摘要目的 探讨18F-FDG PET/MRI异机融合对影像学阴性的难治性颞叶癫痫术前病灶定位、预测预后、指导手术的价值.方法 45例难治性颞叶癫痫患者,行头颅MRI,视频脑电图,及脑PET-CT等术前检查,头颅MRI结果均为阴性,术后2年随访手术疗效,采用Engel's分级评价疗效,后将同一患者的头颅MRI与PET进行异机融合,与手术疗效相结合分析PET/MRI脑代谢图形与手术疗效的关系.结果 37例PET/MRI提示低代谢局限于颞叶的患者中,术后疗效为Ⅰ、Ⅱ级的有29例,22例(76％)患者低代谢位于颞叶内侧;Engel'sⅢ,Ⅳ级患者有8例,6(77％)例患者低代谢超出前颞叶.使用卡方检验低代谢分区与手术疗效的关系,P ＜0.05,差异有统计学意义.结论 PET/MRI提示局限于颞叶内侧、颞极和前颞叶的代谢减低,术后疗效好.PET/MRI融合是一种更加精确的成像,PET/MRI的代谢图型可帮助临床医生确定病灶部位、预测疗效.

abstractsObjective Compared to 18F-FDG PET-CT,to validate the use of interictal 18FFDG PET/MRI registration in the location of epilepsitic lesions and prediction of surgical outcome.Methods Forty-five patients of intractable temporal lobe epilepsy were recruited retrospectively.All patients underwent persurgical evaluation included clinical symptoms,long-term video electroencephalogram(VEEG),PET-CT,and MRI.They were followed-up at least 2 years after surgery and evaluated with Engel's classification.Both volumes of PET and 3D MRI were coregistered into PET/MRI using Siemens 3D volume software to study the relationship between the metabolic patterns of PET/MRI and surgical curative effects.Results The postoperative effect demonstrated that among 37 patients with limited temporal low metabolism detected by PET/MRI,29 cases reached to grade Ⅰ or Ⅱ effects and 22 cases (76％) showed the low metabolism restricted to mesial temporal lobe,while 8 cases reached Engel's grade Ⅲ or Ⅳ and the range of low mechanism in 6 cases beyond the anterior temporal lobe.The significant difference (P ＜ 0.05) was found between the postoperative effects with different metabolic areas by Chi square.Conclusions The temporal hypometabolism over the medial and anterior part of temporal region and the temporal pole might be a better predictor for postoperative seizure control.18F-FDG PET/MRI registration was a more accurate imaging variant in the pediatrion for nonlesional patients.The patterns of PET/MRI metabolic images could further help the surgeon to select patients,plan operation and predict therapy.