Disparity of perfusion and glucose metabolism of epileptogenic zones in temporal lobe epilepsy demonstrated by SPM/SPAM analysis on 15O water PET, [18F]FDG-PET, and [99mTc]-HMPAO SPECT
Disparity of perfusion and glucose metabolism of epileptogenic zones in temporal lobe epilepsy demonstrated by SPM/SPAM analysis on 15O water PET, [18F]FDG-PET, and [99mTc]-HMPAO SPECT
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DOI：
10.1046/j.1528-1157.2001.21801.x
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发表时间：
2001-12-01
期刊：
影响因子：
5.6
通讯作者：
Lee, MC
中科院分区：
文献类型：
--
作者：
Lee, DS;Lee, JS;Lee, MC
目的：采用SPM（统计参数图）和SPAM（统计概率解剖图）定量方法对O-15水和F-18氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）和Tc-99m六亚甲基丙烯胺肟（HMPAO）单光子发射计算机断层扫描（SPELT）进行检测，以阐明灌注与代谢的解耦合及其在癫痫中的意义。方法：对25例内侧颞叶癫痫患者（25例中17例）行[O-15]水、[F-18]FDG-PET、[Tc-99m]HMPAO SPELT检查。对于感兴趣量（VOI）计数分析，使用基于PET和SPELT SPAM模板的VOI归一化计数与正常对照进行比较。对于SPM分析，在逐体素的基础上，检查每个患者的图像与一组正常对照图像的差异（t统计值p < 0.01），发现灌注或代谢明显减少。结果：通过SPAM VOI计数分析，13例患者在[O-15]水PET中发现了低灌注区，21例患者在[F-18]FDG-PET中发现了低代谢区。基于体素的SPM分析，15例[O-15]水PET定位于癫痫区，23例[F-18]FDG-PET定位于癫痫区。[O-15]水PET的定位与[F-18]FDG-PET的定位一致。[0 -15]水PET的低灌注区不存在或小于[F-18]FDG-PET的低代谢区。在17例患者中，有7例在视觉评估中发现了间期[Tc-99m]-HMPAO SPELT。结论：[O-15]水、[F-18]FDG-PET和[Tc-99m]-HMPAO SPELT的SPAM VOI计数和SPM分析显示，在同一患者中，低灌注区与低代谢区一致，但小于低代谢区。灌注和代谢异常的不一致代表了癫痫区灌注和代谢的不耦合，这可能解释了颞叶癫痫灌注成像诊断准确性较低的原因。
Purpose: To elucidate uncoupling of perfusion and metabolism and its significance in epilepsy, O-15 water and F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) and Tc-99m hexamethyl-propyleneamine-oxime (HMPAO) single-photon emission computed tomography (SPELT) were examined by SPM (statistical parametric mapping) and quantitation by using SPAM (statistical probabilistic anatomic map).Methods: [O-15]water and [F-18]FDG-PET, and [Tc-99m]HMPAO SPELT were performed in 25 patients (SPELT in 17 of 25) with medial temporal lobe epilepsy. For volume of interest (VOI) count analysis, the normalized counts using VOI based on SPAM templates of PET and SPELT were compared with those of the normal controls. Perfusion or metabolism was found abnormal if the Z score was >2 for each VOL For SPM analysis, the differences between each patient's image and a group of normal control images (t statistic for p < 0.01) on a voxel-by-voxel basis were examined to find significant decreases in perfusion or metabolism.Results: With SPAM VOI count analysis, areas of hypoperfusion were found in 13 patients in the epileptogenic temporal lobes by [O-15]water PET and areas of hypometabolism in 21 patients by [F-18]FDG-PET. With voxel-based SPM analysis, the epileptogenic zones were localized in 15 by [O-15]water PET and in 23 patients by [F-18]FDG-PET. The localization by [O-15]water PET was concordant with that of [F-18]FDG-PET. The areas of hypoperfusion on [O-15]water PET were absent or smaller than the areas of hypometabolism on [F-18]FDG-PET. Interictal [Tc-99m]-HMPAO SPELT revealed the hypoperfused zones in seven of 17 patients on visual assessment.Conclusions: SPAM VOI count and SPM analysis of [O-15]water and [F-18]FDG-PET and [Tc-99m]-HMPAO SPELT revealed that in the same patients, the areas of hypoperfusion were concordant with but smaller than the areas of hypometabolism. Discordance of perfusion and metabolic abnormalities represents an uncoupling of perfusion and metabolism in the epileptogenic zones, and this might explain the lower diagnostic accuracy of perfusion imaging in temporal lobe epilepsy.