Department of Radiology, Seattle Children's Hospital and the University of Washington, 4800 Sand Point Way NE, Seattle, WA 98105.
Radiographics. 2013 Sep-Oct;33(5):1279-303. doi: 10.1148/rg.335125152.
Positron emission tomography (PET) of the brain is an important problem-solving tool in pediatric neuroimaging, neurology, and neurosurgery. Fluorine 18 fluorodeoxyglucose (FDG) PET or dual-modality PET and computed tomographic (CT) imaging (PET/CT), with magnetic resonance (MR) imaging correlation, can be used to evaluate childhood epilepsy and pediatric brain tumors, areas in which PET adds value in patient management. FDG PET has been widely used in pediatric temporal lobe epilepsy, most commonly manifesting as mesial temporal sclerosis, which demonstrates hypometabolism at interictal PET and hypermetabolism during seizures. Recently, FDG PET has shown added value for patients with extratemporal epilepsy, in whom FDG PET can help identify cortical foci of interictal hypometabolism that are undetectable or difficult to detect with MR imaging. These findings can then guide additional investigations and surgery. FDG PET also enhances medical decision making in children with brain tumors, in whom FDG PET can be used to (a) improve the diagnostic yield of stereotactic biopsies by detecting metabolically active areas of tumor, (b) help guide the surgeon in achieving total tumor resection, and (c) increase detection of residual or recurrent tumor. Technologic advances in the past decade have allowed fusion of PET and MR images, combining the high resolution of MR imaging with the low-resolution functional capability of PET. As dual-modality integrated PET/MR imaging systems become available, CT coregistration for PET can be eliminated, thus reducing patient radiation exposure. Increasing familiarity with normal and abnormal appearances of FDG PET brain images correlated with MR images can enhance diagnostic yield and improve the care of children with epilepsy and brain tumors.
正电子发射断层扫描（PET）是儿科神经影像学、神经病学和神经外科学中的重要问题解决工具。氟 18 氟脱氧葡萄糖（FDG）PET 或双模态 PET 和计算机断层扫描（CT）成像（PET/CT），结合磁共振（MR）成像相关性，可用于评估儿童癫痫和小儿脑肿瘤，在这些领域，PET 可在患者管理中增加价值。FDG PET 在小儿颞叶癫痫中得到了广泛应用，最常见的表现为内侧颞叶硬化，其在发作间期 PET 显示代谢低下，在发作期间显示代谢亢进。最近，FDG PET 对颞叶外癫痫患者具有附加价值，在这些患者中，FDG PET 可以帮助识别发作间期代谢低下的皮质焦点，这些焦点在 MR 成像中无法检测或难以检测。这些发现可以指导进一步的检查和手术。FDG PET 还增强了脑肿瘤患儿的医疗决策，在这些患儿中，FDG PET 可用于 (a) 通过检测肿瘤代谢活跃区域提高立体定向活检的诊断产量，(b) 帮助外科医生实现肿瘤完全切除，以及 (c) 增加对残留或复发性肿瘤的检测。过去十年中的技术进步允许 PET 和 MR 图像融合，将 MR 成像的高分辨率与 PET 的低分辨率功能能力相结合。随着双模态集成 PET/MR 成像系统的出现，PET 的 CT 配准可以消除，从而降低患者的辐射暴露。增加对与 MR 图像相关的 FDG PET 脑图像的正常和异常表现的熟悉程度可以提高诊断产量并改善癫痫和脑肿瘤患儿的护理。
