論文参照

03-30生体磁気-学会誌-抄録集.qxp_レイアウト 1 2015/05/22 18:04 ページ 70
臨床脳磁図
日本生体磁気学会誌特別号
O3-2
Vol.28 No.1 2015　第 30 回日本生体磁気学会大会論文集
Ⓨస᫬ +)2 ศᯒᑟධᚋࡢ 05, 㝜ᛶ᪂⓶㉁࡚ࢇ࠿ࢇࡢ
↔Ⅼデ᩿ࠊᡭ⾡࡟࠾ࡅࡿ⬻☢ᅗࠊ3(763(&7 ࡢ᭷⏝ᛶ
Usefulness of MEG, PET and SPECT in diagnosis and surgical
treatment of patients with MRI-negative neocortical epilepsy
๓ཎ೺ᑑ(1), ✄ḟᇶᕼ(1), ᢡཎ࠶ࡍࡳ(1), ཎᜨᏊ(2), ⏣➃ᱻ(2), ⸨㛫リኸ㔛(2),
‫‮‬ᮏ┿ே(3)
ᮾி་⛉ṑ⛉኱Ꮫ⬻⚄⤒እ⛉ྠ⏕࿨᝟ሗᶵ⬟Ꮫ
ᮾி኱Ꮫ་Ꮫ㒊㝃ᒓ⑓㝔᳨ᰝ㒊
Taketoshi Maehara(1), Motoki Inaji(1), Asumi Orihara(1),
Keiko Hara(2), Azusa Tabata(2), Shiori Touma(2), Masato Yumoto(3)
Departments of (1)Neurosurgery and (2)Bio-informatics, Tokyo Medical and Dental University
(3)Department of Clinical Laboratory ,The University of Tokyo
Abstract We investigated clinical usefulness of
┠ ⓗ 㸧㞴἞࡚ࢇ࠿ࢇࡢእ⛉἞⒪࡟࠾࠸࡚ࡣࠊMRI
MEG, PET, and SISCOM in 6 patients with
㝜ᛶ᪂⓶㉁࡚ࢇ࠿ࢇࡢእ⛉἞⒪ᡂ⦼ࡣ୙Ⰻ࡞ࡇ࡜
MRI-negative
who
ࡀ▱ࡽࢀ࡚࠸ࡿࠋ᭱኱ࡢཎᅉࡣ↔Ⅼデ᩿ࡀᅔ㞴࡞
underwent surgical intervention after ictal
ࡇ࡜࡛࠶ࡿࡀࠊ㏆ᖺ᪂ࡓ࡞࡚ࢇ࠿ࢇࣂ࢖࣐࣮࢜࢝
HFO analysis on intracranial electrodes. Focus
࣮࡜ࡋ࡚ὀ┠ࢆᾎࡧ࡚࠸ࡿ㧗࿘Ἴᚊື(HFO)ศᯒ
areas demonstrated by ictal HFO analysis were
ࡢᑟධࡣࠊMRI 㝜ᛶ᪂⓶㉁࡚ࢇ࠿ࢇࡢデ᩿ࠊᡭ⾡
comparable in 3 of 6 patients with FDG- and
ᡂ⦼ࡢᨵၿ࡟ᐤ୚ࡍࡿ஦ࡀᮇᚅࡉࢀ࡚࠸ࡿ [1]ࠋ௒
FMZ-PET, 2of 3 with SISCOM, and 2of 2 with
ᅇ⬻☢ᅗ࠾ࡼࡧ᰾་Ꮫ᳨ᰝࡢ MRI 㝜ᛶ᪂⓶㉁࡚
MEG. All of 2 patients who showed marked
ࢇ࠿ࢇࡢデ᩿ࠊᡭ⾡ᡂ⦼࡟࠾ࡅࡿ᭷⏝ᛶࢆ HFO
accumulation of dipole on focus areas disclosed
ศᯒᑟධᚋ⑕౛࡟ᑐࡋ᳨࡚ウࡋࡓࠋ
by ictal HFO analysis achieved seizure free
ᑐ ㇟㸧 ᙜ㝔࡛ HFO ゎᯒࡀྍ⬟࡟࡞ࡗࡓ 2013 ᖺ
outcome. Although this study reports only 2
௨ᚋ࡟እ⛉἞⒪ࢆ᪋⾜ࡋࡓ MRI 㝜ᛶ᪂⓶㉁࡚ࢇ
patients and short follow-up periods, MEG is a
࠿ࢇᝈ⪅ 6 ྡࢆᑐ㇟࡜ࡋࡓࠋᖺ㱋ࡣ 18 ᡯ࠿ࡽ 52
useful
ᡯ࡛↔Ⅼࡣഃ㢌ⴥእഃࡀ 4 ౛ࠊ๓㢌ⴥࡀ 2 ౛࡛࠶
neocortical
examination
for
epilepsy
patients
with
ࡗࡓࠋ⾡๓᳨ᰝ࡜ࡋ࡚᪋⾜ࡋࡓ⬻☢ᅗ㸦2 ౛㸧ࠊPET
MRI-negative neocortical epilepsy.
70
03-30生体磁気-学会誌-抄録集.qxp_レイアウト 1 2015/05/22 18:04 ページ 71
日本生体磁気学会誌特別号
Vol.28 No.1 2015　第 30 回日本生体磁気学会大会論文集
㸦 FGD!PET, flumazenil(FMZ)-PET ඲ ౛ 㸧ࠊ
Class I࡛࠶ࡗࡓࠋ㸦Table 1㸧 3)⬻☢ᅗࢆ᪋⾜ࡋ
SISCOM(3 ౛)࡟ὀ┠ࡋ࡚ࠊⓎస᫬ HFO ゎᯒ࡛࠼
ࡓ2౛ࡢ࠺ࡕ1౛ࡣᕥഃ㢌㒊ࡢᗈ⠊࡞㡿ᇦ㸦ᕥୖഃ
ࡽࢀࡓ↔Ⅼデ᩿㒊఩࡜ࡢ㛵ಀ࠾ࡼࡧᡭ⾡ᡂ⦼࡟ࡘ
㢌⁁ࠥᗏ㠃㸧࡟ࢲ࢖࣏࣮ࣝࡣ᥎ᐃࡉࢀࠊෆഃᆺࣃ
࠸᳨࡚ウࡋࡓࠋࡉࡽ࡟ࠊ⬻☢ᅗ᪋⾜ 2 ౛࡟ࡘ࠸࡚
ࢱ࣮ࣥ࡜እഃᆺࣃࢱ࣮ࣥࡀేᏑࡋ࡚࠸ࡓࠋ
ࡣ௚ࡢ᳨ᰝ࡜ࡢ㛵ಀࡶ᳨ウࡋࡓࠋ
FDG-PET࡛ྠ㒊఩࡟ᗈ⠊࡞௦ㅰపୗࢆㄆࡵࠊⓎ
᪉ ἲ 㸧MEGグ㘓࡟ࡣ㸪306ࢳࣕࢿࣝ඲㢌ᆺ⬻☢ィ
స᫬⬻Ἴ࡟ࡼࡿHFOゎᯒ࡛ࡶྠ㒊఩࡟↔Ⅼࡀྠ
V
ᐃࡉࢀࠊഃ㢌ⴥእഃ࠾ࡼࡧᾏ㤿ࡢMSTࢆ⾜࠸Ⓨస
ectorV
iew㸦Elekta Neuromag♫㸪Helsinki,
Finland㸧ࢆ⏝࠸㸪☢Ẽࢩ࣮ࣝࢻ࣮࣒ࣝෆࡢ࣋ࢵࢻ
ࡣᾘኻࡋ࡚࠸ࡿࠋࡶ࠺1౛ࡣࠊྑ๓㢌ⴥᘚ⵹㒊࡟
࡟௮⮩఩࡟࡚㸪Ᏻ㟼㛢║ぬ㓰࠿ࡽ㍍╧╀ᮇ࡟⮳ࡿ
ࢲ࢖࣏࣮ࣝࡢᙉ࠸㞟✚ࡀㄆࡵࡽࢀࡓ⑕౛࡛ࠊFDG
⮬Ⓨ⬻άືࢆ㸪21ࢳࣕࢿࣝEEG࡜ඹ࡟ྠ᫬グ㘓ࡋ
࠾ࡼࡧFMZ-PET࡛ࡣ௦ㅰపୗࡀㄆࡵࡽࢀࡎࠊ
ࡓ㸬MEG㸪EEG࡜ࡶ㸪0.1-200Hzࡢࣂࣥࢻࣃࢫࣇ
SISCOM࡛ࡣ୧ഃᘚ⵹㒊ࡢ⾑ὶቑຍࢆ♧ࡋࡓࠋⓎ
࢕ࣝࢱฎ⌮ᚋ࡟600Hz࡛ࢧࣥࣉࣜࣥࢢࡋ㸪⑕౛ẖ
స᫬⬻Ἴ࡛ࡣྑ๓㢌㒊࡟ᗈ⠊࡞Ⓨస㉳ጞࢆㄆࡵࡓ
ࡢ✺ⓎἼࡢฟ⌧㢖ᗘ࡟ᛂࡌ࡚⣙20㹼40ศ㛫グ㘓
ࡀࠊⓎస᫬HFOࡣ⬻☢ᅗ࡜࡯ࡰ୍⮴ࡋࡓ㒊఩࡟㝈
ࡋࡓ㸬グ㘓ࡋࡓMEGࢹ࣮ࢱ࡟ᑐࡋ㸪time-domain
ᒁࡋ࡚࠸ࡓࠋྠ㒊఩ࡢ↔Ⅼษ㝖⾡ࢆ᪋⾜ࡋ⌧ᅾⓎ
extension of signal space separation (tSSS) ἲ࡟
సࡣᾘኻࡋ࡚࠸ࡿࠋ
ࡼࡿ✵㛫ࣇ࢕ࣝࢱฎ⌮ࢆ⾜࠸㸪እ᮶ࣀ࢖ࢬࢆ㝖ཤ
⤖ ㄒ㸧 ࢃࡎ࠿2⑕౛࡛ࡣ࠶ࡿࡀࠊ⬻☢ᅗࡣMRI㝜
ࡋࡓ㸬㟁※ゎᯒ࡟ඛ❧ࡕ㸪⑕౛ࡢ⫼ᬒάືࡸグ㘓
ᛶ᪂⓶㉁࡚ࢇ࠿ࢇࡢ↔Ⅼデ᩿ࡢࡳ࡞ࡽࡎᡭ⾡ᡂ⦼
≧ἣ࡟ᛂࡌ࡚㸪㐺ᐅ࢜ࣇࣛ࢖ࣥࣁ࢖ࣃࢫ࠾ࡼࡧࣟ
ࡢྥୖ࡟ࡶ᭷⏝࡜⪃࠼ࡽࢀࡓࠋ
࣮ࣃࢫࣇ࢕ࣝࢱ࡟ࡼࡾ㸪⫼ᬒᚎἼࡸ㧗࿘Ἴࣀ࢖ࢬ
ࡢ㝖ཤࢆ⾜ࡗࡓ㸬MEG࡜㢌㒊MRIࡢᗙᶆྜࢃࡏࢆ
⾜࠸㸪㢌⵹㦵ෆഃ㠃ࢆ⌫㠃㏆ఝࡋࡓ㢌㒊ࣔࢹࣝෆ
࡟༢୍㟁ὶ཮ᴟᏊࢆ௬ᐃࡋ㸪㟁※㏆ഐࡢ」ᩘ㸦66
㹼78ಶ㸧ࡢࢳࣕࢿࣝࢆ⏝࠸࡚㸪ಶࠎࡢⓎస㛫Ḵᮇ
ᲲἼࡢᣢ⥆᫬㛫୰ࡢࢧࣥࣉࣜࣥࢢ㛫㝸ẖ࡟㟁※ࢆ
ồࡵࡓ㸬⟬ฟࡉࢀࡓ㟁※ࡣ㸪⮫ᗋ⬻☢ᅗ᳨ᰝゎᯒ
ᣦ㔪࡟๎ࡾ㸪goodness-of-fit (GOF)㸪confidence
volume㸪㟁ὶ࣮࣓ࣔࣥࢺ࡟ࡑࢀࡒࢀタᐃࡋࡓ㝈⏺
್ࢆ‶ࡓࡍࡶࡢࡢࡳ᥇⏝ࡋ㸪ࡑࡢ௚ࡣಙ㢗ᛶࡀప
࠸ࡶࡢ࡜ࡋ࡚Რ༷ࡋࡓ㸬
⤖ ᯝ 㸧 1㸧SPMゎᯒࢆ⏝࠸ࡓFDG-PETࡢ↔Ⅼᥥ
ཧ⪃ᩥ⊩
ฟ⋡ࡣ3/6 (50%)࡛ࠊFMZ-PETࡣ2/6(33%)࡛࠶ࡗ
[1] Jacobs J, Staba R, Asano E, Otsubo H, Wu
ࡓࠋᥥฟ౛ࡢᡭ⾡ᡂ⦼ࡣClass I or II࡛࠶ࡗࡓࠋ
JY, Zijlmans M, Mohamed I, Kahane P, Dubeau
2)SISCOMࡣ3౛࡟⾜࠸ࠊ2౛࡛↔Ⅼࡀᥥฟࡉࢀࡓ
F, Navarro V, Gotman J: High-frequency
ࡀ1౛ࡣᡭ⾡ᡂ⦼ࡀClass IV࡛࠶ࡗࡓࠋ⬻☢ᅗࡣ2
oscillations (HFOs) in clinical epilepsy. Prog
౛࡟⾜࠸ࠊ2౛࡜ࡶ↔Ⅼࡀᥥฟࡉࢀᡭ⾡ᡂ⦼ࡣ
Neurobiol 98: 302-315, 2012.
71

Download Report