18F-FDGPET定位致痫灶在癫痫外科治疗中的价值

目的评价18F-脱氧葡萄糖(FDG)PET定位致痫灶在癫痫外科治疗中的作用.方法对30例难治性癫痫患者行EEG、MRI、PET检查,根据PET检查结果并参考EEG、MRI选择外科治疗方法(开颅手术,X刀治疗,立体定向手术).开颅手术者,术中行皮层脑电图(ECoG)检查,术后送病理检查.所有患者均观察术后疗效.结果致痫灶位于颞叶22例,颞叶外6例,额颞区2例.30例患者中16例行开颅手术,10例X刀治疗,4例立体定向手术.术后除2例癫痫发作无明显改善外,余28例发作明显减少或消失.结论18F-FDGPET检查术前定位致痫灶有助于选择手术方式,提高手术治疗效果.     

比较PET／CT，SPECT和structural MRI对颞叶癫痫的诊断价值

目的：通过对颞叶癫痫(TLE)患者与用结构MRI和EEG结果显示脑代谢异常之间的一致性来评价PET／CT在发作期和发作间期SPECT对致痫灶的空位能力。方法：回顾性分析近两年来19例脑电图或临床上或MRI证实为颞叶癫痫的患者，所有患者均行了手术治疗。其中A组10例进行了发作间期PET／CT检查，另外B组9例同时进行了普通PET(CPET)和发作时和(或)发作期间SPECT检查。     

18F-FDG PET显像对致癎灶的定位及在外科治疗中的价值

目的探讨^18F-脱氧葡萄糖（FDG）PET显像对致痫灶的定位及在引导外科手术和放射定向治疗中的价值.方法原发性癫痫患者110例,皆行^18F-FDG脑三维PET显像,通过目测和半定量方法分析图像.所有患者均行头皮脑电图（EEG）检查,其中26例行皮层脑电图（ECoG）或深部脑电图（DEEG）检查;66例行脑MRI及（或）CT检查.110例中17例行单侧颞叶切除术,69例行X刀或伽玛刀治疗.随访时间＞1年.结果①110例中,PET显像阳性检出率为88.2%,明显高于EEG和脑MRI（分别为67.3%、43.5%,x^2值分别为13.88、24.17,P均＜0.01）,94.8%的病灶为低代谢灶,5.2%为高代谢灶.单病灶检出率PET显像明显高于EEG（分别为60.8%和35.1%,x^2=11.08,P＜0.01）.与ECoG或DEEG相比,PET对致痫灶的检出灵敏度为92%,定位准确性为87%.17例在PET显像引导下行颞叶切除术,69例在PET显像引导下行X刀和伽玛刀治疗,治疗效果良好.结论 ^18F-FDG PET对致痫灶的检出及定位有较高的灵敏度和准确性;对引导癫痫外科手术及放射定向治疗均有价值.     

18 F-FDG PET显像对致痫灶的定位诊断价值

目的　探讨 18F -脱氧葡萄糖 (FDG)PET显像对癫痫灶的定位诊断价值。方法　难治性癫痫患者 2 2例 ,男 15例 ,女 7例 ,平均年龄 19.0岁 ,平均病程 8.2年。所有患者均进行常规 18F -FDGPET显像 ,结合脑电图 (EEG)及MRI、CT对 2 1例患者进行开颅手术 ,术中在皮层脑电图 (EcoG)监测下行致痫灶切除术 ,并送病理学检查 ;另 1例进行立体定向杏仁、海马损毁术。所有患者术后随访疗效。结果　 2 2例癫痫患者中 ,2 1例 18F -FDGPET显像阳性 (95 .5 % ) ,2 0例表现为发作间期低代谢灶 ,1例为发作期高代谢灶 ;EEG检查阳性 17例 (77.3 % ) ,其中 8例无定位意义 ;CT、MRI阳性者 5例 (2 2 .7% ) ;18F -FDGPET定位的致痫灶与EcoG一致的有 18例 (85 .7% ) ,不完全一致的 2例 ,不一致的 1例 ;18F -FDGPET显像阳性 19例中 ,18例手术病理异常 (94.7% ) ,PET阴性的 1例手术病理为正常脑组织 ;开颅手术治疗后 ,癫痫发作完全消失者 9例 (4 2 .9% ) ,癫痫发作次数减少 5 0 %以上者 9例 (4 2 .9% ) ,发作次数无明显变化 3例 (14 .3 % ) ;另 1例进行立体定向杏仁海马损毁术的患者癫痫发作次数无明显变化。结论　18F -FDGPET显像对致痫灶的定位诊断灵敏、准确 ,对指导癫痫外科手术有重要的临床价值     

正电子发射断层扫描辅助定位脑损伤后顽固性癫痫低剂量放射外科治疗

目的 利用正电子发射断层扫描(PET)辅助定位，采用低剂量射线对脑损伤后晚期顽固性癫痫患者进行立体定向放射外科治疗。方法 32例患者依据^18F-2-氟-2-脱氧葡萄糖(FDG)PET显像等检查综合定位致痫灶，然后采用9～13Gy周边剂量对致痫灶行立体定向X刀放射外科治疗。随访至少1年以上，观察发作频率变化情况，评价治疗效果。结果PET表现在原发损伤脑软化病灶周围的皮层组织多呈低代谢改变，多为围绕损伤部位的多个区域，呈现多致痫灶改变。部分患者低代谢灶不仅位于原发损伤部位，还位于对冲伤的部位。大部分患者在治疗后癫痫发作频率及发作程度逐渐减轻，与治疗前相比差异具有显著性意义。经Wieser疗效评定，Ⅰ～Ⅱ级百分比为44％(14／32)，Ⅲ～Ⅳ级为4l％(13／32)，Ⅴ～Ⅵ级为16％(5／32)。所有患者均未见有新的并发症发生。结论PET辅助定位下，低剂量放射外科治疗顽固性创伤性癫痫是一种有效的微侵袭外科治疗新方法。     

^18F—FDG PET脑显像在癫痫图型，病灶定位及预后预测中的价值

目的 分析各种癫痫患者的^18F－脱氧葡萄糖（FDG）PET图像与致痫灶的关系,以期术前较准确地定位,选择手术适应证和预测疗效。方法 73例癫痫患者（男51例,女22例,平均年龄23．3岁）行FDG PET脑显像,并与同期脑电图和MRI结果进行比较,40例进行了手术疗效随访,其中8例术后复查了FDG PET,并比较FDG PET,视频脑电图（VEEG）,MRI对致痫灶术前定位的准确性及脑代谢改变的不同图型与手术疗效的关系,结果（1）72 例癫痫患者发作间期皮层局灶为低代谢表现,仅1例部分癫痫持续状态者表现出发作期的高代谢。（2）FDG PET病变定侧率高于VEEG,低代谢灶检出率高于MRI,（3）40例手术患者中,属于Engels疗效分级I,II级的30例手术切除部位应为确定的致痫灶,FDG PET＜VEEG与MRI定侧定位准确性分别为93．3％,73．3％,53．3％,经X2检验,差异有显著性（P＜0．05）,（4）单侧颞叶低代谢手术效果好;对部分双侧颞叶低代谢者,切除其代谢减低更严重的一侧,发作也会改善,颞叶外癫痫手术效果不如颞叶癫痫好,病灶局限者,手术效果优于伴有其他部位皮层代谢改变者：单侧多脑叶代谢改变者,半大脑切除术效果好;双侧大脑多脑叶弥漫性病变者,手术效果差。结论 FDG PET对癫痫灶定位的灵敏度和准确性优于VEEG和形态学影像技术。FDG PET的代谢图形可帮助临床医生确定病灶部位,选择手术适应证和预测疗效。     

癫痫的X刀治疗

目的 探讨X刀治疗继发性癫痫(SEp)和原发性颞叶癫痫(ITLEp)的方法。方法 使用24hEEG、CT、MRI对继发性癫痫灶定位，应用X刀损毁致痫灶治疗SEp40例；毁损剂量20～30Gy。应用X刀毁损杏仁核治疗ITLEp病人30例；毁损剂量140Gy；准直仪7～10mm；采用140Gy一次和分两次毁损治疗(每次间隔24h)。结果 40例SEp病人和30例ITLEp病人X刀治疗后4～24个月随访：50例病人癫痫发作完全停止(SEp32例，ITLEp18例)；20例病人发作减少50％以上；无并发症发生。结论 应用X刀毁损SEp致痫灶及杏仁核，可安全有效地治疗SEp和ITLEp。     

~(18)F-FDG PET-CT脑显像与EEG对颞叶癫痫灶术前定位价值的对比研究

目的对比18F-FDG PET-CT脑显像与EEG对颞叶癫痫灶术前定位的价值。方法回顾性分析经我院神经外科癫痫中心临床诊断为颞叶癫痫的患者152例,所有患者术前行18F-FDG PET-CT脑显像、长程/视频EEG检查,其中29例定位仍不确切者行颅内电极EEG检查,手术切除组织术后送病理检查,比较结果。结果 (1)本组152例患者PET-CT脑显像定位致痫灶的准确率为80.92%(123/152),长程或视频EEG定位致痫灶准确率为43.42%(66/152),两种检查方法定位致痫灶准确率差异有统计学意义(χ2=45.44,P<0.01);(2)本组29例患者颅内电极EEG定位致痫灶准确率为100%。结论发作间期18F-FDG PET-CT脑显像定位致痫灶灵敏、有效,其价值优于长程/视频EEG;18F-FDG PET-CT脑显像对颅内电极埋置有指导价值,两者联合使用,可以进一步提高致痫灶定位准确率。     

难治性颞叶癫痫83例的手术治疗分析

目的:探讨难治性颞叶癫痫(ITLE)的外科治疗方法和效果。方法:83例ITLE患者,术前均行EEG、MRI检查,其中23例行PET,19例行SPECT检查。经测定位后,行手术治疗。其中30例行标准前颞叶切除,37例行标准前颞叶切除 胼胝体切开,16例行病灶切除 致痫灶切除。术中应用皮层电极或深部电极进行检测,并在显微镜下操作。结果:满意47例(56.6%),显著改善23例(26.5%),良好13例(15.6%)。术后无明显并发症,效果良好。结论:手术是ITLE的主要治疗手段,海马硬化和微血管畸形可能是ITLE发生的主要原因。     

SPECT、EEG、MRI综合评价难治性癫痫灶定位的价值

目的:探讨SPECT、EEG和MRI综合评价难治性癲痫灶定位的临床价值.材料和方法:对41例拟手术的癫痫患者行发作期和发作间期脑血流灌注显像,其结果与EEG、MRI、病理结果及临床表现进行比较,并综合各项检查结果确定致痫灶.结果:41例患者均行手术,有29例患者SPECT、EEG和MRI病灶定位一致,术后发作次数明显减少或痊愈;12例患者三种检查病灶定位不完全一致,11例术后发作次数减少,1例无效.结论:三种检查手段综合评价对定位致痫灶有较高的临床应用价值.对手术前制定手术方案有较高的指导作用.     

顽固性癫痫发作间期PET/CT的显像研究

目的探讨顽固性癫痫患者在发作间期PET／CT显像对癫痫灶定位的诊断价值,以指导手术治疗。资料与方法对28例顽固性癫痫患者,行发作间期的^18F—FDG PET／CT显像。对其中的21例癫痫灶较局限的患者行癫痫灶或颞前叶切除,术中行皮层脑电图（ECoG）或深部脑电图（DEEG）描记,以检测其特异性,术后进行随访。结果28例顽固性癫痫患者中,经PET／CT显像有25例显示出低代谢灶,敏感性为89．3％（25／28）。21例手术患者经随访1年以上,癫痫发作消失者18例。结论PET／CT脑显像对癫痫患者的术前定位具有重要价值。     

18F-FDG PET/CT结合MRI在癫（癎）外科治疗中的应用

目的 探讨18F-脱氧葡萄糖（FDG）PET/CT结合MRI定位致（癎）灶,指导癫（癎）外科治疗的意义.方法 67例癫（癎）外科治疗患者术前均行18F-FDG PET/CT和MRI检查,根据术前评估以及术中皮质脑电图监测结果进行致（癎）灶切除术.术后长期随访,根据Engel分级将患者分为癫（癎）发作完全控制组（Engel Ⅰ）和癫（癎）发作未完全控制组（Engel Ⅱ～Ⅳ）,采用x2检验或Fisher精确检验对数据进行分析.结果 67例中48例患者术后癫（癎）发作完全控制（Engel Ⅰ,71.6%）,11例Engel Ⅱ,5例Engel Ⅲ,3例Engel Ⅳ.18F-FDG PET/CT定位定侧结果与MRI检查结果一致或基本一致者63例,其中71.4%（45/63）术后癫（癎）发作完全控制;18F-FDG PET/CT与MRI检查结果不一致者4例,其中3例术后癫（癎）发作完全控制,2组差异无统计学意义（Fisher精确检验,P＞0.05）.63例中MRI与18F-FDG PET/CT均发现局限性异常者为41例,其中80.5%（33/41）术后癫（癎）发作完全控制;MRI发现局限性病变,但18F-FDG PET/CT呈更广泛性代谢异常者20例,其中55.0%（11/20）术后癫（癎）发作完全控制,2组差异有统计学意义（x2=4.34,P＜0.05）.结论 18F-FDG PET/CT结合MRI可为致（癎）灶定位及预后评估提供重要信息.     

Limited value of interictal brain perfusion SPECT for detection of epileptic foci: High resolution SPECT studies in comparison with FDG-PET

Accurate localization of epileptic foci is important for pre-surgical evaluation of patients with medically intractable epilepsy, and F-18 FDG PET has been proved to be a valuable method for this purpose. To examine the clinical value with interictal brain perfusion SPECT, we performed brain perfusion SPECT of Tc-99m HMPAO by means of a high resolution SPECT camera, and compared the results with F-18 FDG PET images and MRI in 10 patients with medically intractable epilepsy. In 9 of 10 patients (90%), FDG PET images showed focal hypo-metabolism in the area corresponding with the results of electroencephalography (EEG). SPECT images, however, demonstrated hypo-perfused lesions which corresponded with hypo-metabolic lesions on FDG PET images in only 6 cases (60%). Although MRI showed abnormal findings in 8 cases, the lesions were not directly related to epileptic foci in 2 cases. In conclusion, FDG PET is a valuable tool for accurate localization of epileptic foci. Brain perfusion SPECT, however, may not always be paralleled to metabolism visualized on FDG PET images.     

Presurgical identification of epileptic foci with iodine-123 iomazenil SPET: Comparison with brain perfusion SPET and FDG PET

Iodine-123 iomazenil (IMZ) has excellent characteristics for the quantification of central benzodiazepine receptor (BZR) binding with single-photon emission tomography (SPET). In order to evaluate the clinical value of IMZ SPET for presurgical identification of epileptic foci in patients with medically intractable seizures, we measured the binding potential (BP) of BZR using two IMZ SPET scans and compared the results with brain perfusion SPET and fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography (PET). A total of ten patients with intractable partial epilepsy were examined by electroencephalography, magnetic resonance imaging, FDG PET, brain perfusion SPET and IMZ SPET. After neuroimaging examinations, five patients underwent selective surgery, and all of them have since been free of seizures. Two SPET scans were performed at 15 min (early) and 3 h (late) after intravenous injection of¹²³I-IMZ (167 MBq). Parametric images of the ligand transport (K ₁) and binding potential (BP) were calculated by the table look-up method, which is based on a three-compartment two-parameter model, using the standard arterial input function obtained by averaging of six normal volunteers' input functions. BP images delineated the epileptic foci more precisely than either FDG PET or ictal perfusion SPET. FDG PET showed widespread reduction, including the area surrounding the focus, and ictal increase in the cerebral blood flow was seen in possibly activated areas spread from the focus. In four epilepsy cases which originated from the mesial temporal lobe without lateral temporal abnormality, there was no significant decrease in the BP images in the lateral temporal structures, which showed decreased uptake of FDG. It is concluded that parametric images of BP with IMZ are valuable for precise presurgical localization of epileptic foci.     

Presurgical identification of epileptic foci with iodine-123 iomazenil SPET: comparison with brain perfusion SPET and FDG PET

. Iodine-123 iomazenil (IMZ) has excellent characteristics for the quantification of central benzodiazepine receptor (BZR) binding with single-photon emission tomography (SPET). In order to evaluate the clinical value of IMZ SPET for presurgical identification of epileptic foci in patients with medically intractable seizures, we measured the binding potential (BP) of BZR using two IMZ SPET scans and compared the results with brain perfusion SPET and fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography (PET). A total of ten patients with intractable partial epilepsy were examined by electroencephalography, magnetic resonance imaging, FDG PET, brain perfusion SPET and IMZ SPET. After neuroimaging examinations, five patients underwent selective surgery, and all of them have since been free of seizures. Two SPET scans were performed at 15rmin (early) and 3rh (late) after intravenous injection of ¹²³I-IMZ (167rMBq). Parametric images of the ligand transport (K1) and binding potential (BP) were calculated by the table look-up method, which is based on a three-compartment two-parameter model, using the standard arterial input function obtained by averaging of six normal volunteers’ input functions. BP images delineated the epileptic foci more precisely than either FDG PET or ictal perfusion SPET. FDG PET showed widespread reduction, including the area surrounding the focus, and ictal increase in the cerebral blood flow was seen in possibly activated areas spread from the focus. In four epilepsy cases which originated from the mesial temporal lobe without lateral temporal abnormality, there was no significant decrease in the BP images in the lateral temporal structures, which showed decreased uptake of FDG. It is concluded that parametric images of BP with IMZ are valuable for precise presurgical localization of epileptic foci.     

18F-FDG PET/CT脑显像与EEG用于颞叶癫(癎)灶术前定位

目的 对比研究18F-FDG PET/CT脑显像与EEG对颞叶癫(癎)灶术前定位的价值.方法 回顾性分析临床诊断为颞叶癫(癎)的患者152例,其中男108例,女44例,年龄范围3～59岁.所有患者行18F-FDG PET/CT脑显像和长程和(或)视频EEG检查,其中29例无法准确定位者行颅内电极EEG检查.所有患者行手术治疗,手术切除组织行病理检查,以术后病理为“金标准”,术后随访6个月以上.用x2检验对PET/CT脑显像及长程和(或)视频EEG的准确性进行统计学分析.结果 152例患者PET/CT脑显像定位致(癎)灶的准确性为80.92％ (123/152),长程和(或)视频EEG定位致(癎)灶准确性为43.42％ (66/152),2种检查方法定位致(癎)灶的准确性差异有统计学意义(x2=22.72,P＜0.01),29例术前无法准确定位的患者行颅内电极EEG定位致(癎)灶,其准确性为100％.结论 发作间期18F-FDG PET/CT脑显像定位癫(癎)灶价值优于长程和(或)视频EEG,与颅内电极EEG联合使用,可进一步提高对致(癎)灶定位的准确性.     

Extratemporal hypometabolism on FDG PET in temporal lobe epilepsy as a predictor of seizure outcome after temporal lobectomy

We investigated the relationship between the presence of extratemporal hypometabolism on fluorine-18 fluorodeoxyglucose positron emission tomography (FDG PET) and seizure outcome after temporal lobectomy in patients with medically intractable temporal lobe epilepsy (TLE). In 47 patients with intractable unilateral mesial TLE, regional metabolic changes on FDG PET images obtained during the 2 months preceding anterior temporal lobectomy were compared with postoperative seizure outcome. Postoperative seizure outcome was evaluated with a mean follow-up period of 6.1+/-0.6 years (range 5.2-7.2 years). Forty-two (89%) of the 47 patients achieved a good postoperative seizure outcome (Engel class I or II). All patients had hypometabolism in the temporal cortex ipsilateral to the epileptogenic region on FDG PET scans. Fourteen (78%) of the 18 patients with hypometabolism only in the ipsilateral temporal cortex were completely seizure free (Engel class Ia) after surgery. In contrast, five (45%) of the 11 patients with extratemporal cortical hypometabolism confined to the ipsilateral cerebral hemisphere and only four (22%) of the 18 patients with hypometabolism in the contralateral cerebral cortex were completely seizure free after surgery. The postoperative seizure-free rates were significantly different across the three groups of patients with different cortical metabolic patterns ( P<0.005). Furthermore, all of the nine patients with a non-class I outcome (Engel class II-IV) had extratemporal (including contralateral temporal) cortical hypometabolism. Thalamic hypometabolism was noted in 20 (43%) of the 47 patients (ipsilateral in 12, bilateral in 8). Sixteen (59%) of the 27 patients with normal thalamic metabolism were completely seizure free after surgery, while only seven (35%) of the 20 patients with thalamic hypometabolism became completely seizure free ( P<0.05). Multivariate analysis revealed that among variables including clinical, EEG, magnetic resonance imaging, pathological and FDG PET metabolic findings, only cortical metabolic pattern was an independent factor for the prediction of postoperative seizure outcome ( P<0.005). It is concluded that extratemporal cortical hypometabolism outside the seizure focus, in particular hypometabolism in the contralateral cerebral cortex, may be associated with a poorer postoperative seizure outcome in TLE and may represent underlying pathology that is potentially epileptogenic. Thalamic hypometabolism, which was associated, but not independently, with a higher likelihood of postoperative seizures, may be secondary to extratemporal or temporal pathology.     

Diagnostic impact of PET with <Superscript>18</Superscript>F-FDG, <Superscript>18</Superscript>F-DOPA and 3-<Emphasis Type="Italic">O</Emphasis>-methyl-6-[<Superscript>18</Superscript>F]fluoro-DOPA in recurrent or metastatic medullary thyroid carcinoma

Purpose In patients with medullary thyroid carcinoma (MTC), rising levels of the tumour markers calcitonin and CEA after primary surgery indicate tumour recurrence or metastases. The only chance of cure is the resection of localised tumour tissue. For positron emission tomography (PET) with ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) and ¹⁸F-dihydroxyphenylalanine (¹⁸F-DOPA), sensitivities of 78% and 63% have been reported, but in a considerable percentage of MTC patients the source of tumour marker elevation is not detected. The aim of this retrospective data evaluation was to compare the value of PET with ¹⁸F-FDG, ¹⁸F-DOPA and the amino acid tracer 3-O-methyl-6-[¹⁸F]fluoro-DOPA (¹⁸F-OMFD) in the detection of MTC recurrence. Methods Fifteen patients with elevated calcitonin were investigated with PET as part of their individual clinical work-up. All patients underwent ¹⁸F-FDG PET and ¹⁸F-DOPA PET, and ten patients underwent ¹⁸F-OMFD PET. Results With ¹⁸F-FDG, seven patients showed foci in the neck, mediastinum, upper abdomen or bone. In seven patients, ¹⁸F-DOPA revealed suspicious foci; five of these seven patients showed partially corresponding uptake of ¹⁸F-FDG in the neck and mediastinum. Two of these patients underwent surgery and metastases were verified. With ¹⁸F-OMFD, a small focus in the liver was suspected in one patient without a correlate on ¹⁸F-FDG PET, ¹⁸F-DOPA PET or conventional imaging. Conclusion ¹⁸F-FDG and ¹⁸F-DOPA showed foci that were highly suspicious for local recurrence or metastasis of MTC, although histological verification in these patients with numerous previous surgical interventions was performed in only two patients. The amino acid tracer ¹⁸F-OMFD had no diagnostic impact in these patients.     

磁源性影像在灰质异位症伴癫痫患者癫痫灶定位中的应用

目的 探讨磁源性影像(MSI)对灰质异位症(GMH)伴发癫痫患者的癫痫灶定位价值.方法 8例GMH伴发癫痫的患者进行MSI检查,数据采集后进行后处理,观察癫痫灶的位置,并与皮质脑电图(ECoG)比较.影像检查后,所有患者均进行手术治疗,手术后随访13～48个月,观察手术效果.结果 8例患者病理均为灰质异位,其中1例病理结果伴有海马硬化,2例伴有局灶性脑皮质发育不良(FCD)Ⅰ b型,1例伴有FCDⅡb型.8例患者中,MRI显示:结节型灰质异位2例,其中1例伴有脑裂畸形;皮质下型4例;MRI显示正常2例.MSI确定癫痫灶位于右颞叶2例,左额叶2例,双顶叶、左顶叶、左颞叶、左额顶叶各1例.MSI所确定的癫痫灶中,4例患者癫痫灶与异位灰质完全重叠,1例癫痫灶紧邻异位灰质后方,1例癫痫灶与异位灰质部分重叠并且癫痫灶范围明显大于异位灰质,1例患者有2个癫痫灶,分别位于异位灰质及异位灰质前方2 cm,1例患者癫痫灶位于异位灰质后外侧2 cm.8例患者MSI癫痫灶定位与术中ECoG定位完全一致.按Engel癫痫疗效分级,术后6例为Engel Ⅰ级,均为发作停止;2例为EngelⅣ级,手术前后癫痫发作频率无明显变化.结论 MSI可提示灰质异位伴发癫痫患者的癫痫灶定位,是术前无创伤定位的有效手段.

Abstract：

Objective To evaluate the value of magnetic source imaging(MSI) in localizing the epileptic foci of patients with histologically proved grey matter heterotopia(GMH) and seizure. Methods MSI examinations were performed on 8 patients with GMH and seizure. The location of the epileptic foci defined by MSI was compared with the results of the ECoG. After imaging examinations, all patients received operation with 13-48 months follow up to observe the effectiveness of the operation. Results Among the 8 patients, 1 had hippocampal sclerosis,2 had focal cortical dysplasiaof type Ⅰ B and 1 had focal cortical dysplasia of type Ⅱ B. MRI showed normal findings in 2 cases, subcortical heterotopia in 4 cases, and nodulor heterotopia in 2 cases with one having schizencephaly. The epileptic foci defined by MSI were at right temporal lobe in 2 cases, left frontal lobe in 2 cases, biparietal lobe in1 case, left parietal lobe in 1 case, left temporal lobe in 1 case, and left frontal-parietal lobe in 1 case. The epileptic foci defined by MSI were completely overlaid with area of GMH in 4 cases, closely behind the area of GMH in case, and partly overlaid with area of GMH in 1 cases with size larger than that of the latter. One patient showed two epileptic foci with one located within the area of GMH and the other one 2 centimeters anterior to the area of GMH.One case's epileptic focus located 2 centimeters posteolateral to the area of GMH . The locations of the epileptic foci defined by MSI showed no difference with those defined by ECoG in all patients. According to Engel classification of treatment effect of epilepsy, 6 patients achieved Engle class Ⅰ ( seizure free after operation ), and 2 patients Engel class Ⅳ ( no changes in the frequcenty of occurrence of seizures before and after operation ). Conclusion MSI can noninvasively and precisely localize the epileptic foci before operation in patients with GMH and seizure.