儿童难治性癫痫18F-FDG PET/CT皮层下结构影像学分析

目的 观察难治性癫痫患儿¹⁸F-FDG PET/CT表现，探讨皮层下结构在癫痫发作中的参与机制及其临床意义。方法 回顾性分析611例难治性癫痫患儿¹⁸F-FDG PET/CT表现，分析患儿大脑皮层代谢异常区域，观察皮层下结构（基底核、丘脑、小脑）代谢改变。根据年龄将患儿分为低龄组、中龄组和大龄组，并根据皮层异常累及脑叶数将单侧大脑皮层代谢异常患儿分为轻度组和重度组，比较不同组别大脑皮层下结构代谢异常发生率。结果 611例中，525例单侧大脑皮层代谢异常，86例双侧皮层代谢异常。190例皮层下结构代谢改变，其中基底核64例、丘脑113例及小脑105例。不同年龄组大脑皮层下结构代谢异常发生率差异无统计学意义（P均>0.05）；重度组大脑皮层下结构代谢异常发生率明显高于轻度组（P均<0.001）。结论 ¹⁸F-FDG PET/CT可发现难治性癫痫患儿皮层下结构代谢改变，有助于提示皮层病变累及范围。

18F-FDG PET/CT imaging of subcortical structure in children with intractable epilepsy

Objective To observe the metabolic changes of subcortical structures in children with intractable epilepsy using ¹⁸F-FDG PET/CT, and to investigate the mechanism of subcortical structure involvement in epileptic seizures and its clinical significance. Methods Features of ¹⁸F-FDG PET/CT imaging in 611 intractable epilepsy children were analyzed. The metabolic changes of cortex and subcortical structures (basal ganglia, thalamus and cerebellum) were observed. The children were divided into three groups (young, middle and older groups) according to age, also mild group and severe group according to the number of involved lobar, respectively. The incidence of metabolic abnormalities in subcortical structures of different groups were analyzed. Results Among 611 children, unilateral cortical metabolic abnormality was found in 525, and bilateral cortical metabolic abnormalities were found in 86 children. The involvement of subcortical structures was detected in 190 children, including basal ganglia (n=64), thalamus (n=113) and cerebellum (n=105). The incidence of metabolic abnormality in subcortical structures under different age groups was not statistically different (all P>0.05), while the incidence of metabolic abnormality in subcortical structures of severe group was significantly higher than that of mild group (all P<0.001). Conclusion ¹⁸F-FDG PET/CT might be able to detect the metabolic abnormalities of subcortical structures, therefore indicating the involvement of cerebral cortex.