Kuikka J T, Mervaala E, Vanninen E, Kälviäinen R
Department of Clinical Physiology, Kuopio University Hospital, Finland.
Eur J Nucl Med. 1994 Nov;21(11):1247-51. doi: 10.1007/BF00182362.
Ictal increase in regional cerebral blood flow as judged by single-photon emission tomography (SPET) is a common phenomenon during focal epileptic seizures. Up to 2 min postictally, regional hyperperfusion is a consistent finding with technetium-99m hexamethylpropylene amine oxime (HMPAO) in temporal lobe epilepsy. A new 99mTc-labelled lipophilic cerebral blood flow imaging agent, bicisate, has considerably longer radiochemical stability and yields better image quality than 99mTc-HMPAO. In this report, we present the case of a 21-year-old female patient with temporal lobe complex partial seizures. Magnetic resonance imaging revealed right hippocampal sclerosis. A dose of 550 MBq of 99mTc-bicisate was injected 35 s after the onset of a seizure during intracranial EEG-videotelemetry. At the moment of injection, subdural EEG demonstrated the beginning of late ictal discharges and postictal suppression in the right temporomesial areas. Late ictal SPET images showed marked right fronto-temporo-parietal hypoactivity. The interictal SPET study clearly showed right frontotemporal hypoactivity. These preliminary data suggest that 99mTc-bicisate shows late ictal/early postictal hypoactivity which might represent the primary change in neuronal metabolism rather than the secondary change in cerebral blood flow.
通过单光子发射断层扫描（SPET）判断，局灶性癫痫发作期间局部脑血流量的发作期增加是一种常见现象。在发作后长达2分钟内，颞叶癫痫患者使用锝-99m六甲基丙烯胺肟（HMPAO）时，局部血流灌注增加是一个一致的发现。一种新的99mTc标记的亲脂性脑血流显像剂双半胱乙酯，其放射化学稳定性明显更长，且比99mTc-HMPAO产生更好的图像质量。在本报告中，我们介绍了一名21岁患有颞叶复杂部分性发作的女性患者的病例。磁共振成像显示右侧海马硬化。在颅内脑电图-视频遥测期间，癫痫发作开始35秒后注射550 MBq的99mTc-双半胱乙酯。注射时，硬膜下脑电图显示右侧颞叶内侧区域出现晚期发作期放电和发作后抑制。晚期发作期SPET图像显示右侧额颞顶叶明显低活性。发作间期SPET研究清楚地显示右侧额颞叶低活性。这些初步数据表明，99mTc-双半胱乙酯显示出晚期发作期/早期发作后低活性，这可能代表神经元代谢的原发性改变而非脑血流量的继发性改变。
