新皮质癫痫患者的磁共振成像、正电子发射断层扫描和发作期单光子发射计算机断层扫描的对比分析
Comparative analysis of MR imaging, positron emission tomography, and ictal single-photon emission CT in patients with neocortical epilepsy.
作者信息
Hwang S I, Kim J H, Park S W, Han M H, Yu I K, Lee S H, Lee D S, Lee S K, Chung C K, Chang K H
机构信息
Department of Radiology, Seoul National University College of Medicine, 28 Yongondong, Chongno-gu, Seoul, 110744, Korea.
出版信息
AJNR Am J Neuroradiol. 2001 May;22(5):937-46.
BACKGROUND AND PURPOSE
MR imaging, positron emission tomography (PET), and single-photon emission CT (SPECT) play important roles in presurgical localization of epileptic foci. However, comparative study of these imaging methods for cases of neocortical epilepsy has been limited. The purpose of this study was to compare the sensitivities of these three imaging methods for presurgical localization of neocortical epileptogenic foci.
METHODS
We studied 117 consecutive patients who underwent surgery for intractable neocortical epilepsy. The pathologic substrates were neuronal migration disorder (n = 77), tumor (n = 15), and others (n = 25). MR imaging was compared retrospectively with (18)F-fluorodeoxyglucose PET and ictal technetium-99m hexamethylpropyleneamine oxime SPECT regarding their capability to correctly localize the epileptogenic foci. The pathologic findings were used as the standard of reference.
RESULTS
Overall, MR imaging, PET, and ictal SPECT correctly localized the lesions for 59.8%, 77.7%, and 70.3% of the patients, respectively, with a 38% concordance rate among the three methods. PET was most sensitive (71-100%) in detecting all substrates. MR imaging was as sensitive (100%) as PET in detecting tumor but was least sensitive (48.1%) in detecting neuronal migration disorder. Ictal SPECT was more sensitive (75.8%) than MR imaging in detecting neuronal migration disorder. Patients with imaging abnormalities achieved good outcomes in 81.4% of the cases, in contrast to 59.5% for those without imaging abnormalities (P <.05).
CONCLUSION
PET and ictal SPECT were overall more sensitive than was MR imaging, despite the low concordance rate and variable sensitivity depending on substrates. The detection of abnormalities by MR imaging was associated with good outcome. PET or ictal SPECT can be well used as complementary tools, particularly in cases of negative MR imaging findings.
背景与目的
磁共振成像（MR）、正电子发射断层扫描（PET）和单光子发射计算机断层扫描（SPECT）在癫痫灶的术前定位中发挥着重要作用。然而，针对新皮质癫痫病例对这些成像方法进行的对比研究有限。本研究的目的是比较这三种成像方法对新皮质致痫灶术前定位的敏感性。
方法
我们研究了117例连续接受手术治疗的顽固性新皮质癫痫患者。病理基础为神经元迁移障碍（n = 77）、肿瘤（n = 15）和其他（n = 25）。回顾性比较MR成像与18F - 氟脱氧葡萄糖PET以及发作期锝 - 99m六甲基丙烯胺肟SPECT正确定位致痫灶的能力。病理结果用作参考标准。
结果
总体而言，MR成像、PET和发作期SPECT分别在59.8%、77.7%和70.3%的患者中正确定位了病变，三种方法的一致性率为38%。PET在检测所有病理基础方面最敏感（71 - 100%）。MR成像在检测肿瘤方面与PET一样敏感（100%），但在检测神经元迁移障碍方面最不敏感（48.1%）。发作期SPECT在检测神经元迁移障碍方面比MR成像更敏感（75.8%）。有成像异常的患者在81.4%的病例中取得了良好的结果，相比之下，无成像异常的患者为59.5%（P <.05）。
结论
尽管一致性率较低且敏感性因病理基础而异，但PET和发作期SPECT总体上比MR成像更敏感。MR成像检测到异常与良好的结果相关。PET或发作期SPECT可很好地用作补充工具，特别是在MR成像结果为阴性的情况下。
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