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1.
PET与发作间期癫痫灶定位   总被引:3,自引:0,他引:3  
我们用^18F-FDG-PET显像对126例癫痫患者进行了发作间期癫痫灶定位,男81例,女5例,年龄2-56岁,其中110例在PET上可发现明显相对低代谢区,而MRI或CT仅32例发现异常,头皮EEG有102例异常,但无明显确定位价值。  相似文献   

2.
癫痫外科     
PET、EEG、MRI在术前癫痫灶定位价值中的对比研究欧阳辉 邱炳辉 漆松涛 黄祖汉 吴湖炳 王全师 摘要 目的:探讨术中皮层脑电图(ECoG)、术后组织病理和随访结果为标准,比较发作间期18 F-FDG PET显像、EEG、MRI在难治性癫痫外科手术前癫痫灶定位中的价值。方法:术前均行发作间期1 8F-FDG PET脑显像、2~3次 EEG和 MRI检查,术中行ECoG检查,以PET和ECoG定位的癫痫灶范围行癫痫灶切除或多处软脑膜处横纤维切断术,术后切除病变组织行病理检查与外科治疗效果进行随访,比…  相似文献   

3.
癫痫灶的准确定位是决定癫痫外科疗效的关键步骤。目前常用的定位方法有脑电图(EEG),磁共振(MRI),单光子发射断层扫描(SPECT)和正电子发射扫描(PET)等。本文利用患者的临床表现和EEG定位结果作为标准,探讨发作间期18F-脱氧葡萄糖(FDG...  相似文献   

4.
临床上应用EEG、SPECT、ECoG进行致痫灶定位有一定差异性,我们应用PET对10例顽固性癫痫术前定位,来探讨FDG—PET低代谢区与实际癫痫灶的相符合程度,从而衡量其定位的准确性与特异性。方法:10例顽固性癫痫患者,强直阵挛性发作1例,复杂部分...  相似文献   

5.
目的:探讨发作间期18F-脱氧葡萄糖(FDG)正电子发射断层扫描(PET)和99mTc-己撑半脱氨酸(ECD)单光子发射断层扫描对顽固性颞叶癫痫(TLE)的定位诊断价值。方法:53例脑电图(EEG)定位明确的顽固性TLE患者分别行发作间期18F-FDGPET和99mTc-ECDSPECT检查。其中21例磁共振(MRI)显示有结构性病变并与EEG定位结果一致。结果:MRI异常组均在PET和SPECT相应部位出现低代谢和低灌注表现。MRI正常组,PET定位准确性为84.5%,显著高于SPECT的56.3%(P<0.05)。结论:对于无结构性病变的颞叶癫痫,发作间期PET检查有较高的定位诊断价值,SPECT的临床意义相对较小  相似文献   

6.
发作间期PET和SPECT检查对颞叶癫痫定位诊断价值   总被引:1,自引:0,他引:1  
目的:探讨发作间期^18F-脱氧葡萄糖(FDG)正电子发射断层扫描(PET)和^99mTc-已撑半脱氨酸(ECD)单光子发射断层扫描对顽固性颞叶癫痫(TLE)的定位诊断价值。方法:53例脑电图(EEG)定位明确的顽固性TLE患者分别行发作间期^18F-FDGPET和^99mTc-ECDSPECT检查。其中21例磁共振(MRI)显示有结构性病变并与EEG定位结果一致。结果:MRI异常组均在PET和S  相似文献   

7.
发作间期PET和 SPECT检查对颞叶癫痫定位的诊断价值   总被引:2,自引:0,他引:2  
杨建林  王莉 《临床脑电学杂志》1998,7(3):139-140,145
目的:探讨发作间期^18F-脱氧葡萄糖(FDG)正电子发射断层扫描(PET)和^99mTc-已撑半胱氨酸(ECD)单光子发射断层扫描(SPECT)对难治性颞叶癫痫(TLE)的定位诊断价值。方法;53例脑电图(EEG)定位明确的难治性TLE患者分别行发作间期18F0-FDGPET和^99mTc-ECDSPECT检查。其中21例磁共振(MRI)显示有结构性病变并与EEG定位结果一致。结果:MRI异常组  相似文献   

8.
我院在1995年10月~1997年10月间,对住院的顽固性癫痫患者53例,探讨发作间期18F-脱氧葡萄糖(FDG)正电子发射断层扫描(PET)和99mTc-已撑半胱氨酸(ECD)单光子发射断层扫描对顽固性颞叶癫痫(TLE)的定位诊断价值。方法:53例...  相似文献   

9.
目的 比较MRI及FDG-PET在颞叶癫癎致癎灶定位中的价值,探讨癫癎外科术前定位的方法以及手术预后的判断。方法 以手术后癫癎控制状况为标准,对30例颞叶癫癎患者的术前MRI和FDG-PET的结果进行比较,分析MRI及PET各自在癫癎致癎灶定位中的价值。结果MRI有良好的脑结构分辨能力,对于症状性癫癎的定位价值高,当MRI显示海马硬化时,对致癎灶定位的意义大,术后癫癎发作完全控制的可能性大。发作间期PET对于颞叶癫癎定位的敏感性高于MRI,但PET低代谢的范围往往超过致癎灶。与PET的目测方法比较,PET半定量分析并不能提高致癎灶定位的准确性及对手术效果的预测。结论 MRI与PET检查结合可以提高致癎灶定位的准确性及对手术效果的预测,减少颅内记录的应用。  相似文献   

10.
正电子发射计算机断层扫描(positron emission tomography,PET)作为无创性癫■灶定位方法,早在1977年已被Engel应用于临床[1],而我国这一工作在近几年才得到开展。我们用~(18)F-FDGPET对36例顽固性癫■患者进行致■灶定位,其中10例行开颅脑皮层电极检查监测并行致■灶切除术,现报道如下。1 资料1.1 一般资料:本组36例顽固性癫■患者,2次以上脑电图或24小时动态脑电图检查确诊。经神经内科正规抗癫■药物治疗2年以上效果不佳或无效。其中男25例,女11例,…  相似文献   

11.
发作间期颞叶癫痫的18F-FDG PET 显像研究   总被引:11,自引:1,他引:11  
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。  相似文献   

12.
High resolution magnetic resonance imaging (MRI) of the brain was performed on 18 male schizophrenic patients and 15 male normal control subjects using an identical imaging protocol. The number and size of T2 hyperintense foci were clinically quantified by an academic radiologist. Large foci (greater than or equal to 3 mm in diameter) were observed more frequently on patient images (7/18) than on control images (1/15). The imaging protocol detected high rates of focal hyperintensities, but no differences between patients and controls were noted in the total affected brain area (sum of focal areas) or in the presence or absence of foci.  相似文献   

13.
High resolution magnetic resonance imaging (MRI) of the brain was performed on 18 male schizophrenic patients and 15 male normal control subjects using an identical imaging protocol. The number and size of T2 hyperintense foci were clinically quantified by an academic radiologist. Large foci ( 3 mm in diameter) were observed more frequently on patient images ( ) than on control images ( ). The imaging protocol detected high rates of focal hyperintensities, but no differences between patients and controls were noted in the total affected brain area (sum of focal areas) or in the presence or absence of foci.  相似文献   

14.
18F-FDG-PET在颞叶癫痫灶定位中的应用   总被引:1,自引:0,他引:1  
目的 介绍发作间期 18F-FDG-PET进行颞叶癫痫灶定位的方法,探讨发作间期18F-FDG-PET在颞叶癫痫灶定位中的价值.方法 回顾性分析术前行 18F-FDG-PET检查、手术后随访效果达到 Engle Ⅰ级的82例颞叶癫痫患者的临床资料,对 18F-FDG-PET在颞叶癫痫灶中定位敏感率和特异性进行分析,并与脑电图监测和MRI进行比较.结果 发作间期 18F-FDG-PET检查中癫痫灶表现为低代谢灶,其中68例位于癫痫灶侧颞叶或以颞叶为主合并其它区域,9例位于癫痫灶侧颞叶以外,5例未见低代谢灶.18F-FDG-PET对癫痫灶定位诊断准确率为82.9%(68/82),显著优于MRI和脑电图(P<0.05),且在MRI阴性和需要埋置电极进行脑电图检查定位的患者中分别有77.4%(41/53)和75%(15/20)可以达到准确的定位癫痫灶.病理阳性者18F-FDG-PET定位准确率显著高于病理阴性者(P<0.05).结论 18F-FDG-PET定位颞叶癫痫灶具有高敏感性、高特异性的特点,对MRl阴性和需要埋置电极进行检查的颞叶癫痫灶也有良好的定位价值,合理的应用还可能进一步提高结果.  相似文献   

15.
Subcortical metabolic alterations in partial epilepsy   总被引:12,自引:10,他引:2  
The function of subcortical nuclei in partial epilepsy was investigated using positron emission tomography (PET) to measure metabolism in the basal ganglia and thalamus. Sixteen patients undergoing surgical evaluation were studied with 18F-fluorodeoxyglucose (FDG) interictally and had intensive extracranial and intracranial electrophysiologic evaluations. Eight patients had left temporal lobe seizure foci, six had right temporal lobe foci, and two had right posterotemporal or parietal foci. The PET data were analyzed visually and quantitatively, using a multivariate analysis of variance on the quantitative data. Hypometabolism of subcortical nuclei was present ipsilateral to the cortical seizure focus. Cortical hypometabolism was noted focally in the temporal lobe in patients with left temporal lobe seizure foci, whereas patients with right temporal lobe seizure foci had diffuse hemispheric hypometabolism. We postulate that the subcortical hypometabolism is secondary to decreased efferent activity from temporal lobe structures, in particular amygdala and hippocampus, to subcortical nuclei. Diminished subcortical activity may then lead to defective regulation of cortical excitability in the temporal lobe, increasing the likelihood of seizure development and spread.  相似文献   

16.
发作间期癫痫灶的~(18)F-FDG PET/CT显像研究   总被引:1,自引:1,他引:0  
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.  相似文献   

17.
Positron emission tomography (PET) performed with [18F]-2-fluoro-2-deoxy-D-glucose ([18F]FDG) was used to measure local cerebral metabolic rate for glucose (lCMRGlc) interictally in 31 patients with chronic partial epilepsy and 16 age-matched normal subjects. Hypometabolic zones were visualized in 25 patients (81%). Cortical lCMRGlc in hypometabolic zones was within 2 standard deviations of the mean for normal temporal cortex in all but 8 patients. However, in 24 patients asymmetry between the hypometabolic cortex and homologous contralateral cortex was more than 2 standard deviations above the mean cortical asymmetry for normals. There was good correlation between hypometabolic zones and electroencephalogram (EEG) foci in patients with unilateral well-defined EEG foci. Diffuse or shifting EEG abnormalities were often associated with normal PET scans. Of 28 patients who underwent magnetic resonance imaging, 10 showed focal temporal lobe abnormalities corresponding to focal hypometabolism. While the [18F]FDG PET scan cannot currently localize an epileptogenic zone independently, the absence of focal hypometabolism or its presence contralateral to a presumed EEG focus suggests the need for additional electrophysiological data.  相似文献   

18.
Previous studies have focused on medial temporal lobe epilepsy secondary to central nervous system infections. Several large-sample analyses of multi-lobe injuries or complications of medial temporal lobe epilepsy have been reported. The present study selected 29 patients (10 males and 19 females with a mean age of 18 years) with refractory epilepsy secondary to central nervous system infections (meningitis in 8, encephalitis in 21) from Beijing Functional Neurosurgical Institute from May 2006 to August 2008. All patients underwent computer tomography or magnetic resonance imaging, as well as electroencephalogram examinations; cortical electrodes were embedded in 11 patients. In addition, 13 (45%) patients underwent anterior temporal lobectomy, and 16 (56%) underwent extratemporal corcticectomy. Results showed that 18 (62%) patients obtained favorable outcomes following surgical treatment, including 80% with temporal lobe epilepsy and 50% with extratemporal epilepsy. Central nervous system infection was not a contraindication for epilepsy treatment, and identification of epileptic foci proved to be crucial. In addition, a young age at infection, as well as prolonged latent period from time of infection to initial afebrile seizure, were 2 predictive factors for all patients. Cortical electrodes significantly increased the detection rate of epileptic foci, but did not improve prognosis of foci excision.  相似文献   

19.
PURPOSE: To study the effect of antiepileptic drugs (AEDs) on 5-HT(1A)-receptor binding in patients with temporal lobe epilepsy. 5-HT(1A)-receptor binding, measured by positron emission tomography, is reduced in patients with temporal lobe epilepsy. Antiepileptic drugs may act on the serotonergic system, as shown in animal models, and thus affect receptor-binding measurements. METHODS: We analyzed the effect of AEDs on 5-HT(1A)-receptor binding in 31 patients and 10 normal controls. Patients with structural lesions, progressive neurologic disorders, or taking other medications were excluded. None had a seizure for >or=2 days before positron emission tomography (PET). [(18)F]FCWAY PET was performed on a GE Advance scanner with continuous EEG monitoring. Functional images of the distribution volume (V) were generated. Anatomic regions of interest were applied to co-registered PET images, after correction for partial-volume effect. RESULTS: Patients had significantly higher [(18)F]FCWAY free fraction (f(1)) than did controls. No AED effects were observed on interictal [(18)F]FCWAY binding after correction for plasma free fraction. [(18)F]FCWAY V/f1 reduction in epileptic foci was not affected by AEDs. CONCLUSIONS: 5-HT(1A)-receptor binding is reduced in temporal lobe epileptic foci after partial-volume correction. AED plasma free fractions should be measured when PET receptor studies are performed in patients with epilepsy.  相似文献   

20.
Background: Positron emission tomography (PET) with 18F‐fluorodeoxyglucose (FDG) shows widespread hypometabolism even in temporal lobe epilepsy (TLE) patients with mesial temporal foci. 18F‐trans‐4‐fluoro‐N‐2‐[4‐(2‐methoxyphenyl) piperazin‐1‐yl]ethyl‐N‐(2‐pyridyl)cyclohexane carboxamide (18F‐FCWAY) PET may show more specific 5‐HT1A‐receptor binding reduction in seizure initiation than in propagation regions. 18FCWAY PET might be valuable for detecting epileptic foci, and distinguishing mesial from lateral temporal foci in MRI‐negative patients with TLE. Methods: We performed 18FFCWAY‐PET and 18F‐FDG‐PET in 12 MRI‐negative TLE patients who had had either surgery or subdural electrode recording, and 15 healthy volunteers. After partial volume correction for brain atrophy, free fraction‐corrected volume of distribution (V/f1) measurement and asymmetry indices (AIs) were computed. We compared 18FFCWAY‐PET and 18F‐FDG‐PET results with scalp video electroencephalography (EEG), invasive EEG, and surgical outcome. Results: Mean 18FFCWAY V/f1, compared with normal controls, was decreased significantly in fusiform gyrus, hippocampus, and parahippocampus ipsilateral to epileptic foci, and AIs were significantly greater in hippocampus, parahippocampus, fusiform gyrus, amygdala, and inferior temporal regions. Eleven patients had clearly lateralized epileptogenic zones. Nine had congruent, and two nonlateralized, 18F‐FCWAY PET. One patient with bitemporal seizure onset had nonlateralized 18F‐FCWAY‐PET. 18F‐FDG‐PET showed congruent hypometabolism in 7 of 11 EEG‐lateralized patients, bilateral hypometabolic regions in one, contralateral hypometabolism in one, as well as lateralized hypometabolism in the patient with bitemporal subdural seizure onset. Patients with mesial temporal foci tended to have lower superior and midtemporal 18F‐FCWAY V/f1 binding AI than those with lateral or diffuse foci. Conclusion: 18F‐FCWAY‐PET can detect reduced binding in patients with normal MRI, and may be more accurate than 18FFDG‐PET.  相似文献   

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