Swartz B E, Tomiyasu U, Delgado-Escueta A V, Mandelkern M, Khonsari A
California Comprehensive Epilepsy Program, Los Angeles.
Epilepsia. 1992 Jul-Aug;33(4):624-34. doi: 10.1111/j.1528-1157.1992.tb02338.x.
We studied patients with documented temporal lobe seizures to evaluate the predictive value of computed tomography (CT), magnetic resonance imaging (MRI), and F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) for surgical therapy and the relationships between these tests and the pathologic diagnoses. CT detected abnormalities in 32.5%, with an accuracy of 19% when accuracy was defined as congruence with electrophysiologic studies. MRI detected abnormalities in 81%, with an accuracy of 67%. FDG-PET detected abnormalities in 85%, with an accuracy of 82%. Pathologic change was detected in 79% of the excised temporal neocortex, 65% of amygdalae, and 93% of hippocampi. After follow-up periods of 20-71 months (mean 41 months), 67% of patients were free of seizures and 94% had at least a 90% reduction in seizure frequency. There was no relationship between the type of abnormality on MRI or the type of pathology and postoperative outcome. Better outcomes were associated with focal or regional ictal onsets as recorded by surface EEG. Worse outcomes were associated with hypometabolism that extended outside the temporal lobe. Pathologic change in the temporal neocortex was associated with extension of hypometabolism outside the temporal lobe.
我们对有颞叶癫痫记录的患者进行了研究，以评估计算机断层扫描（CT）、磁共振成像（MRI）和F-18氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）对手术治疗的预测价值，以及这些检查与病理诊断之间的关系。CT检测到异常的比例为32.5%，当将准确性定义为与电生理研究一致时，其准确性为19%。MRI检测到异常的比例为81%，准确性为67%。FDG-PET检测到异常的比例为85%，准确性为82%。在切除的颞叶新皮质中，79%检测到病理改变，杏仁核中为65%，海马体中为93%。在20 - 71个月（平均41个月）的随访期后，67%的患者无癫痫发作，94%的患者癫痫发作频率至少降低了90%。MRI上的异常类型或病理类型与术后结果之间没有关系。更好的结果与表面脑电图记录的局灶性或区域性发作起始相关。更差的结果与颞叶外的代谢减低有关。颞叶新皮质的病理改变与颞叶外代谢减低的扩展有关。
