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目的 探讨 18F -脱氧葡萄糖 (FDG)PET显像对癫痫灶的定位诊断价值。方法 难治性癫痫患者 2 2例 ,男 15例 ,女 7例 ,平均年龄 19.0岁 ,平均病程 8.2年。所有患者均进行常规 18F -FDGPET显像 ,结合脑电图 (EEG)及MRI、CT对 2 1例患者进行开颅手术 ,术中在皮层脑电图 (EcoG)监测下行致痫灶切除术 ,并送病理学检查 ;另 1例进行立体定向杏仁、海马损毁术。所有患者术后随访疗效。结果 2 2例癫痫患者中 ,2 1例 18F -FDGPET显像阳性 (95 .5 % ) ,2 0例表现为发作间期低代谢灶 ,1例为发作期高代谢灶 ;EEG检查阳性 17例 (77.3 % ) ,其中 8例无定位意义 ;CT、MRI阳性者 5例 (2 2 .7% ) ;18F -FDGPET定位的致痫灶与EcoG一致的有 18例 (85 .7% ) ,不完全一致的 2例 ,不一致的 1例 ;18F -FDGPET显像阳性 19例中 ,18例手术病理异常 (94.7% ) ,PET阴性的 1例手术病理为正常脑组织 ;开颅手术治疗后 ,癫痫发作完全消失者 9例 (4 2 .9% ) ,癫痫发作次数减少 5 0 %以上者 9例 (4 2 .9% ) ,发作次数无明显变化 3例 (14 .3 % ) ;另 1例进行立体定向杏仁海马损毁术的患者癫痫发作次数无明显变化。结论 18F -FDGPET显像对致痫灶的定位诊断灵敏、准确 ,对指导癫痫外科手术有重要的临床价值
Objective To investigate the value of 18F-FDG PET imaging in the diagnosis of epileptic foci. Methods Twenty-two patients with refractory epilepsy were enrolled, including 15 males and 7 females, with a mean age of 19.0 years and an average duration of 8.2 years. All patients underwent conventional 18F-FDG PET imaging. 21 patients underwent craniotomy combined with EEG and MRI and CT, undergoing epileptogenic resection under the monitoring of cortical EEG, And sent to pathological examination; the other one for stereotactic almond, hippocampal damage surgery. All patients were followed up after treatment. Results Twenty-two cases of epilepsy were positive in 18F-FDG PET imaging (95.5%). 20 cases showed low metabolic period in the interictal period and high metabolic stage in one episode. EEG examination was positive in 17 cases (77.3%), of which 8 had no localization significance. CT and MRI were positive in 5 cases (22.7%). Eighteen cases (85.7%) were consistent with EcoG in 18F-FDG PETEG. 2 cases were completely consistent and 1 case was inconsistent. Of the 19 cases with positive 18F-FDG PET imaging, 18 cases were pathologically abnormal (94.7%) and 1 case was PET-negative. The surgical pathology was normal brain tissue. After craniotomy, epilepsy 9 cases (42.9%) with complete disappearance of seizure, 9 cases (42.9%) with seizure frequency reduction more than 50%, 3 cases (14.3%) with no obvious change in seizure frequency; the other 1 case There was no significant change in the number of seizures in patients with stereotactic almond hippocampal damage. Conclusions 18F-FDG PET imaging is sensitive and accurate for the localization diagnosis of epileptic foci, and has important clinical value for directing epilepsy surgery