发作间期18F-FDG PET在难治性癫痫手术定位中的价值

许多学者认为脑PET显像不仅能诊断癫痫,且能对癫痫灶准确定位,为癫痫的手术、立体定向和放射外科治疗提供了定位依据[1].本研究分析了12例难治性癫痫患者术前18F-FDG PET脑显像与术中皮层脑电图(ECoG)检查、术后病理结果的关系,以探讨术前18F-FDG PET脑显像对癫痫灶定位的价值.     

发作间期^14F—FDG PET在难治性癫痫手术定位中的价值

许多学者认为脑PET显像不仅能诊断癫痫,且能对癫痫灶准确定位,为癫痫的手术、立体定向和放射外科治疗提供了定位依据。本研究分析了12例难治性癫痫患者术前~(18)F-FDG PET脑显像与术中皮层脑电图(ECoG)检查、术后病理结果的关系,以探讨术前~(18)F-FDG PET脑显像对癫痫灶定位的价值。1 资料与方法1.1 临床资料 本组共12例,男8例,女4例,年龄4～48岁,平均21.5岁;病程1.5～20年,平均4.5年;发作类型按照国际癫痫分类标准:全身性发作6例,复杂部分性发作4例,单纯部分性发作1例,部分性发作继发全身性发作1例;均长期服用抗癫痫药物治疗,临床诊断为难治性癫痫,有明确的手术适应症;术前所有患者均行2～5次EEG或动态     

发作间期PET和 SPECT检查对颞叶癫痫定位的诊断价值

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     

18F－FDGPET／CT显像对颞叶癫痫灶定位的价值

目的探讨以18氟-2-脱氧葡萄糖为显影剂的正电子发射断层扫描／计算机断层成像（18F-FDGPET／CT）对颞叶癫痫（TLE）灶的定位价值。方法本研究回顾分析被确诊为TLE的24例患者的临床资料,将术前18F-FDGPET／CT、MRI、视频脑电图（VEEG）与术中颅内电极脑电图和术后病理学检查结果进行对比研究。结果24例TLE患者中,18F-FDGPET／CT准确定位致痫灶21例,MRI准确定位10例,VEEG准确定位10例。18F-FDGPET／CT对TLE致痫灶的敏感性为87．5％（21／24）,其中对内侧颢叶癫痫（MTLE）致痫灶为88．9％（16／18）,对外侧颞叶癫痫（LTLE）致痫灶为83．3％（5／6）。MRI对TLE致痫灶的敏感性为41．7％（10／24）,其中对MTLE致痫灶为55．5％（10／18）,对LTLE致痫灶为0。VEEG对TLE致痫灶的敏感性为41．7％（10／24）,其中对MTLE致痫灶为50．5％（9／18）,对LTLE致痫灶为16．7（1／6）。18F-FDGPET／CT对TLE（包括MTLE和LTME）致痫灶的敏感性均显著高于MRI和VEEG（P〈0．05）,而MRI和VEEG对TLE致痫灶的敏感性无显著差异（P〉0．05）。结论18F-FDGPET／CT对于TLE致痫灶定位具有独特的优势。     

阿尔茨海默病18F-FDG PET显像诊断的研究☆

目的探讨阿尔茨海默病(AD)脑葡萄糖代谢及其18F-脱氧葡萄糖正电子发射计算机断层扫描(18F-FDGPET)显像的影像学特征和PET诊断标准.方法静脉注射18F-FDG后行脑断层显像,检查13例AD、13例非AD痴呆及13例正常人.获得纹状体、丘脑、黑质、顶叶、颞叶、额叶、枕叶、海马单位面积放射性计数与小脑计数的比值(Rcl/cb),进行半定量分析,并与MR进行对照.结果AD患者PET异常率为100%,MR异常者占10/13.PET显像特征①对称性双侧颞顶叶及海马伴额叶或枕叶代谢减低占9例(9/13);②双侧颞叶对称性代谢减低伴海马或额叶代谢下降占3例(3/13);③双顶叶对称性代谢降低1例(1/13).12例(12/13)非AD痴呆表现为不对称、多发性代谢降低,降低区位于黑质、纹状体、丘脑及脑皮质区,MR异常率为11/13.结论在除外脑内结构特异性损害基础上,PET发现对称性双颞顶叶、海马或颞叶、顶叶,伴或不伴枕叶、额叶代谢下降,可诊断AD.PET对AD早期诊断及鉴别诊断具有临床意义.     

发作间期PET对难治性颞叶癫痫的诊断价值

目的分析18例颞叶癫痫患者的正电子发射断层扫描(PET)结果.方法 18例难治性癫痫患者,根据临床症状、脑电图/录像脑电监测(EEG/VEEG)、MRI海马相和单光子发射计算机体层摄影(SPECT)检查诊断为颞叶癫痫.均进行PET检查,结果有16例显示不同程度的颞叶前中部和(或)内侧部的低代谢区域.所有患者均在手术显微镜下采用显微外科技术进行手术,其中右侧颞叶癫痫16例行标准前颞叶及海马杏仁核切除术,左侧颞叶癫痫2例行选择性海马杏仁核切除术.结果随诊观察6～26个月,按照Engel的疗效判断标准,结果I级(癫痫发作消失)11例,II级(极少发作)4例,III级(发作减少75%以上)2例,IV(无改变)1例.结论对于临床上怀疑为颞叶癫痫而上述常规检查方法不能明确癫痫灶者,PET能更好地帮助诊断.     

发作间期PET和SPECT检查对颞叶癫痫定位诊断价值

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     

MRI与PET在颞叶癫痫中定位价值的比较

目的比较MRI及FDG-PET在颞叶癫致灶定位中的价值,探讨癫外科术前定位的方法以及手术预后的判断.方法以手术后癫控制状况为标准,对30例颞叶癫患者的术前MRI和FDG-PET的结果进行比较,分析MRI及PET各自在癫致灶定位中的价值.结果MRI有良好的脑结构分辨能力,对于症状性癫 的定位价值高,当MRI显示海马硬化时,对致灶定位的意义大,术后癫发作完全控制的可能性大.发作间期PET对于颞叶癫定位的敏感性高于MRI,但PET低代谢的范围往往超过致灶.与PET的目测方法比较,PET半定量分析并不能提高致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.     

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。     

发作间期PET和SPECT检查对颞叶癫痫定位诊断价值

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     

18F-FCWAY and 18F-FDG PET in MRI-negative temporal lobe epilepsy

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‐HT_1A‐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 ¹⁸F‐FCWAY‐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 ¹⁸F‐FCWAY‐PET and ¹⁸F‐FDG‐PET results with scalp video electroencephalography (EEG), invasive EEG, and surgical outcome. Results: Mean ¹⁸F‐FCWAY 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 ¹⁸F‐FDG‐PET.     

18F-FDG PET/CT在颞叶内侧癫痫外科定位诊断中的价值

目的探讨18F-脱氧葡萄糖(FDG)PET/CT检查在颞叶内侧癫痫(mesial temporal lobe epilepsy)术前评估和致痫灶定位中的应用价值。方法回顾性分析我科实施手术治疗的85例颞叶内侧癫痫患者的临床资料,经三大检查(症状学、MRI、V-EEG)和18F-FDG PET/CT检查证实致痫灶存在且位于颞叶内侧。经上述方法精准定位后,采用扩大额颞手术切口,皮层脑电描记引导下施行标准前颞叶切除术,部分加做海马杏仁核切除术或(和)皮层热灼术,对术前评估方法,18F-FDG PET/CT检查的意义和手术治疗预后进行分析。结果 85例患者术后随访6个月到5年,Engel效果分级:69例(81.2%)I级,9例(10.6%)Ⅱ级,7例(8.2%)Ⅲ级或Ⅳ级。4例出现硬膜外血肿,15例出现短期并发症,所有病人均无永久性并发症。患者术后服用抗癫痫药物较术前减少或停药。结论 18 F-FDGPET/CT检查是目前颞叶内侧癫痫致痫灶定位精确、直观而有效的手段之一,结合常规三大术前检查,是颞叶内侧癫痫致痫灶定位可靠的无创性检查方法。18F-FDG PET/CT检查对于颞叶内侧癫痫的术前定位诊断具有重要价值。     

Interictal estimation of intracranial seizure onset in temporal lobe epilepsy

ObjectivesTo evaluate the lateralizing and localizing values of interictal focal slow activity (IFSA), single pulse electrical stimulation (SPES) and ¹⁸FDG PET, in order to estimate their potential to complement ictal intracranial recordings and reduce prolonged monitoring in patients with temporal lobe epilepsy.MethodsThe study includes 30 consecutive patients with bilateral temporal subdural electrodes and focal seizure onset. IFSA, SPES and ¹⁸FDG PET when available, were visually assessed and their combined lateralization was based on the majority of the individual lateralizing tests.ResultsIn the 18 patients who had all three tests, lateralization was congruent with seizure onset areas in 15 (83%). When lateralized (15 patients), ¹⁸FDG PET was always congruent with intracranial seizure onset. In all 12 patients without ¹⁸FDG PET, lateralization combining IFSA and SPES was congruent with seizure onset, including two with bilateral independent seizure onset on subdural monitoring. 22 out of the 23 patients who had surgery enjoyed favorable outcome (Engel I or II).ConclusionIntracranial IFSA and SPES can reliably predict the side and site (mesial versus lateral temporal) of seizure onset when they lateralize to the same side.Significance¹⁸FDG PET can be useful in planning electrode implantation. During intracranial recordings, IFSA and SPES have the potential to reduce telemetry time, risks and costs.     

The added value of [18F]-fluoro-D-deoxyglucose positron emission tomography in screening for temporal lobe epilepsy surgery

PURPOSE: [18F]-Fluoro-d-deoxyglucose positron emission tomography (FDG-PET) is an expensive, invasive, and not widely available technique used in the presurgical evaluation of temporal lobe epilepsy. We assessed its added value to the decision-making process in relation to other commonly used tests. METHODS: In a retrospective study of a large series of consecutive patients referred to the national Dutch epilepsy surgery program between 1996 and 2002, the contribution of FDG-PET, magnetic resonance imaging (MRI), and video-electroencephalogram (video-EEG) monitoring findings, alone or in combination, to the decision whether to perform surgery was investigated. The impact of FDG-PET was quantified by comparing documented decisions concerning surgery before and after FDG-PET results. RESULTS: Of 469 included patients, 110 (23%) underwent FDG-PET. In 78 of these patients (71%), FDG-PET findings led clinicians to change the decision they had made based on MRI and video-EEG monitoring findings. In 17% of all referred patients, the decision regarding surgical candidacy was based on FDG-PET findings. FDG-PET was most useful when previous MRI results were normal (p < 0.0001) or did not show unilateral temporal abnormalities (p < 0.0001), or when ictal EEG results were not consistent with MRI findings (p < 0.0001) or videotaped seizure semiology (p = 0.027). The positive and negative predictive values for MRI and video-EEG monitoring, which ranged from 0.48 to 0.67, were improved to 0.62 to 0.86 in combination with FDG-PET. CONCLUSIONS: In patients referred for TLE surgery, FDG-PET findings can form the basis for deciding whether a patient is eligible for surgery, and especially when MRI or video-EEG monitoring are nonlocalizing.     

The contribution of 18F-FDG PET in preoperative epilepsy surgery evaluation for patients with temporal lobe epilepsy A meta-analysis.

OBJECTIVE: To assess the predictive diagnostic added value of positron emission tomography (PET) in preoperative epilepsy surgery evaluation for patients with temporal lobe epilepsy (TLE). METHODS: A meta-analysis of publications from 1992 to 2006 was performed. Forty-six studies were identified that met inclusion criteria presenting detailed diagnostic test results and a classified postoperative outcome. Studies exclusively reporting on patients with brain tumors or on children were excluded. RESULTS: The analyses were complicated by significant differences in study design and often by lack of precise patient data. Ipsilateral PET hypometabolism showed a predictive value of 86% for good outcome. The predictive value was 80% in patients with normal MRI and 72% in patients with non-localized ictal scalp EEG. In a selected population of 153 TLE patients with a follow-up of >12 months PET correlated well with other non-invasive diagnostic tests, but none of the odds ratios of any test combination was significant. CONCLUSION: Our data confirm that ipsilateral PET hypometabolism may be an indicator for good postoperative outcome in presurgical evaluation of drug-resistant TLE, although the actual diagnostic added value remained questionable and unclear. PET does not appear to add value in patients localized by ictal scalp EEG and MRI. Prospective studies limited to non-localized ictal scalp EEG or MRI-negative patients are required for validation.     

Relationship of seizure frequency to hippocampus volume and metabolism in temporal lobe epilepsy

PURPOSE: To examine the relationship between frequency of complex partial (CPS) and secondarily generalized tonic-clonic seizures (sGTCS) on hippocampal volume (HV) and temporal lobe metabolism. METHODS: We performed volumetric magnetic resonance imaging (MRI) and positron emission tomography with 18fluorodeoxyglucose (18FDG-PET) in 32 patients with epilepsy. Temporal lobe foci were localized by ictal video-EEG. RESULTS: We did not find any association between CPS frequency or lifetime number of sGTCS and HV or metabolism ipsilateral to electroencephalographic focus. CONCLUSION: The progress of metabolic or pathologic abnormalities of temporal lobe epilepsy may not be altered by adequate seizure control. The presence of an epileptic focus might be associated with progressive neuronal injury even in clinically well-controlled patients.     

发作间期癫痫灶的~(18)F-FDG PET/CT显像研究

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.     

颞叶癫痫患者脑内细胞凋亡现象的研究

目的探讨细胞凋亡在颞叶癫痫发病机制中的可能作用及意义。方法１５例颞叶癫痫患者为我院手术的病人,选取同一时期死于非神经系统疾病的５例患者作为对照。采用ＴＵＮＥＬ方法原位标记ＤＮＡ片段,观察这１５例颞叶癫痫患者手术切除的海马标本和５例死于非神经系统疾病患者的尸检的海马标本的细胞调亡现象。结果（１）ＴＵＮＥＬ阳性细胞在海马各个部位分布不均匀,有区域性差异。（２）在海马细胞层结构中,主要分布于ＣＡ１－ＣＡ３区的腔隙分子层及齿状回颗粒细胞层外侧。（３）颞叶癫痫患者海马ＣＡ３区ＴＵＮＥＬ阳性细胞平均百分率（５１．１９％）与死于非神经系统疾病患者的（１５．８％）比较有极显著性差异（Ｐ＜０．０１）,且与癫痫发作的病程、年龄及发作频率无关。结论细胞凋亡参与颞叶癫痫的发病过程,但可能并非其发病的特异性因素。