18F-FDG PET/CT在顽固性癫痫病灶定位和治疗决策中的影响

目的探讨18F-脱氧葡萄糖(FDG)正电子发射体层摄影(PET)/计算机体层摄影(CT)显像在顽固性癫痫患者定位与治疗决策中的价值。方法顽固性原发癫痫患者84例,均行FDG显像、头皮脑电图检查(EEG)及MRI检查。分析癫痫患者的FDG显像表现,根据其表现制定治疗计划。以手术患者的皮层脑电图(ECoG)为标准,比较3种检查符合率。随访比较FDG显像不同表现组患者的治疗满意率。统计学方法使用χ2检验、Fisher’s精确统计和Kappa检验。结果 FDG显像、EEG、MRI对癫痫患者的阳性检出率分别为92.9%(78/84)、97.6%(82/84)、22.6%(19/84)。手术52例,伽玛刀治疗19例;放弃治疗13例。PET/CT对治疗的决策更改率为38.1%(32/84)。与ECoG比较,手术患者中PET、EEG、MRI的定位符合率分别为86.5%(45/52)、53.8%(28/52)、30.8%(16/52),FDG PET与ECoG具有中度一致性(Kappa=0.425)。PET/CT上表现为单发局限性病灶组的治疗满意率高于多发病变组(分别为91.1%vs 50.0%,P<0.01)。3例FDG显像阴性患者伽玛刀治疗不满意。结论 18 F-FDG PET/CT显像对癫痫灶定位准确性优于EEG以及MRI,可指导治疗手段的选择。FDG表现为单发病灶及少数多发病灶的患者手术及伽玛刀治疗效果较好。

Value of 18F-FDG PET/CT in localization of epileptogenic focus and therapeutic decision for epilepsy

Objective To explore the value of 18F-FDG PET/CT in the localization of epileptogenic focus and therapeutic decision for epilepsy. Methods 84 patients with medically intractable epilepsy were studied with 18F-FDG PET/CT,EEG and MRI, and the features of FDG PET imaging in epilepsy patients were analyzed. The therapeutic decisions based on the results of PET/CT were evaluated. The accuracies of three modalities for surgical patients were compared with electrocorticogram（ECoG）. Therapeutic satisfactory rates of different performance type groups on FDG PET/CT were compared, z test and Fisher ~xact test and kappa test were in use. Results The sensitivities of FDG PET/CT,EEG and MRI were respectively 92.9%（78/84） ,97.6%（82/84） ,22.6% （19/84）. According to the results of FDG PET/CT, S2 patients were referred for open skull operation, 19 patients for T-knife and 13 patients for abandoning treatment. Therapeutic plans were changed in 32 patients（38.1%）. The accuracies of the three modalities in surgical patients were respectively 86.5% （45/52）, 53.8% （28/52） ,30.8% （16/52）. There was a common correlation between FDG PET/CT and ELOG（Kappa= 0. 435）. Significant difference was found between single-lesion group and multiple-lesion group in the satisfactory rate of surgery and γ-knife therapy （91.1% vs 50. 0%, P〈0. 01）. All 3 cases of PET-negative were unsatisfied with γ-knife therapy. Conclusion In epilepsy localization, the accuracy of ^18F-FDG PET/CT is statistically better than that of EEG and MR/ in operation patients. It can play an important role in therapeutic decision for medically intractable epilepsy. The surgery and γ-knife therapy effects are satisfactory in patients with single-lesion group and some multiple-lesion group in FDG PET/CT.