摘要
目的评价一种在视频脑电监测（VEEG）下结合半定量分析的脑血流灌注SPECT显像法用于癫痫致痫灶定位诊断的价值。方法对81例难治性癫痫患者的临床资料进行回顾性分析。脑血流灌注SPECT在VEEG监测下进行，显像前以睡眠剥夺、逐步减少或停服抗癫痫药的方式争取诱发癫痫发作。影像判读采用视觉判断与半定量分析结合的方法。结果19例同时获得发作期和发作间期显像，62例仅获得发作间期显像。SPECT、VEEG和MRI对病灶的检出率分别为95％、98％和42％，SPECT与VEEG检出率之间差异无统计学意义（P〉0．05），但二者均显著高于MRI（χ^2=52．913，P〈0．001；χ^2=59．247，P〈0．001）。SPECT与VEEG、SPECT与MRI和MRI与VEEG对病灶的定位符合率分别为69％、25％和27％，SPECT与VEEG之间的符合率显著高于SPECT与MRI（χ^2=26．905，P〈0．001）及MRI与VEEG之间的符合率（χ^2=26．905，P〈0．001）。SPECT、VEEG和MRI的定位准确性分别为83％、74％和52％；术后随访结果示，疗效达Ⅰ-Ⅱ级患者中，有11例（n=14）其术前SPECT与VEEG定位结果一致。结论脑SPECT显像法对致痫灶定位具有较高的价值，提倡作为常规检查法用于难治性癫痫的定位诊断。
Objective To investigate the value of the cerebral blood flow SPECT used for localization of epileptogenic zone in patients with intractable epilepsy, which was performed under the video- electroencephalogram （ VEEG ） monitoring combined with the semi-quantitative analysis. Methods Cerebral blood flow SPECT was performed under VEEG monitoring and seizures were captured either by sleep-deprived or by reducing dose or by withholding of antiepileptic drugs （AEDs）. Neurogam analysis was used in the procedure of image interpretation. Results 19 inter-ictal combined with ictal images and 62 only inter-ictal images were obtained in this study. The detection rates of the pathological focus for SPECT, VEEG and MRI were 95%, 98% and 42%, respectively. There was no significant difference between SPECT and VEEG, but both methods were significant higher than MRI （χ^2= 52. 913, P 〈0. 001 ;χ^2 =59. 247, P 〈0. 001）. The accordance rate of localization of pathological focus between SPECT and VEEG （69%） was significant higher than the accordance rate between SPECT and MRI （25% ;χ^2 =25.905, P 〈0.001） and between VEEG and MRI （27% ;χ^2=26.905, P 〈0.001）. The localization accuracy of SPECT, VEEG and MRI were 83% ,74% and 52%, respectively. Of the 14 patients who had an Engel class I or II outcome after surgery, there were llcases came from its coincidence between SPECT and VEEG. Conclusions The cerebral SPECT imaging method applied in this study was relatively simple and convenient and could play an important role in the localization of epileptogenic zone. It could be used as a routine test in patients with intractable epilepsy.
出处
《中华神经外科杂志》
CSCD
北大核心
2014年第6期604-607,共4页
Chinese Journal of Neurosurgery
关键词
难治性癫痫
视频脑电图
致痫灶
Intractable epilepsy
Video electroencephalogram
Epileptogenic zone
