Matheja P, Kuwert T, Stodieck S R, Diehl B, Wolf K, Schuierer G, Ringelstein E B, Schober O
Kliniken und Polikliniken für Nuklearmedizin, Westfälische Wilhelms-Universität Münster, Deutschland.
Nuklearmedizin. 1998;37(7):221-6.
In contrast to medically refractory complex partial seizures (CPS), only limited knowledge exists on cerebral perfusion and metabolism in medically non-refractory CPS. The aim of this study was to investigate the frequency of temporal asymmetries in regional cerebral glucose consumption (rCMRGlc), regional cerebral blood flow (rCBF), and regional cerebral benzodiazepine receptor density (BRD) in this group of patients.
The study included 49 patients with medically non-refractory cryptogenic CPS (age: 36.0 +/- 16.1 years). rCMRGlc was studied with F-18-FDG-PET (FDG), rCBF with Tc-99m-ECD-SPECT (ECD), and BRD with l-123-iomazenil-SPECT (IMZ). All studies were performed interictally and within four weeks in each patient. Duration of epilepsy ranged from 0.1 to 42 years (median 4.0 years). SPECT was performed with the triple-headed SPECT camera Multispect 3, PET with the PET camera ECAT EXACT 47. Using linear profiles, glucose consumption, as well as uptake of ECD and IMZ, were measured in four temporal regions of interest (ROIs), and asymmetry indices were calculated (ASY). The results were compared to 95% confidence intervals determined in control subjects.
Thirty-five of the 49 (71%) patients had at least one significantly elevated ASY; temporal rCMRGlc was asymmetrical in 41% of the patients, temporal BRD in 29%, and temporal rCBF in 24%. One patient had an asymmetry of all three variables, two of temporal rCMRGlc and BRD, three of temporal rCMRGlc and rCBF, and another four of rCBF and BRD. Fourteen patients had an isolated temporal asymmetry in rCMRGlc, seven in BRD, and four in rCBF. A discrepancy in lateralization between the three modalities was not observed.
The majority of patients with medically non-refractory CPS have focal abnormalities of blood flow and metabolism in their temporal lobe. In this group of patients, FDG-PET demonstrates abnormalities with the highest frequency of the three modalities studied, followed by IMZ-SPECT, and ECD-SPECT.
与药物难治性复杂部分性发作（CPS）不同，对于药物非难治性CPS的脑灌注和代谢，人们了解有限。本研究的目的是调查该组患者颞叶区域脑葡萄糖代谢率（rCMRGlc）、区域脑血流量（rCBF）和区域脑苯二氮䓬受体密度（BRD）的颞叶不对称频率。
本研究纳入49例药物非难治性隐源性CPS患者（年龄：36.0±16.1岁）。采用F-18-FDG-PET（FDG）研究rCMRGlc，采用Tc-99m-ECD-SPECT（ECD）研究rCBF，采用l-123-碘美托咪定-SPECT（IMZ）研究BRD。所有检查均在发作间期进行，且每位患者在四周内完成。癫痫病程为0.1至42年（中位数4.0年）。SPECT检查使用三头SPECT相机Multispect 3进行，PET检查使用PET相机ECAT EXACT 47进行。使用线性轮廓法，在四个颞叶感兴趣区（ROI）测量葡萄糖代谢以及ECD和IMZ的摄取，并计算不对称指数（ASY）。将结果与在对照受试者中确定的95%置信区间进行比较。
49例患者中有35例（71%）至少有一项ASY显著升高；41%的患者颞叶rCMRGlc不对称，29%的患者颞叶BRD不对称，24%的患者颞叶rCBF不对称。1例患者所有三个变量均不对称，2例患者颞叶rCMRGlc和BRD不对称，3例患者颞叶rCMRGlc和rCBF不对称，另有4例患者rCBF和BRD不对称。14例患者仅颞叶rCMRGlc不对称，7例患者BRD不对称，4例患者rCBF不对称。未观察到三种检查方法之间的定位差异。
大多数药物非难治性CPS患者颞叶存在血流和代谢的局灶性异常。在该组患者中，FDG-PET显示异常的频率在三种研究方法中最高，其次是IMZ-SPECT和ECD-SPECT。
