【摘要】：研究目的 1、運用基于低頻振幅算法（ALFF）的靜息態(tài)fMRI技術對難治性顳葉癲癇(Temporal lobe epilepsy,TLE)患者發(fā)作間期的腦功能進行研究，分析難治性TLE在靜息狀態(tài)下的特征性腦功能改變，探討其潛在的病理生理機制。 2、對難治性TLE患者發(fā)作間期腦18F-FDG PET-CT的圖像SPM法進行分析，探討發(fā)作間期患者大腦代謝的異常腦區(qū)并對癲癇灶進行定位。 材料與方法 1、選擇16例符合診斷標準的難治性TLE患者及20例年齡性別匹配的健康對照組行靜息態(tài)fMRI檢查。利用DPARSF軟件對靜息態(tài)數(shù)據(jù)進行分析。計算并比較難治性TLE組和健康對照組的ALFF改變的腦區(qū)；并分析ALFF改變腦區(qū)與患病病程長短的相關性。 2、16例患者中12例行18F-FDG PET-CT檢查，并與12例年齡性別匹配的健康對照組對照。利用SPM8后處理軟件對18F-FDG PET-CT圖像數(shù)據(jù)進行處理，分析癲癇患者相對于健康對照組代謝減低或代謝增高的腦區(qū)，并分析每個癲癇患者相對于健康對照組代謝減低或代謝增高的腦區(qū)；利用ROI感興趣區(qū)法分析PET圖像，對致癇灶進行定側定位，并比較ROI及SPM兩種方法對癲癇患者定位的應用。 結果 1、與正常對照組相比難治性TLE患者全腦ALFF值升高的腦區(qū)主要分布于橋腦、中腦及其周圍、右側額葉和顳葉、前扣帶回、左側尾狀核、殼核和枕葉等區(qū)域。ALFF降低的腦區(qū)主要分布于后扣帶回，楔前葉、頂下小葉、內(nèi)側前額葉、左側額葉等腦區(qū)(P0.05)。難治性TLE與患病病程呈正相關的腦區(qū)，主要分布于右側的顳上回及左側額下回區(qū)域；呈負相關的腦區(qū),主要分布于內(nèi)側前額葉、右側頂下小葉、左側顳葉等腦區(qū)(P0.05)。 2、SPM法除發(fā)現(xiàn)顳葉葡萄糖代謝減低外，還伴有同側或雙側額葉及頂葉代謝減低；并發(fā)現(xiàn)對側局部海馬、海馬旁回及局部顳葉葡萄糖代謝呈高代謝表現(xiàn)。 結論 1、難治性TLE患者發(fā)作間期靜息狀態(tài)下存在廣泛的腦功能網(wǎng)絡異常。并與患者發(fā)病病程具有一定的相關性，可能與患者的發(fā)病機制有關，并反映ALFF分析法可以有效地反映癲癇患者異常的神經(jīng)功能網(wǎng)絡，有助于我們解釋難治性TLE的病理生理機制。 2、TLE患者的海馬、海馬旁回等部位ALFF活動增高，提示RS-fMRI具有一定的致癇灶定位價值。 3、ALFF活動減低的腦區(qū)主要分布于默認網(wǎng)絡腦區(qū)，且隨著TLE患者發(fā)病病程增加默認網(wǎng)絡的活動水平趨于減低。 4、18F-FDG PET-CT腦顯像SPM分析法是一種簡便有效定位方法，與PET圖像ROI分析相比，除可以發(fā)現(xiàn)顳葉代謝異常外，還有助于發(fā)現(xiàn)顳葉以外腦區(qū)代謝的異常，，對癲癇患者術前腦功能的評價及術后預后提供更多幫助。 5、TLE患者SPM法的18F-FDG PET-CT腦顯像分析及ALFF分析法均有一定的定位價值，兩者可相互補充。
[Abstract]:Objective 1. The interictal brain function of patients with intractable temporal lobe epilepsy (Temporal lobe epilepsy,TLE) was studied by resting fMRI technique based on low frequency amplitude algorithm (ALFF), and the characteristic changes of brain function of refractory TLE in resting state were analyzed. To explore its underlying pathophysiological mechanism. 2. To analyze the interictal 18F-FDG PET-CT of intractable TLE patients by image SPM method, and to explore the abnormal brain regions of brain metabolism and localize the epileptic foci in interictal patients. Materials and methods 1.Sixteen patients with refractory TLE who met the diagnostic criteria and 20 healthy controls matched with age and sex were examined with resting fMRI. The rest data are analyzed by DPARSF software. To calculate and compare the brain area of ALFF changes in refractory TLE group and healthy control group, and to analyze the correlation between the changes of ALFF brain area and the duration of disease. It was compared with 12 healthy controls matched with age and sex. The data of 18F-FDG PET-CT images were processed by SPM8 post-processing software to analyze the brain regions in which metabolism was decreased or increased in epileptic patients relative to the healthy control group, and the brain regions in which metabolism was decreased or increased in each epileptic patient relative to the healthy control group. The PET images were analyzed by ROI region of interest method, and the location of epileptogenic foci was determined. The application of ROI and SPM in epileptic localization was compared. Results 1. Compared with the control group, the increased global ALFF values in refractory TLE patients were mainly located in the pontine, the midbrain and its surroundings, the right frontal and temporal lobes, the anterior cingulate gyrus and the left caudate nucleus. The areas of decreased ALFF were mainly located in the posterior cingulate gyrus, precuneiform lobe, inferior parietal lobule, medial prefrontal lobe, left frontal lobe and so on (P0.05). Refractory TLE was positively correlated with the course of the disease, mainly in the right superior temporal gyrus and left inferior frontal gyrus, and negatively correlated in the medial prefrontal lobe, right inferior parietal lobule. In addition to the decreased glucose metabolism in the temporal lobe, there was a decrease in glucose metabolism in the ipsilateral or bilateral frontal and parietal lobes, and hypermetabolism of glucose in the contralateral hippocampus, para-hippocampal gyrus and local temporal lobe was found by SPM. Conclusion 1. There are extensive brain functional network abnormalities in patients with refractory TLE during interictal rest. It may be related to the pathogenesis of the patients, and reflect that ALFF analysis can effectively reflect the abnormal neural network in epileptic patients. It is helpful for us to explain the pathophysiological mechanism of refractory TLE. 2in the patients with TLE, the activity of ALFF in hippocampus and perihippocampal gyrus is increased. It is suggested that RS-fMRI has a certain value of localizing epileptogenic foci. 3 the brain regions with decreased activity of ALFF are mainly distributed in the default network brain area. As the course of TLE increased, the level of activity of the default network tended to decrease. 4 ~ (18) F-FDG PET-CT SPM analysis was a simple and effective method for localization. Compared with ROI analysis of PET images, abnormal metabolism of temporal lobe could be found. It is also helpful to find the abnormal metabolism of the temporal lobe in the external brain area, and to provide more help for the preoperative evaluation of brain function and postoperative prognosis in patients with epilepsy. 5 the 18F-FDG PET-CT imaging analysis and ALFF analysis of SPM in patients with epilepsy have certain localization value. The two complement each other.
【學位授予單位】：蚌埠醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R742.1

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