颞叶癫痫发作间期PET-CT与VEEG检查对致癫灶的诊断价值比较

目的 比较分析颞叶癫痫发作间期正电子发射计算机断层显像（PET-CT）和视频脑电图（VEEG）检查对致癫灶的诊断价值。方法 回顾性分析2016年3月至2018年3月手术治疗的80例单侧颞叶癫痫的临床资料。另选取同期健康体检者30例作为对照。术前进行PET-CT和VEEG监测定位致痫灶，以术中监测结果为定位致痫灶的金标准。利用受试者工作特征（ROC）曲线评价PET-CT放射性分布不对称指数（AI）对颞叶癫痫致癫灶的诊断价值。结果 PET-CT、VEEG确定致癫灶的灵敏度分别为88.73%、47.89%，特异度分别为88.89%、66.67%。颞叶癫痫发作间期病灶侧AI显著高于非病灶侧（P<0.05），同时也显著高于健康体检者颞叶内侧AI（P<0.05）及颞叶外侧AI（P<0.05）。ROC曲线分析结果显示，AI=0.153诊断颞叶癫痫致癫灶的曲线下面积为0.730，95%置信区间在0.544~0.916。结论 颞叶癫痫发作间期PET-CT脑显像定位准确率优于VEEG，对手术治疗准确定位有很高的应用价值，且AI为0.153时诊断癫痫灶的效果最好。

Diagnosis of epileptogenic lesions during intermission of temporal lobe epilepsy attack: PET-CT vs. VEEG

Objective To analyze the values of Positron emission computed tomography (PET) -CT and video electroencephalogram (VEEG) to the diagnosis of the epileptogenic lesions during the intermission of temporal lobe epilepsy (TLE) attack. Methods PET-CT and VEEG examinations were performed during the intermission of attack in 80 patients with unilateral TLE who were treated in our hospital from March, 2016 to March, 2018. The values of PET-CT and VEEG to preoperative localization of epileptogenic lesions were analyzed. The receiver operating characteristic (ROC) curve was used to evaluate the value of radiological asymmetry index (AI) to the diagnosis of the epileptogenic lesions in the patients with TLE. Results The sensitivities of PET-CT and VEEG to determining epileptogenic lesions were 88.73% and 47.89% respectively. The specificities of PET-CT and VEEG to determining epileptogenic lesions were 88.89%, and 66.67% respectively. AI in the side with epileptogenic lesion was significantly higher than that of the side without epileptogenic lesion during the intermission of TLE attack in the patients with TLE. ROC analysis results showed that the area under the curve (AUC), 95%CI and Cutoff value of AI to diagnosing epileptogenic lesions were 0.730, 0.544~0.916 and 0.153 respectively. Conclusions The location of epileptogenic lesion by PET-CT is more accurate than that by VEG in the patients with TLE during the intermission of attack, and therefore, it is of very high application value for preoperative accurate positioning of epileptogenic lesions. When AI is 0.153, Yoden index for diagnosing epileptogenic lesions is the largest.