18F-FDG-PET在颞叶癫痫灶定位中的应用

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.

Value of interictal 18F-FDG-PET in localization of epileptogenic focus of temporal lobe epilepsy

Objective To introduce the technique of interictal 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) examination and explore the value of 18F-FDG-PET in the localization of epileptogenic focus of temporal lobe epilepsy (TLE) confirmed by surgical result.Methods Clinical data were retrospectively analyzed in 82 TLE patients having received interictal 18F-FDG-PET preoperative evaluation and got EngleⅠ grade epileptic surgical outcome, and the sensitivity and specialty of interictal 18F-FDG-PET were compared with those of MRI and scalp video-EEG. Results Epileptogenic foci showed hypometabolism on 18F-FDG-PET, and the hypometabolism zones were localized in ipsilateral temporal lobe in 68 cases,beyond ipsilateral temporal lobe in 9 cases; the other 5 had no hypometabolism zone. Accuracy rate of localization of epileptogenic foci by interictal 18F-FDG-PET was 82.9% (68/82), significantly higher than that by MRI or EEG(P＜0.05).77.4%(41/53)epileptogenic foci where MRI showed negative and 75%(15/20)where EEG with imbedded electrode was applied were precisely localized by 18F-FDG-PET. The accuracy was higher in the cases with positive pathological result than in the ones with negative result. Conclusions Interictal 18F-FDG-PET possesses excellent sensitivity and specialty in preopemtive assessment for TLE, and is of good value in the localization of epileptogenic focus where MRI shows negative or invasive electrophysiologic monitoring is needed.Rational application may raise the accuracy rate.