脑电监测在癫痫患者间期皮层和皮层下高代谢灶的判读中的应用

目的　探讨癫痫患者无临床发作情况下18F氟脱氧葡萄糖(18Ffluorodeoxyglucose,18FFDG)正电子发射计算机断层 (positron emission tomography, PET)脑显像呈现高代谢时脑电监测的应用价值。 方法　对北京协和医院2008年1月至2014年3月共3例无临床发作的间期情况下18FFDG PET脑显像呈现皮层或皮层下高代谢的癫痫患者, 静脉注射安定抑制皮层放电,在脑电监测确认无皮层异常放电时复查18FFDG PET脑显像,并对比两次显像结果。结果　病例1为颞叶癫痫患者,在无临床发作时18FFDG PET显像除发现右颞低代谢外,右额部分皮层及同侧基底节、丘脑及左侧小脑局灶代谢增高。脑电监测下抑制皮层放电后的18FFDG PET显像示原额叶皮层及同侧基底节、丘脑、对侧小脑高代谢灶消失。表明该患者上述高代谢灶为颞叶外皮层潜在致痫灶亚临床放电所致,同时证实了致痫灶与同侧基底节丘脑、对侧小脑之间的神经传导。此例改变了先前单纯前颞叶切除术的临床决策。病例2的间期18FFDG PET显像发现右侧大片额叶皮层高代谢,脑电监测下抑制临床下放电后,原皮层高代谢仍存在,原同侧基底节、对侧小脑的高代谢已不明显,证实皮层存在高代谢的基础病变(炎症),而基底节丘脑为继发功能改变,确定了病变性质及范围。病例3为颞叶癫痫患者,临床及脑电无法确定癫痫起源部位,磁共振成像未见明显异常。18FFDG PET显像在无临床发作的情况下左侧海马区呈高代谢,脑电监测下在明确的间期状态复查18FFDG PET脑显像,左侧海马区仍为高代谢。提示该部位存在基础病变(肿瘤),帮助临床确定手术部位。 结论　癫痫患者无临床发作情况下18FFDG PET显像呈现高代谢图像时,在脑电监测下确认绝对的间期状态时复查18FFDG PET显像,有助于分析高代谢的病因及明确病变范围,帮助作出临床决策。     

PET脑显像在癫痫患者致痫灶定位中的价值

目的探讨18F-脱氧葡萄糖(18F-FDG)正电子发射计算机断层(PET)脑显像在各类癫痫患者致痫灶定位中的价值.方法对65例癫痫患者于发作间期行 18F-FDG PET脑显像,将其定位结果与头皮脑电图(EEG)、CT或MRI结果进行比较,并对其中14例定位后接受手术或放射治疗患者的预后情况进行分析.结果 65例患者中,56例(86%)患者发作间期PET图像上可见皮层局限性低代谢灶,4例(6%)可见皮层局限性高代谢灶,其余5例(8%)未见异常代谢灶.在PET图像呈典型低代谢表现的56例患者中,PET定位结果与EEG定侧(判定左右半球)或定位(判定具体脑叶)结果相符者40例(71%),EEG呈弥漫性异常者(无法定位)10例(18%),EEG检查未见异常者1例(2%),另5例(9%)PET定位结果与EEG定位结果不符.该56例患者中,44例(79%)CT或MRI检查阴性,12例(21%)CT或MRI检查阳性,后者中有11例PET定位结果与CT或MRI定位结果相符.明确致痫灶后接受手术或放射治疗的14例患者,平均随访2年,9例(64%)术后未再有癫痫发作或有不同程度的缓解.结论对于头皮EEG无法准确定位和CT、MRI检查阴性的癫痫患者,18F-FDG PET脑显像可替代部分侵入性EEG检查用于致痫灶定位,而不同的PET定位图形对患者手术方案的选择也有重要指导意义.     

PET与伽玛PET在癫痫灶定位中的应用

就正电子发射断层成像 (PET)与伽玛PET在癫痫灶定位中的应用作一介绍     

PET在难治性癫痫中的应用价值与限度

癫痫是多种病因导致的慢性脑疾患，引起大脑神经元过度地反复超同步化放电，出现非诱发性脑功能障碍的临床表现。癫痫在我国发病率高，年发病率约为35／10万，患者近900万，其中约25％为药物难治性癫痫。在成人中，难治性癫痫以颞叶癫痫最常见，通常需外科手术治疗。而术前的准确定侧定位和功能区的评价决定着手术的效果与预后，传统的EEG MRS，MEG和fMRI、SPECT血流灌注对癫痫的定侧定位有很大的参考价值，但灵敏度和特异度不是很高，颅内电极刺激是癫痫灶定位的金标准，但因其有创性、空间分辨率、经济等因素的影响，使其不能成为癫痫灶定位的首选。近20年来，PET技术的发展，使其为临床服务成为可能，同时也在癫痫定位诊断方面提供了很大的参考价值，本文就PET工作原理及其在难治性癫痫中的应用价值与局限加以综述。     

发作间期PET显像与发作期SPECT脑显像在小儿顽固性癫痫定位诊断中的价值

目的:探讨发作间期FDG PET与发作期SPECT脑显像在小儿顽固性癫痫定位诊断中的价值。方法:对30例小儿顽固性癫痫患者行发作间期FDG PET与发作期SPECT显像,并对结果进行对比分析。结果:16例发作间期PET表现为局限性单叶代谢减低,14例表现为多灶或弥漫性改变。发作期SPECT显像18例为单叶局限性高灌注,10例为多处高灌注灶。30例患者中26例(86.7%)两项检查结果相符合,12例PET发作间期呈多病灶或弥漫性改变者,6例于发作期转化为单叶局限性病灶。结论:发作期SPECT结合发作间期PET显像,两者联合应用优势互补,可提高癫痫定位的准确性,为进一步治疗提供更可靠的信息。     

癫痫患者行脑电监测的护理

目的为癫痫患者提供在脑电监测前、中、后的持续护理,保证脑电监测质量,为确定后续治疗方案提供依据。方法对360例有癫痫或疑似癫痫发作病史的患者行视频脑电监测,脑电监测前对患者及陪伴人员进行健康宣教,准备适当的环境,做好脑电监测过程中各种诱发试验和癫痫发作时各种抢救工作及护理安全措施,检测结束后进行皮肤护理。结果215例患者经监测后确定癫痫给予合理调整癫痫药物,避免超用药物,减少药物不良反应。50例患者确定可行手术,得到了根治的机会。69例患者确诊不是癫痫,避免误诊。26例患者因监测期间无发作,家属放弃监测。监测期间无患者外伤、舌咬伤等意外事件发生。监测质量医生满意,图像及脑电图反映清晰。结论视频脑电图监测结果的质量直接影响患者的疾病诊断、治疗方案、癫痫部位定位及药物合理的使用,因此癫痫患者行脑电监测期间的护理配合尤为重要,良好的护理配合在提高脑电图监测结果的准确性和可靠性方面起到非常积极的作用。     

成人颞叶癫痫患者发作间期18F-FDG PET/CT脑代谢显像与术后疗效的关系

目的:探讨成人颞叶癫痫患者发作间期18F-FDG PET/CT脑代谢显像与术后疗效的关系。方法:回顾性分析2013年8月-2018年3月于北部战区总医院接受发作间期18F-FDG PET/CT脑代谢显像,且颞叶均为阳性表现,并于我院神经外科接受手术治疗的颞叶癫痫患者62例,其中女22例,男40例,年龄范围18~58岁,平均(31.48±10.48)岁,按照病灶的数目(单发/多发)、侧别(单侧大脑半球/双侧大脑半球)将PET/CT图像分为单侧单发低代谢病灶组(病灶仅存在于单侧大脑半球颞叶中)、单侧多发低代谢病灶组(病灶存在于颞叶及其他同侧非颞叶中)、双侧多发低代谢病灶组(病灶分布于双侧颞叶或一侧颞叶与对侧非颞叶中),术后随访12~55(30.50±13.42)月,中位随访时间28.5月,根据Engel分级分为疗效满意组(EngelⅠ)45例和疗效不满意组(EngelⅡ+EngelⅢ+EngelⅣ)17例,对两组患者PET/CT图像中病灶的数目、侧别进行单因素分析,并对有统计学意义的因素进行Logistic回归分析,总结出18F-FDG PET/CT图像的代谢改变图型与成人颞叶癫痫患者术后预后的关系。结果:18F-FDG PET/CT脑代谢显像显示病灶的数目、侧别单因素分析结果均具有统计学意义,P值分别为0.001、0.02,进而进行Logistic回归分析,结果显示病变的数目与预后具有很强的相关性(OR=7.219,95%CI:0.339~8.676,P=0.008),而病变的侧别与预后不具有相关性(OR=1.714,95%CI:1.691~30.809,P=0.515)。结论:18F-FDG PET/CT脑代谢显像可用于预测成人颞叶癫痫患者的术后疗效,单发低代谢病灶的患者手术疗效较好,低代谢病灶的数目是手术预后疗效的独立预测因素。     

癫痫手术术中皮层脑电监测的护理

目的 总结术中皮层脑电监测的护理经验.方法 术中使用皮层电极对病灶及相应部位皮层脑电监测,确定癫痫灶的位置及范围,显微镜下行癫痫灶切除,切除后再次进行皮层脑电图监测.结果 本组34例在监测中均有痫样放电,患者术后8～12 d恢复顺利,无并发症.结论 术中皮层脑电监测对癫痫的手术治疗十分重要,对于术前定位的病例,可进一步...     

单光子发射计算机断层显像在癫痫患者脑功能定位中的应用分析

目的探讨单光子发射计算机断层(SPECT)脑局部血流(rCBF)显像对癫痫诊断的临床应用价值。方法对63例癫痫患者进行SPECT脑局部血流灌注显像，与CT、脑电图比较。结果SPECT检查阳性者50例，脑电图检查阳性者48例，CT检查阳性者13例，其中SPECT和脑电图的阳性检出相符率为63％。结论SPECT局部脑血流显像是诊断癫痫病灶的有效方法，对制定癫痫的治疗方案有一定帮助。     

2-Deoxy-2-[18F]fluoro-d-glucose-Positron Emission Tomography and Positron Emission Tomography/Computed Tomography Diagnosis of Patients with Recurrent Papillary Thyroid Cancer

Objective 2-Deoxy-2-[F-18]fluoro-d-glucose positron emission tomography (FDG-PET) has an established role in restaging of various cancers, including papillary and undifferentiated thyroid carcinoma, but detection rates are variable in the published literature. We were therefore prompted to review our experience with FDG-PET in detection of recurrent papillary thyroid cancer (PTC).Methods This is a retrospective study (April 1, 1995–March 31, 2005) of 21 patients with histologic diagnosis of PTC who had PET examinations. The group included seven men and 14 women, with age range of 26–75 years (average 50 ± 16). The PET scan request was triggered by rising levels of thyroglobulin (Tg) in the presence of a negative iodine-131 scan.Results Recurrent/metastatic disease was identified by PET in 16 (76%) of the 21 patients with PTC. The sensitivity and specificity of FDG-PET for disease detection in this cohort were 88.2% [95% confidence interval (CI), 65.7–96.7] and 75% (95% CI, 30.1–95.4), respectively. The Tg levels were 1.0–10.4 ng/ml (average, 4.52 ng/ml) in the patients with negative PET scans and 1.0–38 ng/ml (average, 16.8 ng/ml) in patients with positive scans. The lesions were located in the cervical lymph nodes (8), thyroid bed (4), lungs (4), and mediastinal lymph nodes (2).Conclusion Our study confirms the feasibility of PET in detection of residual/recurrence of PTC, with sensitivity of 88.2% (95% CI, 65.7–96.7) and specificity of 75% (95% CI, 30.1–95.4). Detectable levels of Tg, even in the presence of negative I-131 scan or anatomic imaging, should prompt restaging with FDG-PET.     

结直肠癌18F-FDG的摄取与Glut-1表达的相关性

目的 探讨结直肠癌18F-FDG摄取与肿瘤组织葡萄糖转运蛋白-1(Glut-1)表达的相关性.方法 对20例结直肠癌患者术前进行18F-FDG PET/CT检查,测定肿瘤平均标准摄取值(SUVmean);对手术切除标本进行病理检查,并应用免疫组织化学法检测肿瘤组织Glut-1的表达.分析SUVmean值与组织病理关系及与Glut-1表达的相关性.结果 20例结直肠癌均为高摄取,SUVmean值为5.42±1.67.大体分型中,浸润型结直肠癌的SUVmean值(6.55±1.63)高于肿块型(4.20±1.29)和溃疡型(5.83±1.60),但差异无统计学意义(P＞0.05).M分期中,远处转移者的SUVmean值(7.14±1.07)高于无转移者(4.84士1.41,P=0.04).SUVmean值与Glut-1的表达呈正相关(r=0.53,P=0.02).结论 结直肠癌18F-FDG摄取(SUVmean值)与Glut-1表达呈现正相关.     

2-Deoxy-2-[F-18]Fluoro-d-Glucose–Positron Emission Tomography/Computed Tomography Imaging Evaluation of Esophageal Cancer

We evaluated the clinical utility of 2-deoxy-2-[F-18]fluoro-d-glucose (FDG)–positron emission tomography (PET)/computed tomography (CT) on the precise localization of pathologic foci and exclusion of normal variants in the imaging evaluation of patients with esophageal carcinoma. Combined PET/CT scans were performed in 60 patients (50 males, 10 females, age range 47–84 years) with history of esophageal carcinoma either at the time of initial diagnosis (group I, n = 14) or for surveillance and/or detection of recurrent and metastatic disease (group II, n = 46). Prior treatments included esophagectomy with gastric pull-up (n = 23), surgery and chemotherapy (n = 3), surgery and chemoradiation therapy (n = 10), chemotherapy alone (n = 5), radiation therapy alone (n = 2), and chemoradiation without surgery (n = 3). Diagnostic validation was by tissue sampling in three patients and clinical/radiological follow-up for up to 1.5 years in the remaining patients. In group I, discordant abnormalities were noted in seven patients. PET demonstrated hypermetabolism in normal-size lymph nodes on CT in three patients that were considered likely true positive in view of concurrent existence of other adjacent enlarged hypermetabolic lymph nodes in the same nodal basin. Hypometabolic incidental CT abnormalities of up to 1-cm lung nodules were noted in three patients and pleural effusion in one patient, which were considered true negative in view of no change on follow-up PET/CT studies. In group II, both PET and CT showed concordant abnormalities in 23 patients. The precise image fusion of hypermetabolism in a liver lesion allowed a diagnostic CT-guided biopsy in one patient. PET demonstrated true positive hypermetabolic abnormalities in four patients that localized to structures, which were normal by noncontrast CT criteria, and true negative in one patient with hepatic fatty deposits. PET showed decline in metabolic activity of the primary lesion in one patient after chemotherapy, while the corresponding CT abnormality remained unchanged. PET/CT image fusion provided relevant complementary diagnostic information in 14 patients with discordant findings (23% of total) that resulted in biopsy in three cases, institution of chemotherapy in four cases, and a wait-and-watch strategy in seven cases. In conclusion, our findings add to the current body of literature that suggests that FDG-PET/CT scanning may improve the imaging evaluation of patients with esophageal cancer by providing complementary structural-metabolic information. In particular, our findings support the notion that PET/CT may be the most appropriate imaging modality in the evaluation of patients of esophageal cancer that may impact patient management.     

Positron Emission Tomography Imaging of Small Animals in Anticancer Drug Development

Positron emission tomography (PET) imaging of small animals enables researchers to bridge the gap between in vitro science and in vivo human studies. The imaging paradigm can be established and refined in animals before implementation in humans and image data related to ex vivo assays of biological activity. Small animal PET (saPET) imaging enables assessment of baseline focal pathophysiology, pharmacokinetics, biological target modulation and the efficacy of novel drugs. The potential and challenge of this technology as applied to anticancer drug development is discussed here.     

18FDG PET在宫颈癌远处淋巴结转移中的临床应用价值

目的:探讨18氟-脱氧葡萄糖正电子发射断层扫描仪(18FDG PET)在宫颈癌远处淋巴结转移的临床应用价值.方法:1997年8月至2005年8月,对拥有完整CT和18FDG PET资料的23例宫颈癌远处淋巴结转移患者进行同顾性分析,并对两种检查方法的结果进行比较.结果:23例患者中,18FDG PET与CT比较,大体肿瘤体积大小无变化的占57%(13/23)、增加的占26%(6/23)、缩小的占17%(4/23).肿瘤数目无变化的占48%(11/23)、增加的占30%(7/23)、减少的占22%(5/23).18FDG PET随访复查与初次检查结果一致的达96%(22/23).结论:18FDG PET是宫颈癌远处淋巴结转移诊断及评价预后的重要工具.     

Utility of Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Patients with Fever of Unknown Origin Diagnosed as Lymphoma

Objective

To assess the efficacy of fluorine-18 fluorodeoxyglucose positron emission tomography (¹⁸F-FDG PET)/computed tomography (CT) in the diagnosis of patients with fever of unknown origin (FUO), who were finally diagnosed as lymphoma.

Subjects and Methods

A retrospective study was performed in the First Affiliated Hospital, School of Medicine of Zhejiang University, China, from March 2009 to March 2012. The PET/CT images of consecutive patients with FUO were analyzed. Within 1 week of PET/CT scanning, additional histological tests were also performed if clinically needed.

Results

A total of 73 consecutive patients were included. Of these, 34 (47s%) had a PET/CT finding suggestive of the presence of lymphoma and 29 (85s%) had a diagnosis of confirmed lymphoma; 39 (53s%) had a PET/CT result revealing the absence of lymphoma and 4 (10s%) were diagnosed by biopsy as having lymphoma. The most frequent lymphoma diagnosis was peripheral T cell lymphoma (n = 16; 55s%), followed by diffuse large B cell lymphoma (n = 9; 31s%). The accuracy of PET/CT was 88s%.

Conclusion

In this study, PET/CT had high diagnostic accuracy in patients with FUO resulting from lymphoma, which indicated that PET/CT scanning was a valuable diagnostic tool for these groups of patients with FUO.Key Words: Fever of unknown origin, Positron emission tomography, Computed tomography, Diagnosis, Lymphoma     

18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Following Chimeric Antigen Receptor T-cell Therapy in Large B-cell Lymphoma

Molecular Imaging and Biology - 18F-Fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) is a well-established imaging modality to assess responses in patients with...