单光子计算机断层减影与核磁共振融合成像术在癫痫致痫灶定位中的应用进展_Journal of Epilepsy

Authors：

刘霄 ^1,2,3 , 艾林 ⁴ ,  王群 ^1,2,3

1. ;
2. ;
3. ;
4. ;

Corresponding author：

王群, Email: qwang64@163.com

Keywords：

难治性癫痫; 单光子计算机断层减影与核磁共振融合成像术; 发作期单光子发射计算机断层成像术; 致痫灶定位; 图像融合技术

DOI：

10.7507/2096-0247.20180025

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癫痫是最常见的慢性脑部疾病之一，其中药物难治性癫痫比例为 20%～30%，目前癫痫手术治疗是难治性癫痫的唯一手段，而术前准确定位致痫病灶则是手术成败的关键。发作期单光子计算机断层减影与核磁共振融合成像术（Subtraction ictal single-photon emission computed tomography coregistered to MRI，SISCOM）作为一种全新的技术为癫痫致痫灶的准确定位翻开了新篇章，它克服了传统单光子发射计算机断层成像术（SPECT）空间分辨率不足的缺点，其成像的敏感性与特异性已被证实较单纯的发作期与发作间期 SPECT 成像增加，特别是对于核磁共振（MRI）阴性和颞叶外的癫痫患者，另外 SISCOM 在预测癫痫术后效果方面也具有独特价值。文章就 SISCOM 技术应用介绍、致痫灶定位的准确性、预测术后效果、基于 SISCOM 的新理念以及未来的发展等方面做一综述。

Citation： 刘霄, 艾林, 王群. 单光子计算机断层减影与核磁共振融合成像术在癫痫致痫灶定位中的应用进展. Journal of Epilepsy, 2018, 4(2): 121-125. doi: 10.7507/2096-0247.20180025 Copy

1.	Schuele SU, Luders HO. Intractable epilepsy: management and therapeutic alternatives. Lancet Neurol, 2008, 7(6): 514-524.
2.	Pittau F, Grouiller F, Spinelli L, et al. The role of functional neuroimaging in pre-surgical epilepsy evaluation. Front Neurol, 2014, 5(31): 1-16.
3.	Chen T, Guo L. The roleofSISCOMin preoperative evaluation for patients withepilepsysurgery: A meta-analysis. Seizure, 2016, 41: 43-50.
4.	Perry MS, Bailey L, Freedman D, et al. Coregistration of multimodal imaging is associated with favourable two-year seizure outcome after paediatric epilepsy surgery. Epileptic Disord, 2017, 19(1): 40-48.
5.	O’Brien TJ, So EL, Mullan BP, et al. Subtraction ictal SPECT co-registered to MRI improves clinical usefulness of SPECT in localizing the surgical seizure focus. Neurology, 1998, 50(2): 445-454.
6.	Van Paesschen W. Ictal SPECT. Epilepsia, 2004, 45(Suppl 4): 35-40.
7.	O’Brien TJ, SO EL, Mullan BP, et al. Subtraction peri-ictal SPECT is predictive of extratemporal epilepsy surgery outcome. Neurology, 2000, 55(11): 1668-1677.
8.	Sasaki K, Ohsawa Y, Sasaki M, et al. Cerebral cortical dysplasia: aeeseement by MRI and SPECT. Pediatr Neurol, 2000, 23(5): 410-415.
9.	Dupont P, Zaknun JJ, Maes A, et al. Dynamic perfusion patterns in temporal lobeepilepsy. Eur J Nucl Med Mol Imaging, 2009, 36(5): 823-830.
10.	Kumar A, Chugani HT. The role of radionuclide imaging in epilepsy, Part 1: Sporadic Temporal and Extratemporal Lobe Epilepsy. J Nuci Med Technol, 2017, 45(1): 14-21.
11.	Noachtar S, Arnold S, Yousry TA, et al.Ictaltechnetium-99m ethyl cysteinate dimer single-photon emission tomographicfindings and propagation of epileptic seizure activity in patients with extratemporal epilepsies. Eur J Nucl Med, 1998, 25(2): 166-172.
12.	Stamoulis C, Verma N, Kaulas H, et al. The promise of subtraction ictal SPECT co-registered to MRI for improved seizure localization in pediatric epilepsies: Affecting factors and relationship to the surgical outcome. Epilepsy Res, 2017, 129: 59-66.
13.	Sepkuty JP, Lesser RP, Civelek CA, et al.An automated injection system (with patient selection) for SPECT imaging in seizurelocalization. Epilepsia, 1998, 39(12): 1350-1356.
14.	Van Paesschen W, Dupont P, Van Heerden B, et al. Self-injection ictal SPECTduring partial seizures. Neurology, 2000, 54(10): 1994-1997.
15.	Setoain X, Pavia J, Seres E, et al. Validation of an automatic dose injection system for Ictal SPECT in epilepsy. J Nucl Med, 2012, 53(2): 324-329.
16.	Kim S, Holder DL, Laymon CM, et al. Clinical value of the first dedicated, commercially available automatic injector for ictal brain SPECT in presurgical evaluation of pediatric epilepsy: comparison with manual injection. J Nucl Med, 2013, 54(5): 732-738.
17.	Lee JY, Joo EY, Park HS, et al. Repeated ictal SPECT in partial epilepsy patients: SISCOManalysis. Epilepsia, 2011, 52(12): 2249-2256.
18.	Van Paesschen W, Dupont P, Sunaert S, et al. The use of SPECT and PET in routine clinical practice in epilepsy. Curr Opin Neurol, 2007, 20(2): 194-202.
19.	Newey CR, Wong C, Wang ZI, et al. Optimizing SPECT / SISCOM analysis to localize seizure-onset zone by using varying Zscores. Epilepsia, 2013, 54(5): 793-800.
20.	Kimura Y, Sato N, Ito K, et al. SISCOM technique with a variable Z score improves detectability of focal cortical dysplasia: a comparative study with MRI. Ann Nucl Med, 2012, 26(5): 397-404.
21.	Kudr M, Krsek P, Marusic P, et al. SISCOM and FDG-PET in patients with non-lesional extratemporal epilepsy: correlation with intracranial EEG, histology, and seizure outcome. Epileptic Disord, 2013, 15(1): 3-13.
22.	Carne RP, O’Brien TJ, Kilpatrick CJ, et al. MRI-negative PET-positive temporallobe epilepsy: a distinct surgically remediable syndrome. Brain, 2004, 127(Pt 10): 2276-2285.
23.	Perissinotti A, Setoain X, Aparicio J, et al. Clinical role of subtractionictal SPECT coregistered to MR imaging and (18)F-FDG PET inpediatric epilepsy. J Nucl Med, 2014, 55(7): 1099-1105.
24.	Jalota A, Rossi MA, Pylypyuk V, et al. Resecting critical nodes from an epileptogenic circuit in refractory focal-onset epilepsy patients using subtraction ictal SPECT coregistered to MRI. J Neurosurg, 2016, 125(6): 1565-1576.
25.	Aboian MS, Wong-Kisiel LC, Rank M, et al. SISCOM in children with tuberous sclerosis complex-related epilepsy. Pediatr Neurol, 2011, 45(2): 83-88.
26.	Halasz P. The concept of epileptic networks. Part 1. Ideggyogy Sz, 2010, 63(9-10): 293-303.
27.	Toussyn S, Dupont P, Goffin K, et al. Correspondence between large-scale ictal and interictal epileptic networks revealed by single photon emission computed tomography and electroencephalography-functional magnetic resonance imaging. Epilepsia, 2015, 56(3): 382-392.
28.	Fahoum F, Lopes R, Pittau F, et al. Widespread epileptic networks in focal epilepsies: EEG-fMRI study. Epilepsia, 2012, 53(9): 1618-1627.
29.	Desai A, Bekelis K, Thadani VM, et al. Interictal PET and ictal subtraction SPECT: sensitivity in the detection of seizure foci in patients with medically intractable epilepsy. Epilepsia, 2013, 54(2): 341-350.
30.	Chandra PS, Vaqhania G, Bal CS, et al. Role of concordance between ictal-subtracted SPECT and PET in predicting long-term outcomes after epilepsy surgery. Epilepsy Res, 2014, 108(10): 1782-1789.
31.	Fernandez S, Donaire A, Seres E, et al. PET/MRI and PET/MRI/SISCOM coregistration in the presurgical evaluation of refractory focal epilepsy. Epilepsy Res, 2015, 111: 1-9.
32.	Berkovic SF, Newton MR, Rowe CO. Localization of epileptic foci using SPECT. In: Lüders HO, ed. Epilepsy Surgery New York: Raven Press, 1991: 251-256.
33.	Kazemi NJ, Worrell GA, Stead SM, et al. Ictal SPECT statistical parametric mapping in temporal lobe epilepsy surgery. Neurology, 2010, 74(1): 70-76.
34.	Sulc V, Stykel S, Hanson DP, et al. Statistical SPECT processing in MRI-negative epilepsy surgery. Neurology, 2014, 82(11): 932-939.
35.	Marti Fuster B, Esteban O, Planes X, et al. Focus DET, a new toolbox for SISCOM analysis. Evaluation of the registration accuracy using monte carlo simulation. Neuroinformatics, 2013, 11(1): 77-89.
36.	Suarez Pinera M, Mestre Fusco A, Ley M, et al. Perfusion SPECT, SISCOM and PET(18)F-FDG in the assessment of drug-refractory epilepsy patients candidates for epilepsy surgery. Rev Esp Med Nucl Imagen Mol, 2015, 34(6): 350-357.

1. Schuele SU, Luders HO. Intractable epilepsy: management and therapeutic alternatives. Lancet Neurol, 2008, 7(6): 514-524.
2. Pittau F, Grouiller F, Spinelli L, et al. The role of functional neuroimaging in pre-surgical epilepsy evaluation. Front Neurol, 2014, 5(31): 1-16.
3. Chen T, Guo L. The roleofSISCOMin preoperative evaluation for patients withepilepsysurgery: A meta-analysis. Seizure, 2016, 41: 43-50.
4. Perry MS, Bailey L, Freedman D, et al. Coregistration of multimodal imaging is associated with favourable two-year seizure outcome after paediatric epilepsy surgery. Epileptic Disord, 2017, 19(1): 40-48.
5. O’Brien TJ, So EL, Mullan BP, et al. Subtraction ictal SPECT co-registered to MRI improves clinical usefulness of SPECT in localizing the surgical seizure focus. Neurology, 1998, 50(2): 445-454.
6. Van Paesschen W. Ictal SPECT. Epilepsia, 2004, 45(Suppl 4): 35-40.
7. O’Brien TJ, SO EL, Mullan BP, et al. Subtraction peri-ictal SPECT is predictive of extratemporal epilepsy surgery outcome. Neurology, 2000, 55(11): 1668-1677.
8. Sasaki K, Ohsawa Y, Sasaki M, et al. Cerebral cortical dysplasia: aeeseement by MRI and SPECT. Pediatr Neurol, 2000, 23(5): 410-415.
9. Dupont P, Zaknun JJ, Maes A, et al. Dynamic perfusion patterns in temporal lobeepilepsy. Eur J Nucl Med Mol Imaging, 2009, 36(5): 823-830.
10. Kumar A, Chugani HT. The role of radionuclide imaging in epilepsy, Part 1: Sporadic Temporal and Extratemporal Lobe Epilepsy. J Nuci Med Technol, 2017, 45(1): 14-21.
11. Noachtar S, Arnold S, Yousry TA, et al.Ictaltechnetium-99m ethyl cysteinate dimer single-photon emission tomographicfindings and propagation of epileptic seizure activity in patients with extratemporal epilepsies. Eur J Nucl Med, 1998, 25(2): 166-172.
12. Stamoulis C, Verma N, Kaulas H, et al. The promise of subtraction ictal SPECT co-registered to MRI for improved seizure localization in pediatric epilepsies: Affecting factors and relationship to the surgical outcome. Epilepsy Res, 2017, 129: 59-66.
13. Sepkuty JP, Lesser RP, Civelek CA, et al.An automated injection system (with patient selection) for SPECT imaging in seizurelocalization. Epilepsia, 1998, 39(12): 1350-1356.
14. Van Paesschen W, Dupont P, Van Heerden B, et al. Self-injection ictal SPECTduring partial seizures. Neurology, 2000, 54(10): 1994-1997.
15. Setoain X, Pavia J, Seres E, et al. Validation of an automatic dose injection system for Ictal SPECT in epilepsy. J Nucl Med, 2012, 53(2): 324-329.
16. Kim S, Holder DL, Laymon CM, et al. Clinical value of the first dedicated, commercially available automatic injector for ictal brain SPECT in presurgical evaluation of pediatric epilepsy: comparison with manual injection. J Nucl Med, 2013, 54(5): 732-738.
17. Lee JY, Joo EY, Park HS, et al. Repeated ictal SPECT in partial epilepsy patients: SISCOManalysis. Epilepsia, 2011, 52(12): 2249-2256.
18. Van Paesschen W, Dupont P, Sunaert S, et al. The use of SPECT and PET in routine clinical practice in epilepsy. Curr Opin Neurol, 2007, 20(2): 194-202.
19. Newey CR, Wong C, Wang ZI, et al. Optimizing SPECT / SISCOM analysis to localize seizure-onset zone by using varying Zscores. Epilepsia, 2013, 54(5): 793-800.
20. Kimura Y, Sato N, Ito K, et al. SISCOM technique with a variable Z score improves detectability of focal cortical dysplasia: a comparative study with MRI. Ann Nucl Med, 2012, 26(5): 397-404.
21. Kudr M, Krsek P, Marusic P, et al. SISCOM and FDG-PET in patients with non-lesional extratemporal epilepsy: correlation with intracranial EEG, histology, and seizure outcome. Epileptic Disord, 2013, 15(1): 3-13.
22. Carne RP, O’Brien TJ, Kilpatrick CJ, et al. MRI-negative PET-positive temporallobe epilepsy: a distinct surgically remediable syndrome. Brain, 2004, 127(Pt 10): 2276-2285.
23. Perissinotti A, Setoain X, Aparicio J, et al. Clinical role of subtractionictal SPECT coregistered to MR imaging and (18)F-FDG PET inpediatric epilepsy. J Nucl Med, 2014, 55(7): 1099-1105.
24. Jalota A, Rossi MA, Pylypyuk V, et al. Resecting critical nodes from an epileptogenic circuit in refractory focal-onset epilepsy patients using subtraction ictal SPECT coregistered to MRI. J Neurosurg, 2016, 125(6): 1565-1576.
25. Aboian MS, Wong-Kisiel LC, Rank M, et al. SISCOM in children with tuberous sclerosis complex-related epilepsy. Pediatr Neurol, 2011, 45(2): 83-88.
26. Halasz P. The concept of epileptic networks. Part 1. Ideggyogy Sz, 2010, 63(9-10): 293-303.
27. Toussyn S, Dupont P, Goffin K, et al. Correspondence between large-scale ictal and interictal epileptic networks revealed by single photon emission computed tomography and electroencephalography-functional magnetic resonance imaging. Epilepsia, 2015, 56(3): 382-392.
28. Fahoum F, Lopes R, Pittau F, et al. Widespread epileptic networks in focal epilepsies: EEG-fMRI study. Epilepsia, 2012, 53(9): 1618-1627.
29. Desai A, Bekelis K, Thadani VM, et al. Interictal PET and ictal subtraction SPECT: sensitivity in the detection of seizure foci in patients with medically intractable epilepsy. Epilepsia, 2013, 54(2): 341-350.
30. Chandra PS, Vaqhania G, Bal CS, et al. Role of concordance between ictal-subtracted SPECT and PET in predicting long-term outcomes after epilepsy surgery. Epilepsy Res, 2014, 108(10): 1782-1789.
31. Fernandez S, Donaire A, Seres E, et al. PET/MRI and PET/MRI/SISCOM coregistration in the presurgical evaluation of refractory focal epilepsy. Epilepsy Res, 2015, 111: 1-9.
32. Berkovic SF, Newton MR, Rowe CO. Localization of epileptic foci using SPECT. In: Lüders HO, ed. Epilepsy Surgery New York: Raven Press, 1991: 251-256.
33. Kazemi NJ, Worrell GA, Stead SM, et al. Ictal SPECT statistical parametric mapping in temporal lobe epilepsy surgery. Neurology, 2010, 74(1): 70-76.
34. Sulc V, Stykel S, Hanson DP, et al. Statistical SPECT processing in MRI-negative epilepsy surgery. Neurology, 2014, 82(11): 932-939.
35. Marti Fuster B, Esteban O, Planes X, et al. Focus DET, a new toolbox for SISCOM analysis. Evaluation of the registration accuracy using monte carlo simulation. Neuroinformatics, 2013, 11(1): 77-89.
36. Suarez Pinera M, Mestre Fusco A, Ley M, et al. Perfusion SPECT, SISCOM and PET(18)F-FDG in the assessment of drug-refractory epilepsy patients candidates for epilepsy surgery. Rev Esp Med Nucl Imagen Mol, 2015, 34(6): 350-357.

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单光子计算机断层减影与核磁共振融合成像术在癫痫致痫灶定位中的应用进展

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