摘要：

研究背景 伴海马硬化的内侧颞叶癫是最常见的部分性癫类型，涉及复杂的神经网络。¹⁸F?脱氧葡萄糖（¹⁸F-FDG）PET 有助于揭示癫的脑代谢特征。本研究基于¹⁸F-FDG PET 定量分析探讨伴海马硬化的内侧颞叶癫的代谢特征模式。 方法 共23 例伴海马硬化的内侧颞叶癫患者和性别、年龄相匹配的正常对照者行头部MRI和18F?FDG PET 检查，将PET 图像配准至国际标准空间，并根据自动解剖分区模板将皮质和皮质下核团分割为90 个兴趣区，计算全脑、双侧大脑半球和各兴趣区标准化摄取（SUV）值。 结果 伴海马硬化的内侧颞叶癫患者全脑校正SUV 值低于正常对照者（1.13 ± 0.06对1.20 ± 0.10；t = ? 3.245，P = 0.002），伴海马硬化的内侧颞叶癫患者左侧大脑半球校正SUV 值低于右侧大脑半球（1.10 ± 0.06 对1.15 ± 0.06；t = ? 2.710，P = 0.010）。与正常对照者相比，伴海马硬化的内侧颞叶癫患者有15 个兴趣区代谢降低，分别位于左侧颞叶，包括海马、海马旁回、杏仁核、颞极上部、颞极中部、颞下回、颞横回、梭状回，以及左侧颞叶外结构，包括额下回岛盖、Rolandic 岛盖、岛叶、扣带回中部、尾状核、壳核、丘脑。 结论 ¹⁸F-FDG PET 定量分析可以从代谢角度揭示伴海马硬化的内侧颞叶癫的代谢特征模式，有助于加深对伴海马硬化的内侧颞叶癫病理生理学机制的理解，也为进一步研究此类患者功能改变和癫发作进程提供参考和框架。

关键词: 癫痫, 颞叶, 海马, 磁共振成像, 正电子发射断层显像术

Abstract:

Background  Mesial temporal lobe epilepsy with hippocampal sclerosis (mTLE?HS) is the most common type of focal epilepsy involving complex networks. 18F?fluoro?2?deoxy?D?glucose (18F?FDG) PET provides unique brain metabolic information for epilepsy. This study aims to explore the spatial metabolic characteristics of mTLE?HS based on a quantitative analysis of 18F?FDG PET.  Methods  A total of 23 patients with mTLE?HS and 26 sex? and age?matched healthy controls were enrolled in this study. All of them were performed head MRI and 18F?FDG PET scanning. PET images were registered to standard template and further divided into 90 regions of interest (ROIs) based on anatomical automatic labeling (AAL). Normalized standard uptake value (SUV) in whole brain, bilateral cerebral hemispheres and each ROI were calculated.  Results  The normalized SUV of whole brain in mTLE?HS patients was significantly lower than healthy controls (1.13 ± 0.06 vs. 1.20 ± 0.10; t = ? 3.245, P = 0.002). The normalized SUV of left hemisphere was significantly lower than right hemisphere (1.10 ± 0.06 vs. 1.15 ± 0.06; t = ? 2.710, P = 0.010) in mTLE?HS patients. Compared with controls, the normalized SUV in 15 ROIs of mTLE?HS patients were identified with hypometabolism significantly, which were located in left temporal lobe (hippocampus, parahippocampal gyrus, amygdala, superior temporal pole, middle emporal pole, inferior temporal gyrus and fusiform gyrus, transverse temporal gyrus) and left extratemporal cortex (inferior frontal operculum, Rolandic operculum, insular lobe, median cingulate gyrus, caudate nucleus, putamen and thalamus).  Conclusions  This study revealed the spatial metabolic characteristics of mTLE?HS based on a quantitative analysis of 18F?FDG PET from the metabolic perspective, deepened the understanding on pathophysiological mechanisms of
mTLE?HS, and provided a framework for further analyzing the functional change and seizure progression of mTLE?HS.

 

Key words: Epilepsy, temporal lobe, Hippocampus, Magnetic resonance imaging, Positron-emission tomography