Richardson M P, Koepp M J, Brooks D J, Fish D R, Duncan J S
Epilepsy Research Group, Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, United Kingdom.
Ann Neurol. 1996 Aug;40(2):188-98. doi: 10.1002/ana.410400210.
Previous imaging studies using 11C-flumazenil in patients with mesial temporal lobe epilepsy and neocortical partial seizure disorders have found focal decreases in gamma-aminobutyric acid type A/benzodiazepine receptor binding. These studies used subjective visual assessment and a region of interest approach to quantitation. We performed three-dimensional, 11C-flumazenil positron emission tomography in 12 patients with cortical dysgenesis identified by high-resolution volumetric magnetic resonance imaging and in 26 normal subjects. Spectral analysis was used to produce a parametric image of 11C-flumazenil volume of distribution for each subject. Using volumetric normalization and statistical parametric mapping, we compared the entire brain volume of each patient with the brains of the normal group to produce maps of regions of abnormal 11C-flumazenil binding which were then rendered into the volumetric magnetic resonance images. This allowed a correlation of structure and function to be made. Of the 12 patients, 10 showed at least one region of abnormal 11C-flumazenil binding; the abnormal regions were frequently more extensive than were the lesions seen with magnetic resonance imaging. 11C-Flumazenil binding abnormalities were frequently seen in regions of cortex that had a normal magnetic resonance appearance. Lesions were characterized by increases in gamma-aminobutyric acid type A/benzodiazepine receptor availability, and by the decreases found in previous studies. These findings have implications for the neurobiology of seizure disorders associated with cortical dysgenesis and for the management of such patients if surgery is contemplated.
以往利用11C-氟马西尼对内侧颞叶癫痫和新皮质部分性癫痫障碍患者进行的影像学研究发现，γ-氨基丁酸A型/苯二氮䓬受体结合存在局灶性降低。这些研究采用主观视觉评估和感兴趣区方法进行定量分析。我们对12例经高分辨率容积磁共振成像确诊为皮质发育异常的患者以及26名正常受试者进行了三维11C-氟马西尼正电子发射断层扫描。采用频谱分析为每个受试者生成11C-氟马西尼分布容积的参数图像。利用容积归一化和统计参数映射，我们将每位患者的全脑容积与正常组的脑容积进行比较，以生成11C-氟马西尼结合异常区域的图谱，然后将其叠加到容积磁共振图像上。这使得能够建立结构与功能之间的相关性。在这12例患者中，10例显示至少有一个11C-氟马西尼结合异常区域；异常区域通常比磁共振成像所见的病变范围更广。11C-氟马西尼结合异常在磁共振成像表现正常的皮质区域也经常出现。病变的特征是γ-氨基丁酸A型/苯二氮䓬受体可利用性增加，与以往研究中发现的降低情况相反。这些发现对与皮质发育异常相关的癫痫障碍的神经生物学以及对考虑手术治疗的此类患者的管理具有重要意义。
