Menzel C, Steidele S, Grünwald F, Hufnagel A, Pavics L, Elger C E, Biersack H J
Department of Nuclear Medicine, University of Bonn, Germany.
J Nucl Med. 1996 Jul;37(7):1106-12.
In childhood epilepsy, it is difficult, but of critical importance, to determine whether surgical intervention might be beneficial for an individual patient. Because both established procedures-MRI and electroencephalography (EEG)-have limitations, interictal and ictal regional cerebral blood flow (rCBF) SPECT has proven to be a valuable adjunctive method in the presurgical evaluation of children.
We evaluated the usefulness of the new rCBF tracer 99mTc-ECD in 14 children with focal epilepsy (mean age 9.7 yr). Eleven interictal and 8 ictal studies were performed. Results were correlated with ictal and interictal surface EEG, MRI and histological findings and the postsurgical outcome.
On the basis of the presurgical evaluation, nine patients underwent surgery. MRI studies demonstrated pathological features with possible relation to epilepsy in 50%. Overall, interictal 99mTc-ECD SPECT showed areas of hypoperfusion in 80% of patients. Ictal rCBF SPECT was informative in all patients, including one who showed bifrontal hyperperfusion in accordance with EEG results.
Technetium-99m-ECD has proven to be of value for interictal and ictal rCBF SPECT in childhood epilepsy. No side effects during or after tracer administration were noticed. Ictal and interictal rCBF SPECT showed good correlation with MRI and EEG results in patients in whom correlation with the postoperative situation was possible and presented additional significant information in those patients with normal MRI and uninterpretable EEG results. No false lateralizations occurred. In children with focal epilepsy, interictal rCBF SPECT may accelerate the application of long-term electrocorticography (ECoG) in patients with normal MRI results. Ictal rCBF SPECT may also help to avoid ECoG, if a focal hyperperfusion correlates with a focal MRI abnormality, and the surface EEG gives no contradictory information.
在儿童癫痫中，确定手术干预对个体患者是否有益既困难又至关重要。由于既定的两种检查方法——磁共振成像（MRI）和脑电图（EEG）——都有局限性，发作间期和发作期局部脑血流（rCBF）单光子发射计算机断层扫描（SPECT）已被证明是儿童术前评估中有价值的辅助方法。
我们评估了新型rCBF示踪剂99mTc - ECD在14例局灶性癫痫患儿（平均年龄9.7岁）中的应用价值。进行了11次发作间期和8次发作期研究。结果与发作期和发作间期头皮脑电图、MRI及组织学结果以及术后结果相关联。
基于术前评估，9例患者接受了手术。MRI研究显示50%的患者有与癫痫可能相关的病理特征。总体而言，发作间期99mTc - ECD SPECT显示80%的患者有灌注减低区域。发作期rCBF SPECT对所有患者均有诊断价值，包括1例根据脑电图结果显示双额叶灌注增加的患者。
99mTc - ECD已被证明在儿童癫痫的发作间期和发作期rCBF SPECT中具有价值。在示踪剂给药期间及之后未观察到副作用。在那些术后情况可关联的患者中，发作期和发作间期rCBF SPECT与MRI和脑电图结果显示出良好的相关性，并且在MRI正常和脑电图难以解读的患者中提供了额外的重要信息。未出现假定位。在局灶性癫痫患儿中，发作间期rCBF SPECT可能会加快在MRI结果正常的患者中应用长期皮质脑电图（ECoG）。如果局灶性灌注增加与局灶性MRI异常相关，且头皮脑电图未给出矛盾信息，发作期rCBF SPECT也可能有助于避免使用ECoG。
