CAJ | 학술논문

目的评价PET-CT与静息态功能MRI在颞叶癫痫定侧诊断中的价值.方法对将接受手术治疗的17例难治性癫痫患者行PET-CT与静息态功能MRI检查,同时选择性别、年龄相匹配的17名健康志愿者作为对照组.利用统计参数图(SPM)5后处理软件对所采集静息态功能MRI图像进行分析,测量全脑和双侧海马ReHo值.利用目测分析法及不对称指数分析PET-CT所得图像,测量双侧海马标准化摄取值(SUV).利用配对样本t检验分析双侧颞叶SUV、ReHo值,利用ROC曲线界定出诊断颞叶癫痫的最佳临界值.利用Pearson相关分析判断双侧海马SUV与ReHo值的相关性.利用Kappa一致性检验,分析两者诊断结果的一致性.并将诊断结果与对照组和术后病理结果进行对比分析,评价2种方法在颞叶癫痫定侧诊断中的价值.结果 17例患者PET-CT图像均有颞叶局限性或广泛性代谢减低,其中12例患者能够明确定侧,与术后病理结果对照诊断准确率为70.6％；17例患者行静息态功能MRI检查,11例表现为单侧ReHo值减低,能明确定侧,准确率为64.7％.两种检查方法联合应用可将诊断准确率提高到76.5％ (13/17).颞叶癫痫组患侧海马ReHo值(0.34±0.12)明显低于正常对照组海马ReHo值(0.46±0.07),2者差异有统计学意义(t=3.230,P=0.003),当ReHo值为0.36时,对颞叶癫痫诊断的敏感度为88.2％,特异度为94.1％；17例患者患侧SUV (4.17±0.63)与健侧SUV(4.77±0.56)间差异有统计学意义(t=2.930,P=0.006),当SUV为4.23时,对颞叶癫痫的诊断敏感度为88.2％,特异度为64.7％.2种检查方法在病灶检出率上有存在一致性,但一致性不高(Kappa值为0.49),患侧SUV与ReHo值之间无相关性(r =0.280,P=0.314).结论 PET-CT与静息态功能MRI多模态功能与代谢成像可提高颞叶癫痫定侧的诊断准确性.
목적 평개PET-CT여정식태공능MRI재섭협전간정측진단중적개치.방법 대장접수수술치료적17례난치성전간환자행PET-CT여정식태공능MRI검사,동시선택성별、년령상필배적17명건강지원자작위대조조.이용통계삼수도(SPM)5후처리연건대소채집정식태공능MRI도상진행분석,측량전뇌화쌍측해마ReHo치.이용목측분석법급불대칭지수분석PET-CT소득도상,측량쌍측해마표준화섭취치(SUV).이용배대양본t검험분석쌍측섭협SUV、ReHo치,이용ROC곡선계정출진단섭협전간적최가림계치.이용Pearson상관분석판단쌍측해마SUV여ReHo치적상관성.이용Kappa일치성검험,분석량자진단결과적일치성.병장진단결과여대조조화술후병리결과진행대비분석,평개2충방법재섭협전간정측진단중적개치.결과 17례환자PET-CT도상균유섭협국한성혹엄범성대사감저,기중12례환자능구명학정측,여술후병리결과대조진단준학솔위70.6％；17례환자행정식태공능MRI검사,11례표현위단측ReHo치감저,능명학정측,준학솔위64.7％.량충검사방법연합응용가장진단준학솔제고도76.5％ (13/17).섭협전간조환측해마ReHo치(0.34±0.12)명현저우정상대조조해마ReHo치(0.46±0.07),2자차이유통계학의의(t=3.230,P=0.003),당ReHo치위0.36시,대섭협전간진단적민감도위88.2％,특이도위94.1％；17례환자환측SUV (4.17±0.63)여건측SUV(4.77±0.56)간차이유통계학의의(t=2.930,P=0.006),당SUV위4.23시,대섭협전간적진단민감도위88.2％,특이도위64.7％.2충검사방법재병조검출솔상유존재일치성,단일치성불고(Kappa치위0.49),환측SUV여ReHo치지간무상관성(r =0.280,P=0.314).결론 PET-CT여정식태공능MRI다모태공능여대사성상가제고섭협전간정측적진단준학성.
Objective To evaluate the efficacy of PET-CT brain imaging and resting-state fMRI in preoperative localization of temporal lobe epileptic (TLE)focus.Methods PET-CT and resting-state fMRI were performed in 17 patients with refractory TLE,who then underwent surgical treatment.Seventeen healthy volunteers matched with gender and age were recruited as the control group.The resting-state fMRI images were post processed by SPM5 software.Regional homogeneity(ReHo) values of the whole brain and bilateral hippocampus were obtained and analyzed.PET-CT images were analyzed by visual analysis method and asymmetry index method and the standardized uptake value (SUV) of bilateral hippocampus were obtained.The ReHo values and SUV of the bilateral hippocampus were compared by two independent samples t-test,and analyzed by receiver operating characteristic curve (ROC) for optimized diagnostic threshold.Pearson correlation analysis was employed for evaluating the correlation between the SUV and ReHo values of bilateral hippocampus.The consistency between the diagnostic accuracy of PET-CT and resting-state fMRI was assessed by Kappa consistency test.The outcome of the patient group was compared with that of the control group,and with the pathological results,to evaluate the diagnostic value of the two modalities for preoperative localization of temporal lobe epileptic focus.Results Regional or comprehensive low metabolism of 18F-FDG in temporal lobes was presented in all 17 patients,and 11 patients out of 17 showed lateral decreased ReHo value.The diagnostic accuracy of the two examinations was 70.6％ (12/17) and 64.7％ (11/17) for PET-CT and resting-state fMRI respectively compared with pathological results,and could be increased to 76.5％ (13/17) when the two methods were combined for diagnosis.The ReHo values of the TLE group (0.34 ± 0.12)were significantly lower than those of the control group (0.46 ± 0.07) (t =3.230,P =0.003).The sensitivity and specificity of resting-state fMRI were 88.2％ and 94.1％ respectively when the ReHo value was 0.36.There was significant difference between the SUV of the affected (4.17 ±0.63) and healthy side(4.77 ±0.56) of hippocampus in TLE group(t =2.930,P =0.006).The sensitivity and specificity of PET-CT were 88.2％ and 64.7％ respectively when SUV was 4.23.The two values could be used as a threshold in the localization of temporal lobe epileptic focus.Consistency of lesion detection was revealed between PET-CT and resting-state fMRI though it was not high,and the Kappa value was 0.49.However,no correlation was detected between the SUV and ReHo value using Pearson correlation test(r =0.280,P =0.314).Conclusion Combined PET-CT brain imaging and resting-state fMRI as a multi-modality imaging method might improve the diagnostic accuracy of the TLE focus's localization.