Kaneko Koichiro, Sasaki Masayuki, Morioka Takato, Koga Hirofumi, Abe Koichiro, Sawamoto Hirofumi, Ohya Nobuyoshi, Yoshiura Takashi, Mihara Futoshi, Honda Hiroshi
Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Nucl Med Commun. 2006 Nov;27(11):893-9. doi: 10.1097/01.mnm.0000243380.79872.32.
The aim of this study was to evaluate the usefulness of (123)I-iomazenil (IMZ) single photon emission computed tomography (SPECT) for the pre-surgical identification of epileptogenic areas in patients with temporal lobe epilepsy and to compare the results with those of (123)I-IMP SPECT and (18)Fluorodeoxyglucose positron emission tomography (FDG PET).
We examined seven patients with medically refractory temporal lobe epilepsy (five men and two women; mean age, 28 years) with no remarkable findings on magnetic resonance imaging. Before surgery, IMZ SPECT, IMP SPECT and FDG PET were all performed in the interictal state. Then, visual assessment and region-of-interest (ROI) analysis were performed on each image. Final definitions of the epileptogenic areas were made by electrocorticography and histopathology.
By IMZ SPECT, a decreased IMZ uptake in the ipsilateral temporal lobe was found in all patients, while a similar decrease in the contralateral temporal lobe was also found in one patient. In comparison to IMP SPECT, the extent of the abnormal area on IMZ SPECT was equal to that on IMP SPECT in one patient while it was more restricted to the epileptogenic area in five patients. In comparison to FDG PET, the extent of the abnormal area on IMZ SPECT was equal to that on FDG PET in three patients while it was more restricted in the epileptogenic area in four patients. In ROI analysis, decreases of IMZ, IMP and FDG uptake were observed in the epileptogenic area, although they were not statistically significant.
IMZ SPECT was considered to be useful for pre-surgical determination of the epileptogenic areas in temporal lobe epilepsy with no remarkable MRI findings, and it was also found to be superior to IMP SPECT and FDG PET for this purpose.
本研究旨在评估（123）I-艾美拉唑（IMZ）单光子发射计算机断层扫描（SPECT）在颞叶癫痫患者术前识别致痫区的效用，并将结果与（123）I-碘代安非他明（IMP）SPECT和（18）氟脱氧葡萄糖正电子发射断层扫描（FDG PET）的结果进行比较。
我们检查了7例药物难治性颞叶癫痫患者（5例男性和2例女性；平均年龄28岁），其磁共振成像未发现明显异常。术前，在发作间期均进行了IMZ SPECT、IMP SPECT和FDG PET检查。然后，对每个图像进行视觉评估和感兴趣区（ROI）分析。致痫区的最终定义由皮质脑电图和组织病理学确定。
通过IMZ SPECT，所有患者同侧颞叶均发现IMZ摄取减少，而1例患者对侧颞叶也发现类似减少。与IMP SPECT相比，1例患者IMZ SPECT上异常区域的范围与IMP SPECT上的相等，而5例患者则更局限于致痫区。与FDG PET相比，3例患者IMZ SPECT上异常区域的范围与FDG PET上的相等，而4例患者则更局限于致痫区。在ROI分析中，致痫区观察到IMZ、IMP和FDG摄取减少，尽管差异无统计学意义。
IMZ SPECT被认为对无明显MRI表现的颞叶癫痫患者术前确定致痫区有用，并且还发现其在此方面优于IMP SPECT和FDG PET。
