Matsuda Hiroshi
Department of Nuclear Medicine, Saitama Medical School Hospital.
Rinsho Shinkeigaku. 2005 Nov;45(11):920-2.
Imaging of interictal 18F-FDG PET and ictal SPECT is useful for identifying regions of seizure in epilepsy. Epileptic foci usually show decreased and increased flow/metabolism in the interictal and ictal phase respectively. A fusion technique of high resolution PET and MRI has become indispensable to preoperative evaluation for epileptic surgery. Subtraction ictal SPECT coregistered to MRI (SISCOM) is also an useful technique for localizing significant flow increase in the focus. Central type benzodiazepine receptor imaging using 11C-flumazenil PET or 123I-iomazenil SPECT is an alternative and sensitive technique for localizing epileptogenic regions. This receptor imaging delineates epileptic foci more precisely than 18F-FDG PET. There has been considerable interest in the role that functional magnetic resonance imaging (fMRI) may play in the assessment of patients with epilepsy. The application of fMRI paradigms used in cognitive neuroscience to patients with epilepsy is complicated. Although fMRI is increasingly being used clinically to establish language dominance, further work is required to localize accurately those specific language functions that are most at risk following surgery. Memory paradigms are not yet validated for use in surgical planning, although methodological and technical advances should make this possible in the near future.
发作间期18F-FDG PET和发作期SPECT成像有助于识别癫痫发作区域。癫痫病灶通常在发作间期和发作期分别表现为血流/代谢降低和增加。高分辨率PET与MRI的融合技术已成为癫痫手术术前评估不可或缺的手段。与MRI配准的发作期SPECT减影（SISCOM）也是定位病灶显著血流增加的有用技术。使用11C-氟马西尼PET或123I-碘马西尼SPECT进行中枢型苯二氮䓬受体成像，是定位致痫区域的一种替代且敏感的技术。这种受体成像比18F-FDG PET更精确地描绘癫痫病灶。功能磁共振成像（fMRI）在癫痫患者评估中可能发挥的作用一直备受关注。将认知神经科学中使用的fMRI范式应用于癫痫患者情况较为复杂。尽管fMRI在临床上越来越多地用于确定语言优势半球，但仍需要进一步研究以准确确定手术风险最高的那些特定语言功能的位置。记忆范式尚未在手术规划中得到验证，不过方法学和技术的进步应会在不久的将来使其成为可能。
