本文選題：MRI陰性癲癇 + FDG-PET��； 參考：《浙江大學(xué)》2017年碩士論文

【摘要】：研究背景與目的:1、目的:FDG-PET是目前難治性局灶性癲癇患者行癲癇術(shù)前評(píng)估的重要檢查之一,但因其自身局限性,單獨(dú)FDG-PET檢查的致癇灶檢出率并不高,致癇灶定位準(zhǔn)確性不夠。進(jìn)一步的FDG-PET/MRI融合技術(shù)(PM-C)已被報(bào)道運(yùn)用于臨床,有較高的致癇灶檢出率及較準(zhǔn)確的致癇灶定位特點(diǎn)。本研究為了證明PM-C在MRI陰性局灶性癲癇中的診斷價(jià)值及對(duì)于高分辨頭顱MRI二次分析和臨床決策的指導(dǎo)意義。2、方法:連續(xù)性納入2012年9月1日-2016年8月31日于浙江大學(xué)醫(yī)學(xué)院附屬第二醫(yī)院癲癇中心住院的難治性局灶性癲癇患者。所有患者均行長(zhǎng)程視頻腦電圖監(jiān)測(cè),普通頭顱核磁共振平掃,高分辨薄層并可重建為3D模型的頭顱核磁共振T1WI掃描及其它高分辨磁共振序列,頭顱FDG-PET掃描等。將高分辨頭顱MRI初次分析結(jié)果分為"可疑異常"及"正常",其后使用Analyze和SPM8將高分辨頭顱MRI及FDG-PET圖像進(jìn)行融合,在融合結(jié)果的指導(dǎo)下二次分析高分辨頭顱MRI,將影像判讀結(jié)果的改變類型分為Ⅰ類改變(包括Ⅰa和Ⅰb)、Ⅱ類改變(Ⅱa和Ⅱb)和無(wú)改變?nèi)?臨床決策主要包括埋藏顱內(nèi)電極和手術(shù)治療。綜合臨床及影像特點(diǎn),將難治性局灶性癲癇患者分為顳葉癲癇組和顳葉外癲癇組,并分別比較兩組在PM-C指導(dǎo)下高分辨頭顱MRI二次分析后三類改變的比例及臨床決策改變的特點(diǎn)。3、結(jié)果:本研究共納入112例行PDG-PET掃描的MRI陰性難治性局灶性癲癇患者,其中67例為顳葉外癲癇,40例為顳葉癲癇,5例為不能明確分類。顳葉和顳葉外癲癇的FDG-PET低代謝具有不同特點(diǎn),顳葉癲癇的低代謝范圍通常比較廣泛,且約50%的患者具有遠(yuǎn)隔區(qū)域如同側(cè)眶額回、同側(cè)島葉、同側(cè)島蓋周圍及對(duì)側(cè)前顳葉等低代謝;而顳葉外癲癇的低代謝范圍通常較局限;單獨(dú)的FDG-PET對(duì)于病灶的發(fā)現(xiàn)率在顳葉和顳葉外癲癇中分別為57.5%和29.9%(23/40和20/67),而PM-C結(jié)果給予顳葉和顳葉外癲癇定位致癇灶提供了更多信息(包括Ⅰa、Ⅰb和Ⅱa類改變),總的改變率分別為95%(38/40)和79.1%(53/67);其中有15例BOSD患者,初次高分辨頭顱MRI報(bào)告為正常,在融合結(jié)果的指導(dǎo)下,11例高分辨頭顱MRI二次分析后發(fā)現(xiàn)了病灶,從而改變了臨床決策。4、結(jié)論:本研究發(fā)現(xiàn)綜合FDG-PET/MRI融合與電臨床假設(shè),使得至少一半以上原先頭顱MRI報(bào)告為"陰性"者轉(zhuǎn)變?yōu)?陽(yáng)性",從而改變了是否需要埋藏顱內(nèi)電極或手術(shù)治療等臨床決策。對(duì)于高分辨頭顱MRI始終為陰性的患者,PM-C也提供了額外的定位信息。從而促使這些癲癇難以良好控制的患者能取得更好的治療方式,進(jìn)而控制或者減輕癲癇帶來(lái)的影響。
[Abstract]:Background & AIM: 1. Objective: FDG-PET is one of the important examinations for preoperative evaluation of epilepsy in patients with intractable focal epilepsy. However, due to its limitations, the detection rate of epileptigenic foci by FDG-PET alone is not high, and the accuracy of epileptogenic foci localization is not enough. Further FDG-PET / MRI fusion technique (PM-C) has been reported to be used in clinical practice with high detection rate of epileptogenic foci and accurate localization of epileptogenic foci. The purpose of this study was to demonstrate the diagnostic value of PM-C in MRI negative focal epilepsy and its guiding significance for high-resolution cranial MRI secondary analysis and clinical decision-making. Methods: continuity was incorporated into Zhejiang Province from September 1, 2012 to August 31, 2016. Inpatients with refractory focal epilepsy in epilepsy center of the second affiliated Hospital of University Medical College. All the patients were monitored by video EEG, plain MRI scan, T1WI scan and other high resolution MRI sequences, FDG-PET scan, and so on. The initial results of high-resolution cranial MRI were classified as "suspicious abnormality" and "normal". Analyze and SPM8 were then used to fuse the high-resolution cranial MRI and FDG-PET images. Under the guidance of fusion results, high resolution cranial MRIs were analyzed twice. The results of image interpretation were divided into three types: 鈪，

本文編號(hào)：2060289