FDG-PET与MRI融合技术在MRI阴性局灶性癫痫中的诊断价值

发布时间：2018-06-24 05:46

  本文选题：MRI阴性癫痫 + FDG-PET　； 参考：《浙江大学》2017年硕士论文

【摘要】：研究背景与目的:1、目的:FDG-PET是目前难治性局灶性癫痫患者行癫痫术前评估的重要检查之一,但因其自身局限性,单独FDG-PET检查的致痫灶检出率并不高,致痫灶定位准确性不够。进一步的FDG-PET/MRI融合技术(PM-C)已被报道运用于临床,有较高的致痫灶检出率及较准确的致痫灶定位特点。本研究为了证明PM-C在MRI阴性局灶性癫痫中的诊断价值及对于高分辨头颅MRI二次分析和临床决策的指导意义。2、方法:连续性纳入2012年9月1日-2016年8月31日于浙江大学医学院附属第二医院癫痫中心住院的难治性局灶性癫痫患者。所有患者均行长程视频脑电图监测,普通头颅核磁共振平扫,高分辨薄层并可重建为3D模型的头颅核磁共振T1WI扫描及其它高分辨磁共振序列,头颅FDG-PET扫描等。将高分辨头颅MRI初次分析结果分为"可疑异常"及"正常",其后使用Analyze和SPM8将高分辨头颅MRI及FDG-PET图像进行融合,在融合结果的指导下二次分析高分辨头颅MRI,将影像判读结果的改变类型分为Ⅰ类改变(包括Ⅰa和Ⅰb)、Ⅱ类改变(Ⅱa和Ⅱb)和无改变三类;临床决策主要包括埋藏颅内电极和手术治疗。综合临床及影像特点,将难治性局灶性癫痫患者分为颞叶癫痫组和颞叶外癫痫组,并分别比较两组在PM-C指导下高分辨头颅MRI二次分析后三类改变的比例及临床决策改变的特点。3、结果:本研究共纳入112例行PDG-PET扫描的MRI阴性难治性局灶性癫痫患者,其中67例为颞叶外癫痫,40例为颞叶癫痫,5例为不能明确分类。颞叶和颞叶外癫痫的FDG-PET低代谢具有不同特点,颞叶癫痫的低代谢范围通常比较广泛,且约50%的患者具有远隔区域如同侧眶额回、同侧岛叶、同侧岛盖周围及对侧前颞叶等低代谢;而颞叶外癫痫的低代谢范围通常较局限;单独的FDG-PET对于病灶的发现率在颞叶和颞叶外癫痫中分别为57.5%和29.9%(23/40和20/67),而PM-C结果给予颞叶和颞叶外癫痫定位致痫灶提供了更多信息(包括Ⅰa、Ⅰb和Ⅱa类改变),总的改变率分别为95%(38/40)和79.1%(53/67);其中有15例BOSD患者,初次高分辨头颅MRI报告为正常,在融合结果的指导下,11例高分辨头颅MRI二次分析后发现了病灶,从而改变了临床决策。4、结论:本研究发现综合FDG-PET/MRI融合与电临床假设,使得至少一半以上原先头颅MRI报告为"阴性"者转变为"阳性",从而改变了是否需要埋藏颅内电极或手术治疗等临床决策。对于高分辨头颅MRI始终为阴性的患者,PM-C也提供了额外的定位信息。从而促使这些癫痫难以良好控制的患者能取得更好的治疗方式,进而控制或者减轻癫痫带来的影响。
[Abstract]:Background & AIM: 1. Objective: FDG-PET is one of the important examinations for preoperative evaluation of epilepsy in patients with intractable focal epilepsy. However, due to its limitations, the detection rate of epileptigenic foci by FDG-PET alone is not high, and the accuracy of epileptogenic foci localization is not enough. Further FDG-PET / MRI fusion technique (PM-C) has been reported to be used in clinical practice with high detection rate of epileptogenic foci and accurate localization of epileptogenic foci. The purpose of this study was to demonstrate the diagnostic value of PM-C in MRI negative focal epilepsy and its guiding significance for high-resolution cranial MRI secondary analysis and clinical decision-making. Methods: continuity was incorporated into Zhejiang Province from September 1, 2012 to August 31, 2016. Inpatients with refractory focal epilepsy in epilepsy center of the second affiliated Hospital of University Medical College. All the patients were monitored by video EEG, plain MRI scan, T1WI scan and other high resolution MRI sequences, FDG-PET scan, and so on. The initial results of high-resolution cranial MRI were classified as "suspicious abnormality" and "normal". Analyze and SPM8 were then used to fuse the high-resolution cranial MRI and FDG-PET images. Under the guidance of fusion results, high resolution cranial MRIs were analyzed twice. The results of image interpretation were divided into three types: 鈪，

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