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目的利用单光子发射计算机断层摄影(SPECT)半定量分析有效控制与控制不良的MRI阴性的全面性强直阵挛发作癫(GTCS)病人的局部脑血流差异,探讨脑血流灌注与其预后的关系。材料和方法对29例有效控制的和12例控制不佳的MRI阴性的GTCS病人进行发作间期99mTc-ECD-SPECT脑血灌流显像,10例年龄匹配的健康人作对照,用感兴趣区(ROI)的不对称指数(%AI)进行半定量分析。将SPECT分析结果与病人的临床表现与EEG相比较。结果①控制不佳组与有效控制组在丘脑和基底节区的%AI存在显著性差异(P<0.05);②控制不佳组SPECT脑显像的异常率(83.3%,10/12)明显高于有效控制组的异常率(17.2%,5/29),两组具有显著性差异(P<0.01);而两组病人的EEG异常率分别为58.3%、44.8%(7/12、13/29),无显著性差异(P>0.05)。结论控制不佳的MRI阴性的GTCS病人往往存在发作间期的低血流灌注脑区,提示癫的难治性;而控制良好的病人多无明显异常发现,可能预后较好。
Objective To semi-quantitatively analyze the regional cerebral blood flow in patients with MRI-negative comprehensive tonic-clonic seizures (GTCS) with single photon emission computed tomography (SPECT) and to explore the relationship between cerebral blood flow perfusion and prognosis . Materials and Methods 99cTc-ECD-SPECT brain perfusion imaging was performed in 29 patients with effectively controlled and 12 poorly controlled MRI-negative GTCS patients. Ten healthy matched age-matched controls were used as controls. (ROI) asymmetry index (% AI) for semi-quantitative analysis. The results of SPECT analysis were compared with those of patients with EEG. Results ① There was a significant difference of% AI in hypothalamus and basal ganglia between poorly controlled group and effective control group (P <0.05). ② The abnormal rate of SPECT brain imaging in poorly controlled group (83.3%, 10/12) was significantly (17.2%, 5/29) in the control group were significantly higher than those in the control group (P <0.01). The abnormal rates of EEG in the two groups were 58.3% and 44.8%, respectively / 29), no significant difference (P> 0.05). CONCLUSIONS: Poorly controlled MRI-negative GTCS patients often have hypoperfusion brain regions during the interictal period, suggesting the intractable epilepsy. However, patients with well-controlled GTCS have no obvious abnormalities and may have a better prognosis.