摘要目的 探讨发作期单光子发射计算机断层显像减影和MRI图像配准(subtraction ictal SPECT co-registered to MRI,SISCOM)在癫痫源定位中的价值.方法 我们收集了2例代表性病例,其中1例具有脑软化灶:左顶叶弥散性囊性变;而另一例虽头颅MRI阴性,但需要鉴别颞叶内侧及颞叶外起源.2例患者均因术前无创性评估不能确定癫痫源,在充分知情同意的前提下,分别在发作间歇期和发作期注射示踪剂99mTc-双半胱乙酯进行SPECT检查.通过运用SISCOM技术处理,包括经过线性配准、体素标准化以及减影后,以灌注变化增高3个标准差作为差异有统计学意义,显示灌注增高的结果.结果 2例患者均观察到发作期与发作间歇期相比存在局灶的灌注增高.其中1例与弥散性软化灶相比,周围出现局限性高灌注;而另一例为内侧颞叶起源发作的典型高灌注模式.2例患者均准确定位了癫痫源区,在此基础上进行了手术治疗,术后均无发作.结论 SISOCM技术对难治性癫痫复杂病例可能具有积极的临床应用价值.

abstractsObjective To investigate the value of subtraction ictal SPECT co-registered to MRI (SISCOM) on localizing epileptogenic focus.Methods Two representative patients were enrolled.One suffered from refractory seizure due to diffuse encephalomalacia on left parietal lobe,while another showed MRI negative with frequency uncontrolled seizure,of which the origin from the medial temporal lobe or the temporal lobe needed to be identified.As the conventional approaches including semiological analysis,MRI and scalp electroencephalogram failed to describe the epileptogenic zone exactly,interictal and ictal 99mTcethyl cysteinate dimer (ECD) SPECT was further performed,followed by SISCOM processing,including linear coregister,voxel normalization and subtraction with ictal and interictal 99mTc-ECD SPECT.Three standard deviation of focal area hyperperfusion above the interictal period was considered as statistical significance.Results Definitely,significant hyperperfusion changes were observed on both patients.Although the lesions of 1 patient were diffuse,significant hyperperfusion appeared on limited areas surrounding the lesions;meanwhile,typical pattern of medial temporal lobe was observed in the other patient.The epileptogenic zones were located in the brains of both patients,without attack after surgical treatment.Conclusion SISCOM is of great help in localizing epileptogenic zone in presurgical evaluation in intractable epilepsy,especially in complex patients.