目的 探讨18F-FDG PET 显像对颞叶微小病灶并发颞叶癫痫的癫痫灶定位的诊断价值.方法 CT或MRI检查发现颞叶小病灶、有癫痫发作的21例患者,发作期间行18F-FDG PET显像及EEG检查,对比二者对癫痫灶定位的相符情况.结果 21例患者中,18F-FDG PET检查阳性19例,正常2例,其灵敏度为90.5%(19/21),特异度为84.2%(16/19).16例癫痫灶18F-FDG PET与EEG定位一致患者,行病灶及前颞叶切除术;2例18F-FDG PET未检出癫痫灶患者行单纯病灶切除术;3例癫痫灶为两侧颞叶患者,口服抗癫痫药物治疗.18例术后患者随访1～5年,癫痫发作完全消失12例,发作减少6例,总有效率为94.4%.结论 发作期间18F-FDG PET 显像对颞叶微小病灶并发颞叶癫痫癫痫灶的检出率较高,但PET显示的低代谢区比病灶及癫痫灶范围大,手术时尚需综合分析临床特点及EEG检查结果,进一步明确致痫灶.%Objective To explore the value of 18 F-fluorodeoxyglucose-positron emission tomography( 18 F-FDG PET ) in the diagnosis of refractory epilepsy complicated with small temporal lobe lesions. Methods Twenty-one epilepsy patients complicated with small temporal lobe lesions confirmed by CT or MRI were enrolled in the study. A comparison between 18 F-FDG PET and EEG for their diagnosis of temporal lobe epilepsy was done. Results 18 F-FDG PET indicated that there were 19 positive cases and 2 normal cases in 21 patients, with the sensitivity of 90. 5%( 19/21 ) and the specificity of 84. 2% ( 16/19 ). Sixteen epilepsy patients underwent lesion and anterior temporal resection, in which 18F-FDG PET results agreed satisfactorily with EEG results. Two epilepsy patients who didn't be identified by 18F-FDG PET underwent lesionectomy. Three patients with bilateral temporal epilepsy took antiepileptic drugs orally. Eighteen cases were followed up from 1 year to 5 years after operation,no attack of seizures in 12 cases and marked improvement in 6 cases, the total effective rate was 94. 4%. Conclusion Interical 18F-FDG PET has a higher detection rate of epileptic foci, but the hypometabolic zone identified by PET is more larger than the range of lesions and epileptic foci. A comprehensive analysis of the clinical features and EEG results is needed to define the epileptic foci for surgery.
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