Menzel C, Grünwald F, Pavics L, Hufnagel A, Stawovy B, Reichmann K, Elger C E, Biersack H J
Department of Nuclear Medicine, University of Bonn, Germany.
Eur J Nucl Med. 1994 Nov;21(11):1243-6. doi: 10.1007/BF00182361.
The clinical application of technetium-99m bicisate (ethyl cysteinate dimer, ECD) for ictal and interictal studies of regional cerebral blood flow (rCBF) in a patient suffering from medically intractable simple and complex partial seizures is reported. The interictal study was performed 60 min p.i. and the ictal studies were performed at 60 min p.i. using an annular crystal single photon emission tomography (SPET) system dedicated for high-resolution brain SPET imaging. Visual evaluation of the studies was carried out, as well as semiquantitative measurement of regional tracer uptake. Magnetic resonance imaging (MRI) scans revealed atrophy of almost the complete left frontal lobe and the ventral parts of the left temporal lobe, including in part the temporomesial structures. The left parietal and occipital structures and the right hemisphere were normal. The interictal study showed a large perfusion defect involving the whole left frontal lobe as well as the left temporal lobe with remaining small areas of normal cortical tracer uptake. The ictal studies detected circumscribed hyperperfusion within the left mesial temporal lobe (ventral part of the hippocampus). Additionally an increase in perfusion could be seen within the entire remaining left temporal lobe. Semiquantitative evaluation of tracer uptake comparing both studies detected markedly increased uptake within the focus compared to the remaining left temporal lobe. On this basis the newly available tracer for studies of rCBF, 99mTc-bicisate, seems to be of value for the detection of epileptogenic foci. Additionally, the value of ictal rCBF studies in the presurgical evaluation of those patients presenting severe morphological alterations on MRI is clearly underlined by this case.
报告了锝-99m双半胱乙酯（ethyl cysteinate dimer，ECD）在一名患有药物难治性简单和复杂部分性癫痫的患者中用于发作期和发作间期局部脑血流（rCBF）研究的临床应用。发作间期研究在静脉注射后60分钟进行，发作期研究在静脉注射后60分钟使用专门用于高分辨率脑单光子发射断层扫描（SPET）成像的环形晶体单光子发射断层扫描系统进行。对研究进行了视觉评估以及局部示踪剂摄取的半定量测量。磁共振成像（MRI）扫描显示几乎整个左额叶和左颞叶腹侧部分萎缩，包括部分颞叶内侧结构。左顶叶和枕叶结构以及右半球正常。发作间期研究显示一个大的灌注缺损，累及整个左额叶以及左颞叶，仅剩余小面积的正常皮质示踪剂摄取区域。发作期研究在左颞叶内侧（海马体腹侧部分）检测到局限性高灌注。此外，在整个剩余的左颞叶内可见灌注增加。比较两项研究的示踪剂摄取半定量评估发现，与剩余的左颞叶相比，病灶内摄取明显增加。在此基础上，新可用的用于rCBF研究的示踪剂99mTc-双半胱乙酯似乎对癫痫病灶的检测有价值。此外，该病例清楚地强调了发作期rCBF研究在对MRI显示严重形态学改变的患者进行术前评估中的价值。
