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More than 50% of the purpose of drug refractory epilepsy may benefit from surgery. Preoperative accurate positioning epileptic focus is the key to successful operation. Currently, 18 F-FDG PET brain metabolic imaging positioning epileptic focus more, and proven to have a higher positioning sensitivity but low specificity. And the application 13 N-NH 3 PET perfusion imaging positioning epileptic focus, not yet reported, smaller foreign. This study of 31 patients with drug-refractory epilepsy patients with 13 N-NH 3 18 F-FDG PET imaging, preliminary summary epileptic foci of interictal blood flow, metabolic imaging characteristics discussed 13 N-NH 3 the perfusion scintigraphy positioning epileptic foci value and the combination of both imaging The value of the imaging agent, locate epileptic foci pixel statistical parametric mapping (SPM) and to explore the application value. Materials and methods selected from November 2003 to December 2008 in our hospital neurosurgery hospitalized 31 cases of drug-refractory epilepsy patients, 19 cases were male and 12 females, aged 12 to 52 years, with an average age of 28.6 ± 11.7 years old. All patients at the onset between phase line 13 N-NH 3 18 F-FDG two imaging agent for imaging. Image results using visual analysis combined with semi-quantitative analysis, visual analysis of all PET images in a blinded fashion by two nuclear medicine physicians, two in a row or two images appear radioactive abnormal increase or reduce the stove, judged to be abnormal; abnormal image or suspicious The abnormal Department outlined regions of interest (ROI), and calculate the asymmetry index (AI), considering the visual analysis of the results and the asymmetry index determination of epileptic foci. The largest cluster of 18 cases 18 F-FDG metabolic imaging data using SPM method analysis, two-sample t-test with 20 healthy control group data, to get a statistically significant, judged epileptic foci. Results the intraoperative cortical electrodes, depth electrodes detect the situation and postoperative outcomes epileptic focus in the temporal lobe in 15 cases (48.4%) in the frontal lobe in 8 patients (25.8%), located in the parietal lobe in 2 cases (6.5%) , located in multiple lobes of the brain in 6 patients (19.4%). Interictal to 13 N-NH 3 perfusion imaging positioning sensitivity of 58.1%, 18 F-FDG PET metabolic imaging the positioning sensitivity to 71.0%, the combination of both imaging methods in 25.8% of cases can be to regain correct positioning, positioning sensitivity of 77.4%. Two imaging methods locate epileptic foci performance by the Kappa test, K = 0.515, p = 0.000, with a moderate consistency. AI values ??by paired t test, p = 0.023, the difference was statistically significant, FDG imaging group asymmetry index greater than NH 3 imaging group. According to the MRI images whether lesions of 31 patients were divided into lesion group and non-lesion group, two imaging methods lesion group, the non-lesion group detection the epileptic foci performance after x 2 test was not statistically significance. The SPM analysis localization of epileptic foci sensitivity of 83.3%, the SPM method with visual analysis United ROI method by McNemar test was no significant difference. Conclusions epileptic focus interictal period PET imaging characteristic changes not only for low perfusion, low metabolism, but also showed high perfusion, low metabolism; 13 N-NH 3 PET flow imaging can effectively locate epileptic foci, locate epileptic foci performance 18 F-FDG PET metabolic imaging with medium consistency. Combined with two imaging agent for imaging, complementary advantages, can be satisfied with the positioning sensitivity. Locate epileptic foci of SPM method sensitivity and visual analysis combined with semi-quantitative method no significant difference between the SPM method has the advantages of an objective, repeatable, but did not significantly improve the ability to locate epileptic foci of visual Joint ROI method.
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