PET/CT和MRI术前定位神经节细胞胶质瘤相关药物难治性癫痫

目的 评价¹⁸F-FDG PET/CT脑显像和头颅MRI术前定位神经节细胞胶质瘤（GG）相关药物难治性癫痫的价值。方法 回顾性分析23例药物难治性癫痫、且术后病理证实为GG患者,术前均接受MR及PET/CT检查;定性分析MRI信号特点及PET/CT低代谢范围,与术后CT所示手术区域相对照,分析两种方法术前定位GG相关药物难治性癫痫的价值。结果 23例中,12例致痫灶为单一病理类型,11例为多重病理类型,包括5例GG和皮质发育不良（FCD）、4例GG和皮质胶质增生、1例GG累及海马及1例GG、FCD和海马硬化。23例中,18例MRI显示单一部位实性或囊实性异常信号,其中8例（单一病理类型）与手术切除致痫灶范围完全一致;5例MRI阴性。¹⁸F-FDG PET/CT示8例幕上单一部位葡萄糖代谢减低,均与手术所示GG病灶部位一致;15例幕上多部位代谢减低,其中11例与手术切除范围完全一致。MRI定位准确率34.78%,阳性率78.26%;¹⁸F-FDG PET/CT定位准确率82.61%,阳性率为100%（P均<0.05）。结论 ¹⁸F-FDG PET/CT脑显像术前定位GG相关药物难治性癫痫优于MRI;联合应用二者有助于提高定位精准度。

PET/CT and MRI in preoperative localization of drug-resistant epilepsy associated with ganglioglioma

Objective To observe the value of ¹⁸F-FDG PET/CT and brain MR imaging in preoperative localization of drug-resistant epilepsy associated with ganglioglioma (GG). Methods Data of 23 patients with medically intractable epilepsy of GG confirmed by postoperative pathology were retrospectively analyzed. All patients underwent MRI and PET/CT before operation. MRI signal characteristics and hypometabolism ranges on PET/CT were qualitatively analyzed and compared with operation area showed on postoperative CT images. The values of these two methods for preoperative localization of GG-related drug-resistant epilepsy were analyzed. Results Among 23 patients with epileptogenic foci, 12 had single pathological type and 11 had multiple pathological types abnormalities, including 5 of GG and focal cortical dysplasia (FCD), 4 of GG and cortical gliosis, 1 of GG involving hippocampus, 1 of GG, FCD and hippocampal sclerosis. In 23 patients, 18 cases had single solid or cystic abnormal signals on MRI, the ranges of epileptogenic foci in 8 cases (single pathological type) were identical with those of surgical resection, whereas the other 5 cases had negative MRI results. ¹⁸F-FDG PET/CT showed glucose metabolism decreasing in a single supratentorial site in 8 cases, which were consistent with the location of GG lesions of surgical resections, while the metabolism of supratentorial areas decreased in 15 cases, 11 of which were completely consistent with ranges of resection. The accuracy of MRI for preoperative localization of epilepsy was 34.78%, of ¹⁸F-FDG PET/CT was 82.61%; the positive rate of MRI was 78.26%,of ¹⁸F-FDG PET/CT was 100% (both P<0.05). Conclusion ¹⁸F-FDG PET/CT brain imaging was superior to MRI in preoperative localization of GG-related drug-refractory epilepsy. Combination of both might improve the precision of preoperative localization.