摘要目的 探讨正电子发射断层显像术(PET)-MRI影像融合技术在MRI阴性的药物难治性癫痫术前评估中的应用价值.方法 回顾性分析2015年1月至2016年6月北京丰台医院癫痫中心-首都医科大学附属北京天坛医院医疗联盟收治的34例MRI阴性的药物难治性癫痫患者的临床资料.所有患者均行无创性检查(包括头皮视频脑电图、MRI、PET-CT、PET-MRI融合影像)和有创性检查(立体定向脑电图)以进行术前评估.其中30例患者行手术切除致痫灶,4例行保守治疗.采用Engel分级评估手术疗效.比较PET-CT与PET-MRI对致痫灶定位的一致率,同时纳入发作频率、发作间期头皮脑电、PET-MRI影像结果以及手术部位,采用二元Logistic回归分析探讨患者预后的影响因素.结果 术后平均随访12.5个月(4～ 20个月).Engel分级Ⅰ级者占77％ (23/30).PET-MRI融合影像判读结果与致痫灶的一致率(83％)显著高于PET-CT(37％) (P ＜0.01).对预后影响因素的分析结果显示,PET-MRI影像未显示局灶性低代谢为患者术后癫痫复发的危险因素(P =0.042).结论 PET-MRI影像融合技术可显著提高PET对于MRI阴性的药物难治性癫痫患者致痫灶的定位价值,PET-MRI影像未显示局灶性低代谢的患者术后更易出现癫痫复发.

abstractsObjective To evaluate the role of PET-MRI coregistration in presurgical evaluation of MRI-negative drug-resistant epilepsy.Methods A retrospective study was conducted on the clinical data of 34 patients with MRI-negative refractory epilepsy who underwent presurgical evaluation at Epilepsy Center of Fengtai Hospital,Medical Alliance of Beijing Tiantan Hospital,Capital Medical University from January 2015 to June 2016.All patients received non-invasive (such as Scalp video-EEG,MRI,PET-CT and PET-MRI coregistration) and invasive (stereo-electroencephalography,SEEG) examinations during presurgical evaluation.A total of 30 patients underwent resection surgery subsequently and 4 patients underwent conservative therapy.The Engel scale was used to assess the surgery outcomes.The resuhs of PET-CT and PET-MRI coregistration were compared with respect to the localization consistency of epileptogenic focus.Seizure frequency,interictal scalp EEG,PET-MRI coregistration and surgical location were included in the prognostic factor analysis by means of binary Logistic regression.Results The mean postoperative followup period was 12.5 months (4 ～ 20 months).The Engel Class Ⅰ rate was 23/30 (77％).The rate of consistency between PET-MRI coregistration results and epileptogenic focus was significantly higher than that of PET-CT (83％ vs.37％,P ＜0.01).Prognostic factor analysis suggested that PET-MRI results without showing localized hypometabolism predicted seizure recurrence (P =0.042).Conclusions PET-MRI coregistration could significantly improve the localizing value of PET for epileptogenic focus.Patients without localized hypometabolism on PET-MRI coregistration images might be more likely to expreience seizure recurrence.