난치성 측두엽간질의 발작간 뇌혈류 SPECT, MRI와 수술성과 비교

Abstract

Interictal single photon emission computed tomography of regional cerebral blood flow (rCBF SPECT) in 18 intractable temporal lobe epilepsy patient,s(8 male and 10 female patients : average 23.5 years old) were eompared with 2.0 T magnetic resanance imaging (MRI). And surgical outcome was analysed with the findings, symptom duration and lateralization of temporal lobe. Preoperatively rCRF SPKCT was done in all 18 patients with intravenous injection of 740 MRq 99mTc HMPAO. MRI was also done preoperatively in 13 patients, Surgical outcome was classified by Engels outcome classification (four part classification recommended at the first Palm Desert conference). rCRF SPECT detected correctly lateralising abnormality of temporal lobe hypoperfusion in 13/ 18(72.2%), contralateral temporal lobe hypoperfusion in 2/18(11.1%) and showed no definite abnormality in 3/18(16.7%). The positive predictive value of unilateral temporal lobe hypoperfusion was 87%. MRI detected correct localising abnormality in 8/13(61.5%), such as hippocampal atrophy(7/13), asymmetric temporal horn(6/13), anterior t,emporal lobe atrophy(1/13), increased signal intensity from hippocampus(1/13) and ealcific density(3/13), and no abnormal finding was noted in 5/13(38.5%), There was no false positive findings and the positive predictive value of MRI was 100%, Only 2 cases showed same lateralization findings in rCBF SPECT and MRI. There was no significant correlation between symptom duration and no abnormal findings on SPECT or MRI. Surgical outcome showed elass 1 in 15/18(83.3%), and class II in 2/18(11.1%). One case of no abnormal finding in both SPECT and MRI showed elass I1I surgical outcome. No class IV surgical out.come was noted. Surgical outcome, lat.eralization of epileptic focus in temporal lobe and abnormal findings in rCBR SPECT or MRI were not significantly correlated.