脑18F-FDG PET/CT显像对脑癫痫灶的定位及定侧诊断价值

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摘要目的探讨脑18氟-脱氧葡萄糖（18F-FDG）正电子发射断层计算机扫描（PET/CT）显像对脑癫痫灶的定位以及定侧诊断价值。方法选择2011年6月～2013年7月北部战区总医院收治的难治性癫痫患者69例，分别行脑18F-FDG发作间期PET/CT显像、磁共振成像（MRI）及脑电图（EEG）检查，并与术中脑电监测及手术病理结果进行对比。结果 69例癫痫病灶切除患者中，PET/CT定位及定侧准确率分别为62.3%（43/69）、78.3%（54/69）。其中，PET/CT定位单纯颞叶病灶43例，经术中脑电监测及手术病理证实定位一致36例，准确率为83.7%（36/43），定侧一致37例，准确率为86.0%（37/43），均高于非颞叶病灶定位以及定侧准确率[26.9%（7/26）、65.4%（17/26）]，差异有统计学意义（P < 0.05）。PET/CT对于脑癫痫的定侧准确率[78.3%（54/69）]明显高于定位准确率[62.3%（43/69）]，差异有统计学意义（P < 0.05）。MRI定位准确率为42.0%（29/69），EEG定位准确率为44.9%（31/69）。PET对脑癫痫的定位准确率高于MRI及EEG（χ2 = 5.692、4.196，均P < 0.05）。结论脑18F-FDG PET/CT显像对癫痫灶的定位价值远高于MRI及EEG常规检查手段，尤其在颞叶癫痫的定位诊断中具有重要临床应用价值。

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	郝珊瑚武晓丹王治国战莹张国旭▲

关键词 ：癫痫, 18氟-脱氧葡萄糖, 正电子发射断层计算机扫描, 磁共振成像, 脑电图

Abstract：Objective To explore the value of fludeoxyglucose (18F-FDG) positron emission tomography-computed tomography (PET/CT) in the accurate localization and lateralization of brain epileptogenic focus. Methods From June 2011 to July 2013, 69 patients with medically intractable epilepsy from the General Hospital of Northern Theater Command were selected. 18F-FDG interictal PET/CT, magnetic resonance imaging (MRI), electroencephalo gram (EEG) were performed in those patients and the results were compared with the electroenephalogram monitoring during operations and the pathological tests. Results Among 69 cases of epileptic focus resection, accuracy rate of localization and lateralization of epileptogenic focus by interictal 18F-FDG PET/CT were 62.3% (43/69) and 78.3% (54/69) respectively. Among 43 case of PET/CT localization of simple temporal lobe lesions, the intraoperative electroencephalogram monitoring and surgical pathology confirmed the same localization in 36 cases and the same lateralization in 37 cases, with an accuracy rate of 83.7% (36/43) and an accuracy rate of 86.0% (37/43), which were higher than those in non-temporal lobe lesions [26.9% (7/26), 65.4% (17/26)], the differences were statistically significant (P < 0.05). The lateral accuracy [78.3% (54/69)] of PET/CT for brain epilepsy was significantly higher than that in the location [62.3% (43/69)], the difference was statistically significant (P < 0.05). Accuracy rate of localization of epileptogenic focus in 69 patients by MRI was 42.0% (29/69), accuracy rate of localization of epileptogenic focus in 69 patients by EEG were 44.9% (31/69). PET/CT had higher accuracy rate of localization than MRI and EEG (χ2 = 5.692, 4.196, all P < 0.05). Conclusion Interical 18F-FDG PET/CT possesses higher value than routine examinations such as MRI and EEG in the localization of epileptogenic focus, especially in temporal lobe localization focus.

Key words： Epilepsy 18F-deoxyglucose Positron emission tomography-computed tomography Magnetic resonance imaging Electroencephalogram

基金资助:辽宁省自然科学基金项目（20180550191、20170 540952、20170540927）。

通讯作者: ▲通讯作者

作者简介: 郝珊瑚（1976-），女，硕士，副主任医师，主要从事PET/CT诊断与神经系统疾病相关研究。

引用本文:

郝珊瑚武晓丹王治国战莹张国旭▲. 脑18F-FDG PET/CT显像对脑癫痫灶的定位及定侧诊断价值[J]. 中国医药导报, 2018, 15(34): 149-152.
HAO Shanhu WU Xiaodan WANG Zhiguo ZHAN Ying ZHANG Guoxu▲. The diagnostic value of brain 18F-FDG PET/CT in the localization and lateralization of brain epileptogenic focus. 中国医药导报, 2018, 15(34): 149-152.

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http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2018/V15/I34/149

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