ECT脑血流灌注显像、CT和MRI在难治性癫痫中的诊断价值分析

doi:10.7517/issn.1674-0475.190516

摘要/Abstract

摘要： 选择2013年10月~2018年12月于我院收治的53例经临床确诊的难治性癫痫患者临床资料，所有患者均于发作间期分别行常规CT、MRI、SPECT检查，观察3种方法对致痫病灶检出和定位准确率，探讨单光子发射计算机断层成像术（SPECT）、CT和MRI在难治性癫痫中的诊断价值。结果显示，SPECT检测患侧rCBF低于健侧[（46.05±7.62）vs（54.51±9.39），P<0.05]，MRI检测患侧NAA（cho+Cr）低于健侧[（0.47±0.05）vs（0.69±0.11），P<0.05]。SPECT对致痫灶检出率、定位准确率分别为81.13%、73.58%，均高于MRI和常规CT（P<0.05）。联合SPECT、CT、MRI对致痫灶检出率、定位准确率达94.34%、92.45%，高于单独诊断（P<0.05），联合rCBF+NAA（cho+Cr）预测致痫病灶位置的AUC达0.923，灵敏度和特异度达82.26%、98.91%，高于rCBF、NAA（cho+Cr）（P<0.05）。结论：PET-CT、MRI对难治性癫痫术前定位均有较高临床应用价值，PET-CT在致痫灶检率、定位定侧方面更有优势，联合诊断更有助于提高定位准确率。

关键词: 难治性癫痫, SPECT, CT, MRI, 定位

Abstract: The clinical data of 53 patients with intractable epilepsy admitted to our hospital from October 2013 to December 2018 were retrospectively selected. All patients were examined by routine CT, MRI and SPECT during the interval of epilepsy. The accuracy of detection and localization of epileptic foci by three methods was observed. To explore the diagnostic value of single-photon emission computed tomography (PET-CT), CT and MRI in intractable epilepsy. Results:The rCBFdetected by SPECT of the affected side was lower than that of the healthy side[(46.05±7.62)vs(54.51±9.39), P < 0.05]. The NAA (cho+Cr) detected by MRI of the affected side was lower than that of the healthy side[(0.47±0.05) vs (0.69±0.11), P<0.05]. The detection rate and localization accuracy of SPECT for epileptogenic focus were 81.13% and 73.58%, respectively, which were higher than those of MRI and conventional CT (P<0.05). The detection rate and localization accuracy of combined SPECT, CT and MRI were 94.34% and 92.45%, higher than that of single diagnosis (P<0.05). The AUC of rCBF + NAA (cho + Cr) in predicting the location of epileptogenic focus was 0.923, the sensitivity and specificity were 82.26% and 98.91%, higher than that of rCBFand NAA (cho + Cr) (P<0.05). Conclusion:SPECT, and MRI have high clinical value in preoperative localization of intractable epilepsy. SPECT, has more advantage in the detection rate of epileptogenic foci and localization and lateral localization. Combined diagnosis is more helpful to improve the accuracy of localization.

Key words: intractable epilepsy, SPECT, CT, MRI, localization

李玉花, 罗昕, 于克文, 巩晓, 刘伟, 曾祥芹, 何兵. ECT脑血流灌注显像、CT和MRI在难治性癫痫中的诊断价值分析[J]. 影像科学与光化学, 2019, 37(4): 378-384.

LI Yuhua, LUO Xin, YU Kewen, GONG Xiao, LIU Wei, ZENG Xiangqin, HE Bing. Diagnostic Value of ECT Cerebral Perfusion Imaging, CT and MRI in Intractable Epilepsy[J]. Imaging Science and Photochemistry, 2019, 37(4): 378-384.

参考文献

[1] Hauser R M, Henshall D C, Lubin F D.The epigenetics of epilepsy and its progression[J].Neuroscientist, 2018, 24(2):186-200.
[2] 邵明岩, 吴晓牧, 徐荣.PET-CT、MRI及EEG对发作间期难治性癫痫患者致痫灶定位的研究[J].南昌大学学报(医学版), 2014, 54(9):33-37. Shao M Y, Wu X M, Xu R.Localization of epileptogenic focus with PET-CT, MRI and EEG in patients with interictal intractable epilepsy[J].Journal of Nanchang University(Medical Sciences), 2014, 54(9):33-37.
[3] Rüber T, David B, Elger C E.MRI in epilepsy:clinical standard and evolution[J].Current Opinion in Neurology, 2018, 31(2):223-231.
[4] Wang G B, Long W, Li X D, Xu G Y, Lu J X.Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) combined with positron emission tomography-computed tomography (PET-CT) and video-electroencephalography (VEEG) have excellent diagnostic value in preoperative localization of epileptic foci in children with epilepsy[J].Medical Science Monitor, 2017, 23:1-10.
[5] Garriga M, Milà M, Mir M, Al-Baradie R, Huertas S, Castejon C, Casas L, Badenes D, Giménez N, Font M A, Gonzalez J M, Ysamat M, Aguilar M, Slevin M, Krupinski J.123 I-FP-CIT SPECT imaging in arly diagnosis of dementia in patients with and without a vascular component[J].Frontiers in Systems Neuroscience, 2015, 9:99.
[6] 王雪梅, 赵世刚, 王宏伟, 高乃康, 韩晓东.PET/CT与脑电图和MRI对难治性癫痫的对比研究[J].中华临床医师杂志(电子版), 2010, 4(8):1213-1217. Wang X M, Zhao S G, Wang H W, Gao N K, Han X D.Comparative study on diagnosis of refractory epilepsy by PET/CT, EEG and MRI[J].Journal of Clinicians (Electronic Edition), 2010, 4(8):1213-1217.
[7] 关乐, 卢洁, 曹燕翔, 张人玲, 梁志刚, 李坤成.海马硬化所致颞叶癫痫SPECT与MRI脑血流灌注对照研究[J].国际医学影像学杂志, 2018, 28(11):1769-1774. Guan L, Lu J, Cao Y X, Zhang R L, Liang Z G, Li K C.Interictal SPECT and MRI cerebral blood flow control study in hippocampal sclerosis temporal lobe epilepsy[J]. Journal of Medical Imaging, 2018, 28(11):1769-1774.
[8] 赵春雷, 陈自谦, 钱根年, 付丽媛, 杨忠东, 王楷堂.MRI与¹⁸F-FDG PET对难治性颞叶癫痫定侧诊断价值[J].功能与分子医学影像学(电子版), 2016, 5(1):813-817. Zhao C L, Chen Z Q, Qian G N, Fu L Y, Yang Z D, Wang K T.An investigation on the clinical application of MRI and 18F-FDG PET in the localization of intractable temporal lobe epilepsy[J].Functional and Molecular Medical Imaging(Electronic Edition), 2016, 5(1):813-817.
[9] 刘梁新, 简忠庆.癫痫的CT诊断及其价值评价[J].中国伤残医学, 2014, 22(18):116-117. Liu L X, Jian Z Q.CT diagnosis of epilepsy and its value evaluation[J].Chinese Journal of Trauma and Disability Medicine, 2014, 22(18):116-117.
[10] Jha P, Agarwal K K, Sahoo M K, Kumar R.Mammillary body:chronic refractory epilepsy seizure focus detected by ¹⁸F-FDG PET-CT[J].Clinical Nuclear Medicine, 2016, 41(5):419-420.
[11] Gupta S, Jayalakshmi S, Lingappa L, Konanki R, Vooturi S, Sudhakar P, Panigrahi M.Ictal FDGPET and SPECT in hemifacial seizures due to cerebellar epilepsy-case report[J].Neurology India, 2019, 67(1):169-172.
[12] Karande S, Deshmukh N, Rangarajan V, Agrawal A, Sholapurwala R.Brain SPECT scans in students with specific learning disability:preliminary results[J].Journal of Postgraduate Medicine, 2019, 65(1):33-37.
[13] Shiga T, Suzuki A, Sakurai K, Kurita T.Takeuchi W,Toyonaga T,Hirata K,Kobashi K,Katoh C,Kubo N,Tamaki N.Dual isotope SPECT study with epilepsy patients using semiconductor SPECT system[J].Clinical Nuclear Medicine, 2017, 42(9):663-668.
[14] Takayama R, Imai K, Ikeda H, Baba K, Usui N, Takahashi Y, Inoue Y.Successful hemispherotomy in two refractory epilepsy patients with cerebral hemiatrophy and contralateral EEG abnormalities[J].Brain Development, 2018, 40(7):601-606.
[15] Momen A A, Ahmadi F, Malekian A.Davoodzadeh H, Kabirinia H. Evaluation of hospitalized intractable epileptic children with SPECT scan in Ahvaz, south west of Iran[J].Journal of Clinical Diagnostic Research, 2016, 10(10):SM01-SM03.
[16] Martinez-Rios C, McAndrews M P, Logan W, Krings T, Lee D, Widjaja E.MRI in the evaluation of localization-related epilepsy[J].Journal of Magnetic Resonance Imaging, 2016, 44(1):12-22.
[17] Yang J Y, Beare R, Seal M L, Harvey A S, Anderson V A, Maixner W J.A systematic evaluation of intraoperative white matter tract shift in pediatric epilepsy surgery using high-field MRI and probabilistic high angular resolution di-ffusion imaging tractography[J].Journal of Neurosurgery, 2017, 19(5):592-605.
[18] Fadaie F, Mobarakeh N M, Fesharaki S S, Harirchian M H, Kharazi H H, Rad H S, Habibabadi J M.¹H-MRS metabolite's ratios show temporal alternation in temporal lobe seizure:comparison between interictal and postictal phases[J].Epilepsy Research, 2016, 128:158-162.
[19] 刘红军, 尚丽, 余五珍, 张小燕, 王守章.药物难治性癫痫MRI表现与脑电图及病理对照研究[J].中国生化药物杂志, 2017, 37(10):421-422. Liu H J, Shang L, Yu W Z, Zhang X Y, Wang S Z.Comparative study of MRI manifestations and EEG and pathology of drug refractory epilepsy[J]. Chinese Journal of Biochemical Pharmaceutics, 2017, 37(10):421-422.
[20] 刘海波, 杨中鑫, 范英俊, 张杰.颞叶癫痫患者脑部病理改变与EF-Tumt、EF-Tsmt表达情况分析[J].中国医学前沿杂志(电子版), 2017, 9(3):128-131. Liu H B, Yang Z X, Fan Y J, Zhang J.Analysis of brain pathological changes and the expression of EF-Tumt and EF-Tsmt in patients with temporal lobe epilepsy[J].Chinese Journal of the Frontiers of Medical Science (Electronic Version), 2017, 9(3):128-131.