118例难治性癫痫患者的磁共振成像与正电子发射断层扫描及发作期单光子发射计算机断层扫描的比较。
Comparison of MR imaging with PET and ictal SPECT in 118 patients with intractable epilepsy.
作者信息
Won H J, Chang K H, Cheon J E, Kim H D, Lee D S, Han M H, Kim I O, Lee S K, Chung C K
机构信息
Department of Radiology, Seoul National University College of Medicine, Korea.
出版信息
AJNR Am J Neuroradiol. 1999 Apr;20(4):593-9.
BACKGROUND AND PURPOSE
MR imaging, PET, and ictal SPECT have been studied extensively as individual techniques in the localization of epileptogenic foci, but only a few comparative studies have been done. We evaluated the concordance rates of ictal video/EEG, MR imaging, PET, and ictal SPECT to compare the sensitivities of these imaging methods in the lateralization of epileptogenic foci.
METHODS
The study included 118 consecutive patients who underwent surgery for medically intractable epilepsy and who were followed up for 12 months or more. MR imaging was compared retrospectively with ictal video/EEG, FDG-PET, ictal 99mTc-HMPAO SPECT, and invasive EEG as to their ability to localize the epileptogenic focus; the pathologic findings served as the standard of reference.
RESULTS
MR imaging was concordant with video/EEG, PET, and ictal SPECT in 58%, 68%, and 58% of patients, respectively. With the pathologic diagnosis as the standard of reference, MR imaging, PET, and ictal SPECT correctly lateralized the lesion in 72%, 85%, and 73% of patients, respectively. Of the patients with good outcomes, MR imaging, PET, and ictal SPECT were correct in 77%, 86%, and 78%, respectively. In the good outcome group, MR imaging was concordant with PET and ictal SPECT in 73% and 62% of patients, respectively. Of 45 patients who underwent invasive EEG, MR imaging was concordant with the invasive study in 47%; PET in 58%; and ictal SPECT in 56%. Of 26 patients with normal MR findings, PET and ictal SPECT correctly lateralized the lesion in 80% and 55%, respectively.
CONCLUSION
Overall concordance among the techniques is approximately two thirds or less in lateralizing epileptogenic foci. PET is the most sensitive, even though it provides a broad approximate nature of the epileptogenic zone, which is not adequate for precise surgical localization of epilepsy. PET and/or ictal SPECT may be used as complementary tools in cases of inconclusive lateralization with ictal video/EEG and MR imaging.
背景与目的
磁共振成像（MR成像）、正电子发射断层扫描（PET）以及发作期单光子发射计算机断层扫描（ictal SPECT）作为癫痫灶定位的单独技术已得到广泛研究，但仅有少数比较研究。我们评估了发作期视频/脑电图、MR成像、PET以及发作期SPECT的一致性率，以比较这些成像方法在癫痫灶定侧方面的敏感性。
方法
该研究纳入了118例因药物难治性癫痫接受手术且随访12个月或更长时间的连续患者。回顾性比较MR成像与发作期视频/脑电图、氟代脱氧葡萄糖PET（FDG-PET）、发作期锝-99m六甲基丙二胺肟SPECT（ictal 99mTc-HMPAO SPECT）以及侵入性脑电图在癫痫灶定位能力方面的差异；病理结果作为参考标准。
结果
MR成像与视频/脑电图、PET以及发作期SPECT的一致性分别为58%、68%和58%的患者。以病理诊断作为参考标准，MR成像、PET以及发作期SPECT分别在72%、85%和73%的患者中正确定侧病变。在预后良好的患者中，MR成像、PET以及发作期SPECT的正确率分别为77%·、86%和78%。在预后良好组中，MR成像与PET以及发作期SPECT的一致性分别为73%和62%的患者。在45例接受侵入性脑电图检查的患者中，MR成像与侵入性检查的一致性为47%；PET为58%；发作期SPECT为56%。在26例MR表现正常的患者中，PET和发作期SPECT分别在80%和55%的患者中正确定侧病变。
结论
在癫痫灶定侧方面，这些技术之间的总体一致性约为三分之二或更低。PET最为敏感，尽管它提供的是癫痫灶区域大致范围，不足以用于癫痫的精确手术定位。在发作期视频/脑电图和MR成像定侧不明确的情况下，PET和/或发作期SPECT可作为辅助工具。
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