess an 18F-FDG PET image, an SPM analysis as well as visual interpretation were applied. RESULTS: In 9 of 29 patients, the 18F-FDG PET scan revealed BTH by the SPM analysis, while only 3 patients showed BTH by the visual assessment. When the patients were classified into the unilateral temporal hypometabolism (UTH) and BTH groups based on the SPM results, bitemporal IEDs occurred significantly more frequently in the BTH group than in the UTH group (66.7% versus 22.2%). Bilateral independent seizure onset seen on the scalp EEG and bitemporal epilepsy were present only in the BTH group. Lateralized ictal onset was present less frequently in the BTH group than in the UTH group (44.4% versus 83.3%). There was no statistically significant difference in age at onset, duration of epilepsy, generalized seizure, history of febrile convulsion and CNS infection, lateralization throughout the whole tracing, lateralization on the IAT test, and surgical outcome between the UTH and BTH groups. CONCLUSION: Bilaterality of the EEG findings correlated with BTH on 18F-FDG PET by the SPM method. Our results suggest that analysis of 18F-FDG PET by using SPM may have a role in predicting those patients with bitemporal excitability or bitemporal independent epileptogenicity, and these patients should be monitored carefully.     

18F-FDG PET/CT脑显像评价认知障碍患者中的脑小血管病变对皮层功能的影响

目的 探讨18氟代脱氧葡萄糖（18F-fluorodeoxyglucose,18F-FDG）正电子发射断层成像/计算机断层扫
描（positron emission tomography/computed tomography,PET/CT）脑显像评价认知障碍患者中的脑小血
管病变对皮层功能的影响。
方法 本研究为回顾性研究,纳入2009年1月～2010年12月北京协和医院PET中心行18F-FDG PET/CT
脑显像且颅脑磁共振成像（magnetic resonance imaging,MRI）提示存在小血管病变的认知障碍患者21例,
其中临床诊断血管性痴呆（vascular dementia,VaD）10例,阿尔茨海默病（Alzheimer’s disease,AD）或混
合型痴呆（mixed dementia,MD）11例。首先目测两组患者的18F-FDG PET/CT脑显像皮层及皮层下核团代
谢减低特点,并结合颅脑MRI判断病变血管对脑代谢的影响。使用NeuroQ软件和Scenium软件对18F-FDG
PET/CT脑图像在像素基础上进行定量分析比较两组患者的皮层代谢情况。
结果 通过目测和NeuroQ软件分析发现VaD组患者18F-FDG PET/CT脑显像图像特点为无规律,不对
称皮层或皮层下核团代谢减低,其中额叶皮层代谢减低范围最广,程度最重。结合颅脑MRI改变,考
虑皮层和皮层下核团代谢减低主要为小血管病变引起。AD或MD组患者脑代谢均呈现双侧颞顶叶代谢
减低,其中8例出现皮层代谢减低不对称表现,6例出现基底节丘脑不对称代谢减低表现,与典型AD
的表现不符,结合颅脑MRI表现,考虑为病变血管所致,小血管病变可能导致相应皮层代谢减低。通
过定量分析发现两组患者的SUV比值在左右顶叶、内外颞叶和枕叶差异具有显著性。
结论 18F-FDG PET/CT脑显像作为功能影像可以推断小血管病变与皮层及皮层下核团代谢的关系。     

Magnetic resonance imaging in intractable partial epilepsy: correlative studies

A study was performed evaluating magnetic resonance imaging (MRI) in 35 patients with intractable complex partial seizures in whom computed tomographic (CT) scans showed no focal abnormalities. These results were correlated with positron emission tomography evaluation (PET), the electroencephalographic ictal onset, and findings during pathological examination. Seven patients had structural lesions that were epileptogenic, detected by MRI; the lesions were tuberous sclerosis, astrocytomas, or hamartomas. Three of these 7 patients underwent PET scanning, which was normal in all. Of 18 patients with mesial temporal sclerosis, 10 were shown by PET to have temporal lobe hypometabolism, though all 18 had normal MRI findings. The results indicate that MRI contributes information to that provided by CT and PET, by detecting nonsclerotic epileptogenic lesions of the temporal lobe.