发作间期SPECT对难治性颞叶癫痫的诊断价值

摘要

目的:探讨难治性颞叶癫痫(TLE)单光子发射计算机断层(SPECT)的影像特征及定位诊断价值.方法:选择35例经临床手术证实的难治性TLE,术前均行发作间期SPECT脑血流灌注显像和常规MRI扫描.以临床定位结果做对照,观察难治性TLE的SPECT影像改变,分析发作间期脑血流灌注显像定位诊断颞叶致痫灶的临床应用价值.结果:难治性颞叶癫痫SPECT的影像特征为致痫灶侧前颞叶内侧和/或外侧皮质的血流灌注减低,对侧前颞叶的内侧皮质可出现轻度的灌注减低.常合并与患侧同侧的一处或以上脑区的灌注减低.SPECT致痫灶定位诊断的阳性率达77.14％00(27/35),尤其能检出52.94％ (9/17) MRI阴性TLE的致痫灶.结论:发作间期SPECT脑血流灌注显像能丰富难治性TLE的定位诊断信息,提高定位MRI阴性TLE患者致痫灶的比例.%Objective:To explore the characteristics and its localization value of single photon emission computed tomography (SPECT) in the patients with intractable temporal lobe epilepsy (TLE). Methods: Thirty-five selected patients with unilateral intractable TLE verified by operation and pathology were studied. All of them were performed interictal SPECT cerebral blood flow (CBF) perfusion imaging and routine magnetic resonance imaging (MRI) before the operation. The characteristics of SPECT imaging were ovserved and the value of the location diagnosis in epilepsy focus of interictal CBF perfusion imaging was explored. Results: In interictal period, the epilepsy foci were observed as hypoperfusion zone, appeared in both or either of medial and lateral parts of unilateral temporal lobes, mild hypoperfusion may appeared in medial part of contralateral temporal lobes and some of them had mild hypoperfusion in other lobes of brain besides the temporal lobes. Location accuracy rate of SPECT was 77. 14% (27/35), and 52. 94% (9/17) of cases with negative MRI showed positive SPECT. Conclusion:Interictal SPECT CBF perfusion imaging can provide TLE localization information. For patients with negative MRI. SPECT can greatly improve the accuracy rate of foci localization.