目的 评价基于SPM的脑内不对称分析法在18F-FDG PET代谢显像对单侧难治性颞叶癫(间)(TLE)患者致(间)灶辅助定侧定位诊断中的应用价值.方法 回顾性分析2012年3月至2015年7月间73例[男42例、女31例,平均年龄(27.10±9.78)岁]单侧TLE患者及30名[男17名、女13名,平均年龄(33.79±5.46)岁]健康对照组的临床及影像学资料.通过18F-FDG PET/CT检查对TLE患者主要致(间)灶进行定侧定位,18F-FDG PET图像分析采用基于SPM的脑内不对称分析法、视觉分析法及不对称指数(AI)分析法.综合术后病理及预后,比较3种方法对单侧TLE患者主要致(间)灶的检出符合率.数据分析采用χ2分析及χ2分割检验.结果 运用基于SPM的脑内不对称分析法、视觉分析法及AI分析法对单侧TLE患者定侧定位诊断符合率分别为87.67％(64/73)、75.34％(55/73)及69.86％(51/73),差异有统计学意义(χ2=6.993,P<0.05);两两比较的结果显示,脑内不对称分析法与AI分析法、脑内不对称分析法与视觉分析法间差异有统计学意义(χ2值:8.481和5.818,均P<0.017),视觉分析法与AI分析法间差异无统计学意义(χ2=0.500,P>0.017),脑内不对称分析法的符合率明显高于视觉分析法及AI分析法.结论 基于SPM的脑内不对称分析法可以相对客观、准确地对单侧难治性TLE患者的主要致(间)灶进行定位,有较高的临床应用价值.%Objective To evaluate the diagnostic value of the SPM-based interhemispheric asymmetry analysis (SIAA) of 18F-FDG PET brain imaging in localization of temporal lobe epileptic foci.Methods A total of 73 patients (42 males,31 females,average age: (27.10±9.78) years) diagnosed as temporal lobe epilepsy (TLE) and 30 healthy volunteers (17 males,13 females,average age: (33.79±5.46) years) from March 2012 to July 2015 were enrolled in this retrospective study.18F-FDG PET brain imaging was performed on all subjects to localize temporal lobe epileptic foci.The results of 18F-FDG-PET were analyzed by SIAA,visual analysis and asymmetry index (AI) analysis.The accuracy of the three methods was evaluated according to the postoperative pathological results and curative effect.χ2 test and partition of χ2 test were used to analyze the data.Results The accuracies of localization with SIAA,visual analysis and AI analysis were 87.67％(64/73),75.34％(55/73) and 69.86％(51/73),respectively (χ2=6.993,P<0.05).The accuracy of SIAA was higher than that of visual analysis and AI analysis (χ2 values: 5.818 and 8.481,both P<0.017),while there was no significant difference between AI analysis and visual analysis (χ2=0.500,P>0.017).Conclusion The SIAA of 18F-FDG PET brain imaging may be a more objective and accurate method in localization of TLE foci.
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