难治性颞叶癫痫患者发作间期静息态fMRI与PET-CT的多模态研究
发布时间：2018-09-12 13:49
【摘要】：研究目的 1、运用基于低频振幅算法（ALFF）的静息态fMRI技术对难治性颞叶癫痫(Temporal lobe epilepsy,TLE)患者发作间期的脑功能进行研究，分析难治性TLE在静息状态下的特征性脑功能改变，探讨其潜在的病理生理机制。 2、对难治性TLE患者发作间期脑18F-FDG PET-CT的图像SPM法进行分析，探讨发作间期患者大脑代谢的异常脑区并对癫痫灶进行定位。 材料与方法 1、选择16例符合诊断标准的难治性TLE患者及20例年龄性别匹配的健康对照组行静息态fMRI检查。利用DPARSF软件对静息态数据进行分析。计算并比较难治性TLE组和健康对照组的ALFF改变的脑区；并分析ALFF改变脑区与患病病程长短的相关性。 2、16例患者中12例行18F-FDG PET-CT检查，并与12例年龄性别匹配的健康对照组对照。利用SPM8后处理软件对18F-FDG PET-CT图像数据进行处理，分析癫痫患者相对于健康对照组代谢减低或代谢增高的脑区，并分析每个癫痫患者相对于健康对照组代谢减低或代谢增高的脑区；利用ROI感兴趣区法分析PET图像，对致痫灶进行定侧定位，并比较ROI及SPM两种方法对癫痫患者定位的应用。 结果 1、与正常对照组相比难治性TLE患者全脑ALFF值升高的脑区主要分布于桥脑、中脑及其周围、右侧额叶和颞叶、前扣带回、左侧尾状核、壳核和枕叶等区域。ALFF降低的脑区主要分布于后扣带回，楔前叶、顶下小叶、内侧前额叶、左侧额叶等脑区(P0.05)。难治性TLE与患病病程呈正相关的脑区，主要分布于右侧的颞上回及左侧额下回区域；呈负相关的脑区,主要分布于内侧前额叶、右侧顶下小叶、左侧颞叶等脑区(P0.05)。 2、SPM法除发现颞叶葡萄糖代谢减低外，还伴有同侧或双侧额叶及顶叶代谢减低；并发现对侧局部海马、海马旁回及局部颞叶葡萄糖代谢呈高代谢表现。 结论 1、难治性TLE患者发作间期静息状态下存在广泛的脑功能网络异常。并与患者发病病程具有一定的相关性，可能与患者的发病机制有关，并反映ALFF分析法可以有效地反映癫痫患者异常的神经功能网络，有助于我们解释难治性TLE的病理生理机制。 2、TLE患者的海马、海马旁回等部位ALFF活动增高，提示RS-fMRI具有一定的致痫灶定位价值。 3、ALFF活动减低的脑区主要分布于默认网络脑区，且随着TLE患者发病病程增加默认网络的活动水平趋于减低。 4、18F-FDG PET-CT脑显像SPM分析法是一种简便有效定位方法，与PET图像ROI分析相比，除可以发现颞叶代谢异常外，还有助于发现颞叶以外脑区代谢的异常，，对癫痫患者术前脑功能的评价及术后预后提供更多帮助。 5、TLE患者SPM法的18F-FDG PET-CT脑显像分析及ALFF分析法均有一定的定位价值，两者可相互补充。
[Abstract]:Objective 1. The interictal brain function of patients with intractable temporal lobe epilepsy (Temporal lobe epilepsy,TLE) was studied by resting fMRI technique based on low frequency amplitude algorithm (ALFF), and the characteristic changes of brain function of refractory TLE in resting state were analyzed. To explore its underlying pathophysiological mechanism. 2. To analyze the interictal 18F-FDG PET-CT of intractable TLE patients by image SPM method, and to explore the abnormal brain regions of brain metabolism and localize the epileptic foci in interictal patients. Materials and methods 1.Sixteen patients with refractory TLE who met the diagnostic criteria and 20 healthy controls matched with age and sex were examined with resting fMRI. The rest data are analyzed by DPARSF software. To calculate and compare the brain area of ALFF changes in refractory TLE group and healthy control group, and to analyze the correlation between the changes of ALFF brain area and the duration of disease. It was compared with 12 healthy controls matched with age and sex. The data of 18F-FDG PET-CT images were processed by SPM8 post-processing software to analyze the brain regions in which metabolism was decreased or increased in epileptic patients relative to the healthy control group, and the brain regions in which metabolism was decreased or increased in each epileptic patient relative to the healthy control group. The PET images were analyzed by ROI region of interest method, and the location of epileptogenic foci was determined. The application of ROI and SPM in epileptic localization was compared. Results 1. Compared with the control group, the increased global ALFF values in refractory TLE patients were mainly located in the pontine, the midbrain and its surroundings, the right frontal and temporal lobes, the anterior cingulate gyrus and the left caudate nucleus. The areas of decreased ALFF were mainly located in the posterior cingulate gyrus, precuneiform lobe, inferior parietal lobule, medial prefrontal lobe, left frontal lobe and so on (P0.05). Refractory TLE was positively correlated with the course of the disease, mainly in the right superior temporal gyrus and left inferior frontal gyrus, and negatively correlated in the medial prefrontal lobe, right inferior parietal lobule. In addition to the decreased glucose metabolism in the temporal lobe, there was a decrease in glucose metabolism in the ipsilateral or bilateral frontal and parietal lobes, and hypermetabolism of glucose in the contralateral hippocampus, para-hippocampal gyrus and local temporal lobe was found by SPM. Conclusion 1. There are extensive brain functional network abnormalities in patients with refractory TLE during interictal rest. It may be related to the pathogenesis of the patients, and reflect that ALFF analysis can effectively reflect the abnormal neural network in epileptic patients. It is helpful for us to explain the pathophysiological mechanism of refractory TLE. 2in the patients with TLE, the activity of ALFF in hippocampus and perihippocampal gyrus is increased. It is suggested that RS-fMRI has a certain value of localizing epileptogenic foci. 3 the brain regions with decreased activity of ALFF are mainly distributed in the default network brain area. As the course of TLE increased, the level of activity of the default network tended to decrease. 4 ~ (18) F-FDG PET-CT SPM analysis was a simple and effective method for localization. Compared with ROI analysis of PET images, abnormal metabolism of temporal lobe could be found. It is also helpful to find the abnormal metabolism of the temporal lobe in the external brain area, and to provide more help for the preoperative evaluation of brain function and postoperative prognosis in patients with epilepsy. 5 the 18F-FDG PET-CT imaging analysis and ALFF analysis of SPM in patients with epilepsy have certain localization value. The two complement each other.
【学位授予单位】：蚌埠医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R742.1
[Abstract]:Objective 1. The interictal brain function of patients with intractable temporal lobe epilepsy (Temporal lobe epilepsy,TLE) was studied by resting fMRI technique based on low frequency amplitude algorithm (ALFF), and the characteristic changes of brain function of refractory TLE in resting state were analyzed. To explore its underlying pathophysiological mechanism. 2. To analyze the interictal 18F-FDG PET-CT of intractable TLE patients by image SPM method, and to explore the abnormal brain regions of brain metabolism and localize the epileptic foci in interictal patients. Materials and methods 1.Sixteen patients with refractory TLE who met the diagnostic criteria and 20 healthy controls matched with age and sex were examined with resting fMRI. The rest data are analyzed by DPARSF software. To calculate and compare the brain area of ALFF changes in refractory TLE group and healthy control group, and to analyze the correlation between the changes of ALFF brain area and the duration of disease. It was compared with 12 healthy controls matched with age and sex. The data of 18F-FDG PET-CT images were processed by SPM8 post-processing software to analyze the brain regions in which metabolism was decreased or increased in epileptic patients relative to the healthy control group, and the brain regions in which metabolism was decreased or increased in each epileptic patient relative to the healthy control group. The PET images were analyzed by ROI region of interest method, and the location of epileptogenic foci was determined. The application of ROI and SPM in epileptic localization was compared. Results 1. Compared with the control group, the increased global ALFF values in refractory TLE patients were mainly located in the pontine, the midbrain and its surroundings, the right frontal and temporal lobes, the anterior cingulate gyrus and the left caudate nucleus. The areas of decreased ALFF were mainly located in the posterior cingulate gyrus, precuneiform lobe, inferior parietal lobule, medial prefrontal lobe, left frontal lobe and so on (P0.05). Refractory TLE was positively correlated with the course of the disease, mainly in the right superior temporal gyrus and left inferior frontal gyrus, and negatively correlated in the medial prefrontal lobe, right inferior parietal lobule. In addition to the decreased glucose metabolism in the temporal lobe, there was a decrease in glucose metabolism in the ipsilateral or bilateral frontal and parietal lobes, and hypermetabolism of glucose in the contralateral hippocampus, para-hippocampal gyrus and local temporal lobe was found by SPM. Conclusion 1. There are extensive brain functional network abnormalities in patients with refractory TLE during interictal rest. It may be related to the pathogenesis of the patients, and reflect that ALFF analysis can effectively reflect the abnormal neural network in epileptic patients. It is helpful for us to explain the pathophysiological mechanism of refractory TLE. 2in the patients with TLE, the activity of ALFF in hippocampus and perihippocampal gyrus is increased. It is suggested that RS-fMRI has a certain value of localizing epileptogenic foci. 3 the brain regions with decreased activity of ALFF are mainly distributed in the default network brain area. As the course of TLE increased, the level of activity of the default network tended to decrease. 4 ~ (18) F-FDG PET-CT SPM analysis was a simple and effective method for localization. Compared with ROI analysis of PET images, abnormal metabolism of temporal lobe could be found. It is also helpful to find the abnormal metabolism of the temporal lobe in the external brain area, and to provide more help for the preoperative evaluation of brain function and postoperative prognosis in patients with epilepsy. 5 the 18F-FDG PET-CT imaging analysis and ALFF analysis of SPM in patients with epilepsy have certain localization value. The two complement each other.
【学位授予单位】：蚌埠医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R742.1
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