| | | 比较发作间期PET, MRI和EEG对难治性癫痫的定位价值
| | 康复医学论文 作者：李一明，张华，井晓荣，高国栋
【关键词】 发作
Comparison of localizing value of interictal PET, MRI and EEG in preoperative evaluation of intractable epilepsy
【Abstract】 AIM: To compare the results of ictal PET, scalp Video EEG (VEEG), intracranial EEG and MRI in patients with intractable epilepsy and to explore the application value of 18FFDG PET and MRI in the localization of epileptogenic focus. METHODS: Brain imaging of 18FFDG PET, MRI and EEG was obtained in 65 patients ［male 44, female 21, age averaging (30.1±18.5) years］ with intractable epilepsy. Fortytwo patients received surgical treatment and intracranial electrodes were placed in 13 patients. All the patients who had undergone surgery had MRI examination 1 month after surgery. Seizure control was also evaluated according to Engels classification of surgical outcome. The efficacy of PET for the localization of epileptogenic focus was compared with that of VEEG, MRI and intracranial EEG. RESULTS: ① Fiftyeight patients showed interictal focal hypometabolism, 3 patients with continuous seizure showed ictal hypermetabolism and 4 patients were normal. ② FDG PET localized the seizure foci in patients whose VEEG showed bilateral or no definite epileptoform discharge. FDG PET image demonstrated more metabolic changes than structural changes shown by MRI. ③ According to Engels classification, 71.4% (30/42) were classified as grade I, whose lesions were confirmed to be epileptogenic foci. The localization accuracy of intracranial EEG, FDG PET, VEEG and MRI for seizure foci was 96.7%, 90.0%, 76.7% and 53.3%, with significant difference when calculated by χ2 test (P<0.05). ④ Surgical outcome of the patients with abnormal MRI image was better than that with normal MRI image. The effect of surgical removal of the hypometabolic focus in one temporal lobe was better than that in bilateral lobe. Patients with epileptogenic foci in temporal lobe had a better outcome than those with foci in other lobes. In the patients with other hypometabolic lesions besides major lesion, the removal of the major lesion was not as effective as that in the patients only with major lesions. CONCLUSION: The sensitivity and accuracy of the FDG PET imaging in localizing the seizure focus are significantly higher than those of MRI and VEEG. The FDG PET metabolic images combined with MRI and scalp VEEG can help the neurosurgeons to localize the epileptogenic focus, confirm the operative indications and predict the surgical outcomes.
【Keywords】 epilepsy; tomography, emissioncomputed; magnetic resonance spectroscopy; video electroencephalography; intracranial electroencephalography
【摘要】 目的康复医学论文： 分析难治性癫痫患者正电子发射断层扫描 (PET)、视频脑电图监测 (VEEG)、颅内脑电图（Intracranial EEG）以及MRI结果，探讨18脱氧葡萄糖(FDG)PET及MRI对致痫灶进行定位的康复医学论文应用价值. 方法： 难治性癫痫患者65（男44，女21)例，平均年龄(30.1±18.5)岁，均行VEEG，发作间期PET及MRI检查，42例进行了手术治疗，其中13例行颅内电极埋藏术，所有患者均术后1 mo复查MRI，定期电话随访，根据Engel疗效分级评估手术疗效，比较PET, MRI和VEEG在对致痫灶的术前定位准确性并分析它们之间的关系. 结果： ① 58例癫痫患者发作间期脑皮层为低代谢表现，3例癫痫患者发作间期脑皮层为高代谢表现，4例癫痫患者发作间期脑组织代谢未见明显异常. ② FDG PET病变定侧率高于VEEG，FDG PET低代谢灶检出率高于MRI. ③ 42例手术患者中，属于Engels疗效分级Ⅰ级的30例手术切除部位定为准确的致痫灶，颅内EEG, FDG PET, VEEG与 MRI定侧定位准确性分别为96.7%, 90.0%, 76.7%, 53.3%，经χ2检验，颅内EEG, PET与MRI有显著性差异(P<0.05). ④ MRI阳性患者比MRI阴性患者的手术效果好；单侧颞叶低代谢手术效果好；颞叶癫痫手术效果优于颞叶外癫痫；PET示局灶性脑组织代谢减低者，手术效果优于伴有其他部位皮层代谢改变者. 结论： 发作间期FDG PET对癫痫灶定位的灵敏度和准确性优于MRI和头皮EEG，头皮EEG, MRI及FDG PET相结合可帮助临床医生确定病灶部位、选择手术适应证和预测疗效.
【关键词】 癫痫；体层摄影术，发射计算机；磁共振波谱学；视频脑电描记术；颅内脑电描记术
0引言
一般而言，20%的癫痫患者经过两种以上一线药物正规治疗后仍频繁癫痫发作，成为药物难治性癫痫，其中40%的药物难治性癫痫有手术指征［1］. 其中70%～90%颞叶癫痫通过手术可以治愈［2］，但颞叶外癫痫的手术疗效一直不尽人意. 手术成功的关键在于癫痫的准确定位，这依赖于科学合理的术前辅助检查，其中头皮EEG有助于癫痫的电生理诊断，MRI能帮助了解脑的结构改变，均存在致痫灶定位的敏感性和特异性低的问题，无法指导癫痫外科治疗. PET能从代谢、血流灌注方面对致痫灶进行显像和定量分析，从而观察出病灶区域性的特异性变化，但其显像范围往往比癫痫灶要大. 随着颅内电极在国内的逐步开展，颅内EEG则能最终精确地定位致痫灶的位置及完成功能区定位. 癫痫手术的疗效得到大幅升高. 200312/200504，第四军医大学癫痫外科中心收治的65例难治性癫痫患者应用FDG PET, MRI，VEEG检查，其中42例接受外科手术治疗，13例患者行颅内EEG检查，对比这些辅助检查之间的关系，探讨其在致痫灶定位的作用.
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