CAJ | 학술논문

目的：探讨癫痫患者无临床发作情况下18F-氟脱氧葡萄糖（18F-fluorodeoxyglucose，18F-FDG）正电子发射计算机断层（positron emission tomography， PET）脑显像呈现高代谢时脑电监测的应用价值。方法对北京协和医院2008年1月至2014年3月共3例无临床发作的间期情况下18 F-FDG PET脑显像呈现皮层或皮层下高代谢的癫痫患者，静脉注射安定抑制皮层放电，在脑电监测确认无皮层异常放电时复查18 F-FDG PET脑显像，并对比两次显像结果。结果病例1为颞叶癫痫患者，在无临床发作时18 F-FDG PET显像除发现右颞低代谢外，右额部分皮层及同侧基底节、丘脑及左侧小脑局灶代谢增高。脑电监测下抑制皮层放电后的18 F-FDG PET显像示原额叶皮层及同侧基底节、丘脑、对侧小脑高代谢灶消失。表明该患者上述高代谢灶为颞叶外皮层潜在致痫灶亚临床放电所致，同时证实了致痫灶与同侧基底节丘脑、对侧小脑之间的神经传导。此例改变了先前单纯前颞叶切除术的临床决策。病例2的间期18 F-FDG PET显像发现右侧大片额叶皮层高代谢，脑电监测下抑制临床下放电后，原皮层高代谢仍存在，原同侧基底节、对侧小脑的高代谢已不明显，证实皮层存在高代谢的基础病变（炎症），而基底节丘脑为继发功能改变，确定了病变性质及范围。病例3为颞叶癫痫患者，临床及脑电无法确定癫痫起源部位，磁共振成像未见明显异常。18 F-FDG PET显像在无临床发作的情况下左侧海马区呈高代谢，脑电监测下在明确的间期状态复查18 F-FDG PET脑显像，左侧海马区仍为高代谢。提示该部位存在基础病变（肿瘤），帮助临床确定手术部位。结论癫痫患者无临床发作情况下18 F-FDG PET显像呈现高代谢图像时，在脑电监测下确认绝对的间期状态时复查18 F-FDG PET显像，有助于分析高代谢的病因及明确病变范围，帮助作出临床决策。目的：探討癲癇患者無臨床髮作情況下18F-氟脫氧葡萄糖（18F-fluorodeoxyglucose，18F-FDG）正電子髮射計算機斷層（positron emission tomography， PET）腦顯像呈現高代謝時腦電鑑測的應用價值。方法對北京協和醫院2008年1月至2014年3月共3例無臨床髮作的間期情況下18 F-FDG PET腦顯像呈現皮層或皮層下高代謝的癲癇患者，靜脈註射安定抑製皮層放電，在腦電鑑測確認無皮層異常放電時複查18 F-FDG PET腦顯像，併對比兩次顯像結果。結果病例1為顳葉癲癇患者，在無臨床髮作時18 F-FDG PET顯像除髮現右顳低代謝外，右額部分皮層及同側基底節、丘腦及左側小腦跼竈代謝增高。腦電鑑測下抑製皮層放電後的18 F-FDG PET顯像示原額葉皮層及同側基底節、丘腦、對側小腦高代謝竈消失。錶明該患者上述高代謝竈為顳葉外皮層潛在緻癇竈亞臨床放電所緻，同時證實瞭緻癇竈與同側基底節丘腦、對側小腦之間的神經傳導。此例改變瞭先前單純前顳葉切除術的臨床決策。病例2的間期18 F-FDG PET顯像髮現右側大片額葉皮層高代謝，腦電鑑測下抑製臨床下放電後，原皮層高代謝仍存在，原同側基底節、對側小腦的高代謝已不明顯，證實皮層存在高代謝的基礎病變（炎癥），而基底節丘腦為繼髮功能改變，確定瞭病變性質及範圍。病例3為顳葉癲癇患者，臨床及腦電無法確定癲癇起源部位，磁共振成像未見明顯異常。18 F-FDG PET顯像在無臨床髮作的情況下左側海馬區呈高代謝，腦電鑑測下在明確的間期狀態複查18 F-FDG PET腦顯像，左側海馬區仍為高代謝。提示該部位存在基礎病變（腫瘤），幫助臨床確定手術部位。結論癲癇患者無臨床髮作情況下18 F-FDG PET顯像呈現高代謝圖像時，在腦電鑑測下確認絕對的間期狀態時複查18 F-FDG PET顯像，有助于分析高代謝的病因及明確病變範圍，幫助作齣臨床決策。
목적：탐토전간환자무림상발작정황하18F-불탈양포도당（18F-fluorodeoxyglucose，18F-FDG）정전자발사계산궤단층（positron emission tomography， PET）뇌현상정현고대사시뇌전감측적응용개치。방법대북경협화의원2008년1월지2014년3월공3례무림상발작적간기정황하18 F-FDG PET뇌현상정현피층혹피층하고대사적전간환자，정맥주사안정억제피층방전，재뇌전감측학인무피층이상방전시복사18 F-FDG PET뇌현상，병대비량차현상결과。결과병례1위섭협전간환자，재무림상발작시18 F-FDG PET현상제발현우섭저대사외，우액부분피층급동측기저절、구뇌급좌측소뇌국조대사증고。뇌전감측하억제피층방전후적18 F-FDG PET현상시원액협피층급동측기저절、구뇌、대측소뇌고대사조소실。표명해환자상술고대사조위섭협외피층잠재치간조아림상방전소치，동시증실료치간조여동측기저절구뇌、대측소뇌지간적신경전도。차례개변료선전단순전섭협절제술적림상결책。병례2적간기18 F-FDG PET현상발현우측대편액협피층고대사，뇌전감측하억제림상하방전후，원피층고대사잉존재，원동측기저절、대측소뇌적고대사이불명현，증실피층존재고대사적기출병변（염증），이기저절구뇌위계발공능개변，학정료병변성질급범위。병례3위섭협전간환자，림상급뇌전무법학정전간기원부위，자공진성상미견명현이상。18 F-FDG PET현상재무림상발작적정황하좌측해마구정고대사，뇌전감측하재명학적간기상태복사18 F-FDG PET뇌현상，좌측해마구잉위고대사。제시해부위존재기출병변（종류），방조림상학정수술부위。결론전간환자무림상발작정황하18 F-FDG PET현상정현고대사도상시，재뇌전감측하학인절대적간기상태시복사18 F-FDG PET현상，유조우분석고대사적병인급명학병변범위，방조작출림상결책。
Objective To evaluate the role of vedio-electroencehpalography ( VEEG) monitoring in inter-preting the cortical and subcortical hypermetabolic foci in interictal 18 F-fluorodeoxyglucose ( 18 F-FDG) positron emission tomography ( PET) imaging in patients with epilepsy .Methods From January 2008 to March 2014 in Peking Union Medical College Hospital , 3 epileptic patients whose first 18 F-FDG PET scan showed unexplained hypermetabolic foci without seizure underwent repeated 18 F-FDG PET scan in the interictal status proved by VEEG monitoring after discharge suppression by intravenous diazepam .Then compared the first and second scan images.Results For case 1 who suffered from epilepsy originating from medial right temporal lobe , unexplain-able hypermetabolic foci in right frontal lobe , basal ganglia , thalamus, and left cerebellum were present in in-terictal 18 F-FDG PET scan.After suppressing cortical discharge under VEEG monitoring , the second 18 F-FDG PET scan showed that the cortical and subcortical hypermetabolism disappeared , indicating that the hypermetabol-ic foci in the first scan was due to the subclinical discharge in a potential extratemporal seizure origin site , and the existence of efferent network activity from that origin site to ipsilateral basal ganglia and thalamus and contra -lateral cerebellum .The original clinical decision of simple anterior temporal lobectomy was altered based on the findings.For case 2, hypermtabolism was present in a large part of right frontal lobe , which persisted after sup-pressing discharge under VEEG monitoring .While the hypermetabolic foci in ipsilateral basal ganglia and contra-lateral cerebellum became less obvious in the second 18F-FDG PET scan, proving that the original lesion (inflam-mation) with hypermetabolism existed in the cortex , and the hypermetabolic foci in basal ganglia and thalamus were due to secondary functional change .Case 3 suffered from temporal lobe epilepsy with origin undeterminable with clinical information , electroencephalogram , or magnetic resonance imaging .Hypermtabolic left hippocampus was shown in both the first 18 F-FDG PET scan and the second PET scan under definite interictal status with VEEG monitoring , suggested the existence of a hypermetabolic lesion ( tumor ) , facilitating the clinical decision on surgical site .Conclusions For the epileptic patients with hypermetabolic foci in 18 F-FDG PET without sei-zure, repeated 18 F-FDG PET imaging in definite interictal status under VEEG monitoring can help interpret the etiology and define the extent of lesions for better clinical decision-making .