Coubes P, Awad I A, Antar M, Magdinec M, Sufka B
Department of Neurological Surgery, Cleveland Clinic Foundation, OH 44195.
Neurol Res. 1993 Jun;15(3):160-8. doi: 10.1080/01616412.1993.11740129.
The respective contribution of interictal HMPAO-SPECT and FDG-PET to the imaging of the epileptogenic zone in intractable temporal lobe epilepsy is not known. Ten consecutive patients with drug resistant focal epilepsy of temporal lobe origin were studied with prolonged noninvasive video-EEG monitoring, magnetic resonance imaging, interictal FDG-PET and HMPAO-SPECT. Five patients demonstrated unitemporal and 5 patients bitemporal interictal and/or ictal EEG epileptiform abnormalities. We developed a 3-dimensional semiquantitative method for interpretation and comparison of FDG-PET and HMPAO-SPECT using a 15-compartment model of the temporal lobe. In all 5 patients with unilateral epileptogenicity, interictal hypometabolism and hypoperfusion were recorded on the side of the EEG abnormalities without discrepancy between PET and SPECT. The severity and the extent of focal abnormalities were consistently greater on PET than on SPECT, in agreement with previously well documented better 'sensitivity' of PET. Among the 5 patients with bitemporal epileptogenicity, results of SPECT and PET were convergent in only 2 cases. In this group, SPECT abnormalities appeared more profound but either SPECT or PET were not constantly correlated with the side of predominant EEG epileptogenicity. Abnormalities on PET and SPECT were more frequently limited to mesiobasal structures among cases with unilateral epileptogenicity and tended to involve neocortical structures in bitemporal cases. We conclude that interictal FDG-PET and HMPAO-SPECT provide the same type of information on the side of the epileptogenic zone in cases with clearly unilateral epileptogenicity, with abnormalities more intense and more extensive on PET.(ABSTRACT TRUNCATED AT 250 WORDS)
发作间期HMPAO-SPECT和FDG-PET对难治性颞叶癫痫致痫区成像的各自贡献尚不清楚。对连续10例颞叶起源的耐药性局灶性癫痫患者进行了长时间无创视频脑电图监测、磁共振成像、发作间期FDG-PET和HMPAO-SPECT检查。5例患者表现为单颞叶发作，5例患者表现为双颞叶发作间期和/或发作期脑电图癫痫样异常。我们开发了一种三维半定量方法，使用颞叶的15区模型来解释和比较FDG-PET和HMPAO-SPECT。在所有5例单侧致痫性患者中，发作间期低代谢和低灌注记录在脑电图异常侧，PET和SPECT之间无差异。PET上局灶性异常的严重程度和范围始终大于SPECT，这与之前充分记录的PET更好的“敏感性”一致。在5例双颞叶致痫性患者中，SPECT和PET结果仅在2例中一致。在这组患者中，SPECT异常似乎更明显，但SPECT或PET均与主要脑电图致痫性侧不始终相关。在单侧致痫性病例中，PET和SPECT异常更常局限于中基底结构，而在双颞叶病例中则倾向于累及新皮质结构。我们得出结论，在明确单侧致痫性的病例中，发作间期FDG-PET和HMPAO-SPECT在致痫区一侧提供相同类型的信息，PET上的异常更强烈、更广泛。（摘要截短于250字）
