Runge U, Kirsch G, Petersen B, Kallwellis G, Gaab M R, Piek J, Kessler C
Department of Neurology, Ernst-Moritz-Arndt-University of Greifswald, Germany.
Acta Neurol Scand. 1997 Nov;96(5):271-6. doi: 10.1111/j.1600-0404.1997.tb00283.x.
Forty-one ECD (Technetium-99m-ethyl cysteinate dimer) SPECT investigations were undertaken in the course of a presurgical diagnostic work-up in 23 patients with pharmacoresistant focal epilepsy. In 21 patients, both an ictal and interictal SPECT were conducted. In the patients receiving ictal SPECT the tracer was injected between 7 and 30 s after the seizure onset. Of the interictal SPECTs 17 of 23 showed focal hypoperfusion which was consistent in 17 cases (74%) with the area of the electrophysiological focus (EF) and 6 patients had a normal interictal SPECT. Of the ictal SPECTs 18 of 21 (86%) showed regional hyperperfusion, 18 of them in the same location as the EF. Ictal SPECT showed a hypoperfusion similar to that in interictal SPECT in another 3 patients. In these cases seizure duration was short (28-54 s), so that the tracer reached the brain postictally. Our results show that ictal ECD-SPECT is an effective method for demonstrating an epileptogenic focus. Possible reasons for false-negative ictal SPECT results are discussed.
在对23例药物难治性局灶性癫痫患者进行术前诊断检查过程中，进行了41次锝-99m-乙基半胱氨酸二聚体（ECD）单光子发射计算机断层扫描（SPECT）检查。21例患者同时进行了发作期和发作间期SPECT检查。在接受发作期SPECT检查的患者中，在癫痫发作开始后7至30秒之间注射示踪剂。在发作间期SPECT检查中，23例中有17例显示局灶性灌注减低，其中17例（74%）与电生理病灶（EF）区域一致，6例患者发作间期SPECT正常。在发作期SPECT检查中，21例中有18例（86%）显示局部血流灌注增加，其中18例与EF位于同一位置。另外3例患者发作期SPECT显示出与发作间期SPECT类似的灌注减低。在这些病例中，癫痫发作持续时间较短（28 - 54秒），因此示踪剂在发作后到达大脑。我们的结果表明，发作期ECD - SPECT是显示癫痫病灶的有效方法。讨论了发作期SPECT结果假阴性的可能原因。
