Jack C R, Mullan B P, Sharbrough F W, Cascino G D, Hauser M F, Krecke K N, Luetmer P H, Trenerry M R, O'Brien P C, Parisi J E
Department of Diagnostic Radiology, Mayo Clinic, Rochester, MN 55905.
Neurology. 1994 May;44(5):829-36. doi: 10.1212/wnl.44.5.829.
We performed a retrospective study of 53 consecutive "nonlesional" temporal lobectomy patients to assess the relative utility of MRI versus interictal single-photon emission computed tomography (SPECT) in this patient population. We compared the seizure lateralizing properties of MRI and SPECT using multiple blinded expert reviewers for both SPECT and MRI with a test-retest reviewer paradigm and measurements of hippocampal volume from MRI. The criterion standard for seizure lateralization was satisfactory postoperative seizure control (n = 43). The rate of correct seizure lateralization was significantly greater for MRI than for SPECT (p < or = 0.01), and the rate of incorrect lateralization was significantly less for MRI than for SPECT. The most accurate MRI measure was hippocampal volume measurements, which correctly lateralized the seizures in 86.0% of cases. The correct lateralization rate for SPECT was 45.4%. The MRI and SPECT studies tended to be noncomplementary with respect to seizure lateralization, and SPECT was likely to give an incorrect or indeterminate result in patients who were not lateralized by MRI. Concordant MRI-EEG lateralization was a strong predictor of satisfactory postoperative seizure control, while no relationship between postoperative seizure control and SPECT findings was present.
我们对53例连续接受“非病变性”颞叶切除术的患者进行了一项回顾性研究，以评估在该患者群体中，磁共振成像（MRI）与发作间期单光子发射计算机断层扫描（SPECT）的相对效用。我们采用重测评审模式，让多名对SPECT和MRI均不知情的专家评审员，对比了MRI和SPECT的癫痫发作定位特性，并测量了MRI的海马体积。癫痫发作定位的标准参照为术后癫痫控制情况良好（n = 43）。MRI的癫痫发作正确定位率显著高于SPECT（p≤0.01），且MRI的错误定位率显著低于SPECT。最准确的MRI测量指标是海马体积测量，其在86.0%的病例中能正确定位癫痫发作。SPECT的正确定位率为45.4%。在癫痫发作定位方面，MRI和SPECT的结果往往并非互补，对于MRI未能定位的患者，SPECT可能会给出错误或不确定的结果。MRI与脑电图（EEG）的定位一致性是术后癫痫控制情况良好的有力预测指标，而术后癫痫控制与SPECT检查结果之间不存在关联。
