Table of Contents

HK J Paediatr (New Series)
Vol 18. No. 3, 2013

HK J Paediatr (New Series) 2013;18:178-181

Case Report

Presurgical Evaluation of Epileptogenic Focus in Temporal Lobe Epilepsy by 11C-Flumazenil PET and 123I-Iomazenil SPECT: A Case Report
11C-氟馬西尼PET與123 碘-西尼SPECT於術前定位顳葉癲癇灶的一例報導

G Imataka, M Ogino, S Sakamoto, O Arisaka


Meticulous neuroradiological evaluations, including 123I-iomazenil (IMZ) single photon emission computed tomography (SPECT) and 11C-flumazenil (FMZ) positron emission tomography (PET), preoperatively disclosed epileptogenic foci in a 16-year-old boy with temporal lobe epilepsy. Interictal scalp electroencephalography showed spikes in the left temporal region. Left hippocampal sclerosis was seen on magnetic resonance imaging. Hypoperfusion in the entire left temporal lobe was seen on 99mTc ethyl-cysteinate dimer (ECD) SPECT. Hypometabolism over most of the left temporal lobe was apparent on 18F-fluorodeoxyglucose (FDG) PET. An area of hypoperfusion dominating the left temporal lobe was identified on 123I-IMZ SPECT. A low-uptake area in the left temporal lobe was seen on 11C-FMZ PET. Anteromedial temporal lobectomy and multiple subpial transection with intraoperative electrocorticography resulted in satisfactory seizure outcomes. Use of 123I-IMZ SPECT and 11C-FMZ PET appeared to demonstrate the epilepsy focus more localised than 99mTc ECD SPECT and 18F-FDG PET.

患兒男,16歲,顳葉癲癇,為術前定位癲癇灶,進行了一系列影像學檢查,包括: 123碘-西尼(123I-iomazenil ,123I-IMZ)單光子發射型電腦體層掃描(SPECT)、 11C-氟馬西尼(11C-flumazenil ,11C-FMZ)正電子發射型電腦體層掃描(PET)。檢查結果:發作期間腦電圖顯示左側顳葉有異常放電;顱腦磁共振檢查發現左側海馬硬化; 99m鍀-雙半胱乙酯(99mTc ethyl-cysteinate dimer ,99mTc ECD)-SPECT 檢查顯示整個左側顳葉的低灌注信號;18F-氟代去氧葡萄糖( 18F-fluorodeoxyglucose ,18F-FDG)-PET 檢查顯示左側顳葉大部分區域的低代謝表現。然而123 I-IMZ SPECT 可以顯示左側顳葉低灌注的主導區域,11C-FMZ-PET 亦可以很好地顯示左側顳葉的局部放射性稀疏。隨後患兒進行了前內側顳葉切除術與多處軟膜下橫切術,術中監測皮層腦電圖,取得了滿意的手術效果。結論:相對於99mTc ECD-SPECT與18F-FDG-PET, 123I-IMZ SPECT與 11C-FMZ PET能更精確地定位癲癇病灶。

Keyword : Hippocampal sclerosis; Positron emission tomography (PET); Single photon emission computed tomography (SPECT)



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