摘要
目的 探讨18氟-氟代脱氧葡萄糖(18F-FDG)正电子发射体层摄影(PET)/CT与MRI高分辨成像在局灶性皮质发育不良(FCD)合并难治性癫痫患者中的诊断价值及显像特点.方法 回顾性分析2017年1月至2022年12月于济宁医学院附属医院就诊的42例FCD合并难治性癫痫患者的临床资料,所有患者术前均行头颅18F-FDG PET/CT显像及MRI高分辨成像,并对图像进行PET/MRI异机融合.采用卡方检验、Kappa一致性检验比较PET/CT、MRI、PET/MRI异机融合对患者癫痫灶的定位效能;根据患者性别、病灶部位、癫痫灶病理类型、癫痫发作类型、疗效进行分组,采用独立样本t检验、方差分析比较不同亚组间FCD合并难治性癫痫患者的最大标准摄取值(SUVmax)、放射性分布不对称指数(AI)之间的差异.结果 在42例患者中,MRI、PET/CT、PET/MRI异机融合检查的阳性率分别为85.7％(36/42)、95.2％(40/42)、100.0％(42/42),致痫灶定侧率分别为 71.4％(30/42)、92.9％(39/42)、95.2％(40/42),定位率分别为 57.1％(24/42)、81.0％(34/42)、88.1％(37/42).MRI 与 PET/CT对致痫灶的定侧率及定位率差异(x2=6.574、5.570;P=0.010、0.018)及与PET/MRI异机融合的病灶阳性率、致痫灶定侧率及定位率差异(x2=6.385、8.571、10.118;P=0.012、0.003、0.001)均有统计学意义.MRI与PET/CT的病灶阳性率及PET/CT与PET/MRI异机融合的病灶阳性率、致痫灶定侧率及定位率差异均无统计学意义(x2=2.184、2.024、0.210、0.819;P=0.139、0.155、0.647、0.365).将PET/CT、PET/MRI异机融合显像对致痫灶的定位情况行Kappa一致性检验,得出Kappa=0.721,提示两者在致痫灶定位上较为一致.颞叶型癫痫患者的SUVmax值低于、AI值高于颞叶外型患者(分别为7.4±1.3比9.6±1.6、15.5±2.6 比 12.9±2.4;t=5.154、6.083;P=0.001、0.001).疗效良好组(根据 Engel 疗效分级系统,Ⅰ～Ⅱ 级为疗效良好)患者的SUVmax值高于、AI值低于疗效不佳组(Engel疗效分级系统,Ⅲ～Ⅳ级为疗效不佳)患者(分别为9.5±1.9 比7.9±2.1、13.5±3.3 比 14.8±3.0;t=2.789、3.722;P=0.042、0.029).不同性别、病理类型、发作类型患者间的SUVmax值、AI值差异均无统计学意义(均P＞0.05).结论 不同类型FCD合并难治性癫痫患者的影像学显像特征存在差异,PET/MRI异机融合在FCD合并难治性癫痫患者中的诊断效能优于MRI,且与PET/CT在致痫灶定位上较为一致.
Abstract
Objective To investigate the diagnostic value and imaging characteristics of MRI combined with 18F-fluorodeoxyglucose(FDG)positron-emission tomography(PET)/CT in focal cortical dysplasia(FCD)complicated with refractory epilepsy.Methods A retrospective analysis was performed on 42 patients with FCD complicated with refractory epilepsy who were admitted to the Affiliated Hospital of Jining Medical University from January 2017 to December 2022.All patients underwent preoperative MRI and 18F-FDG PET/CT,and PET/MRI fusion was performed on the images.Chi-square test and Kappa consistency test were used to compare the localization diagnostic efficacy of PET/CT,MRI and PET/MRI fusion for epileptic foci.The patients were categorized based on gender,lesion location,pathological type,seizure type,and efficacy.Independent sample t-test and analysis of variance were used to compare maximum standardized uptake(SUVmax)values and asymmetry index(AI)of the patients between different groups.Results Among the 42 patients,the positive rates of MRI,PET/CT,PET/MRI fusion examinations were 85.7％(36/42),95.2％(40/42),100.0％(42/42),the lateral localization rates were 71.4％(30/42),92.9％(39/42),95.2％(40/42),and the localization rates were 57.1％(24/42),81.0％(34/42),88.1％(37/42),respectively.There were significant differences in the lateral localization rates and localization rates of epileptogenic foci between MRI and PET/CT(x2=6.574,P=0.010;x2=5.570,P=0.018).There were significant differences in the positive rates of lesions,the lateral localization rates and the localization rates of epileptogenic foci between MRI and PET/MRI fusion(x2=6.385,P=0.012;x2=8.571,P=0.003;x2=10.118,P=0.001).There were no significant differences in the positive rates of lesions between MRI and PET/CT,and in the positive rates of lesions,the lateral localization rates and localization rates of epileptogenic foci between PET/CT and PET/MRI fusion(X2=2.184,P=0.139;x2=2.024,P=0.155;x2=0.210,P=0.647;x2=0.819,P=0.365).The Kappa consistency test of PET/CT and PET/MRI fusion imaging was performed for the location of epileptogenic foci,and the Kappa=0.721 was obtained,indicating that they were consistent in the location of epileptogenic foci.The SUVmax values of patients with temporal lobe epilepsy were lower,and the AI values were higher than that of patients with extra temporal lobe epilepsy(7.4±1.3 vs 9.6±1.6,15.5±2.6 vs 12.9±2.4;t=5.154,6.083;P=0.001,0.001).The SUVmax values of patients with good efficacy(according to the Engel efficacy grading system,grades Ⅰ-Ⅱ indicating good efficacy)were higher,and the AI values were lower than that of patients with poor efficacy(according to the Engel efficacy grading system,grades Ⅲ-Ⅳ indicating poor efficacy;9.5±1.9 vs 7.9±2.1,13.5±3.3 vs 14.8±3.0;t=2.789,3.722;P=0.042,0.029).There were no significant differences in SUVmax and AI values among different genders,pathological types and seizure types(all P＞0.05).Conclusions The imaging characteristics of patients with different types of FCD complicated with refractory epilepsy are different.PET/MRI fusion is better than MRI in the diagnosis of FCD complicated with refractory epilepsy,and is consistent with PET/CT in the location of epileptogenic foci.
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