质子磁共振波谱分析和正电子发射体层摄影对颞叶癫痫定侧诊断的比较研究

目的 探讨质子磁共波谱分析（^1H MRS)、正电子发射体层摄影（PET）和脑电图（EEG）对颞叶癫痫定侧诊断的价值。方法 选择15例经手术病理证实的顽固性颞叶癫痫患者为研究对象。术前行^1H MRS、PET和EEG定位,并行单侧前颞切除术。根据手术病理和随访结果评价诊断价值。结果 用连续视频监护头皮EEG定位,15例中的13例定位于一侧颞,其中5例伴有对侧传导。另2例因头皮EEG无法定位而行颅内电极EEG,手术最终以头皮EEG或颅内EEG的定位结果进行。手术病理示各种程度的海马硬化表现,术后随访12例癫痫控制,3例发作减少,提示EEG定位全部准确。用^1H MRS定侧,12例定侧准确（80％）,1例定侧错误,另2例无法定侧。MRS发现双侧异常5例（33％）。用FDG－PET定侧,14例准确,1例错误,发现双侧异常2例。结论 ^1H MRS、PET和EEG都是对颞叶癫痫定侧诊断的有效方法。

Comparison of (1)H MRS, PET and EEG in lateralization of temporal lobe epilepsy

Objective To evaluate and compare the role of 1?H MRS, PET and EEG in lateralization diagnosis (LD) of temporal lobe epilepsy (TLE). Methods 15 patients with intractable TLE verified by operation and pathology were studied. Before unilateral anterior temporal lobectomy, 1?H MRS, PET and EEG were performed for the LD of TLE. The diagnostic value of 1?H MRS, PET and EEG was compared based on the pathology and follow up results. Results With video scalp EEG monitoring, the focus was localized in one temporal lobe for 13 patients among which 5 had abnormal waves conducted to the contralateral lobe. Intracranial EEG was performed for other 2 patients because scalp EEG failed to make the LD. Ultimately, partial temporal lobectomy was performed in all patients based on LD by scalp EEG or intracranial EEG. The pathological findings of operation specimens showed various degree of hippocampal sclerosis. The surgery was proved to be effective by follow ups of all 15 patients, with their conditions controlled in 12 cases and better in two. EEG succeeded to make correct LD in all cases. 1?H MRS made correct LD in 12 cases (80%) and incorrect LD in 1 case, and failed to made LD in 2 cases. Five bilateral abnormalities (33%) were found by MRS. FDG PET made correct LD in 14 cases (93%) and incorrect LD in 1 case, and found two cases with bilateral abnormalities (13%). Conclusion 1H MRS, PET and EEG are all effective means in LD of TLE. Up to now, scalp EEG is the first choice and continuous video EEG monitoring has its own unique advantage. As a kind of simple, noninvasive and objective method, MRS can be used as a routine examination in conjunction with conventional MRI. Although PET is quite sensitive, it is expensive and has a number of limitations. So it can be used depending on the affordability of patients or diagnostic need. Combination of MRI, MRS, PET and scalp EEG may improve the reliability of the LD compared with use of any one of them alone. While the results of these methods are controversial, intracranial EEG is inevitable.