颞叶癫痫的质子磁共振波谱与PET/CT及术后病理对照研究

目的：对颞叶癫痫患者术前的质子磁共振波谱（1H MRS）与正电子发射断层扫描（PET/CT）、脑电图（EEG）及术后病理进行对照研究，评价1H MRS对颞叶癫痫的诊断价值。方法：16例颞叶癫痫病人，术前均做发作期间脑电图和/或长程脑电图监测及PET/CT检查。对28例健康志愿者和16例患者分别进行双侧海马的1H MRS采集，定量分析N-乙酰天门冬氨酸（NAA）、肌酸（Cr）和胆碱（Cho）代谢物的变化。3例患者手术切除致痫灶送病检。结果：病侧组、对侧组和对照组的NAA/Cr、Cho/Cr和NAA/（Cho+Cr）值之间的差异均有统计学意义（P<0.05）。16例患者中5例为单侧异常，11例为双侧异常，14例可确定异常侧，定位敏感度87%。结论：患者1H MRS示病侧与EEG、PET和病理改变有较好的对应性，1H MRS不仅可以发现双侧病变，而且可以指出病变严重的一侧，为术前致痫灶的定位提供可靠的依据。

Comparison of 1H MRS, PET/CT and postoperational pathology of the patients with temporal lobe epilepsy

Objective: To compare the results of the preoperational 1H MRS with PET/CT, electroencephalogram(EEG) and postoperational pathology of the patients with temporal lobe epilepsy(TLE) and to determine the relative utility of the preoperational 1H MRS for the diagnosis and presurgical lateralization of temporal lobe epilepsy. Methods: EEG and PET/CT were performed in all of the 16 patients. 1H MRS was performed in 16 patients with TLE and 28 healthy volunteers. Signals from N-acetylaspartate(NAA), creatine(Cr) and choline-containing compounds(Cho) were observed. The focus of 3 patients was resected with the intraoperative monitoring of EEG and the pathological examination were performed. Results: Analysis demonstrated the difference of NAA/Cr, Cho/Cr and NAA/(Cho+Cr) among the abnormal side, contralateral side and control group had statistical significance (P<0.05). On the basis of NAA/(Cho+Cr) ratio, lateralization was achieved in 14 cases. Bilateral abnormalities were showed in 11 cases with the ipsilateral side more severe than that of contralateral side. Unilateral abnormalities were showed in 5 cases. 1H MRS had a sensitivity of 87% for lateralization of seizure in TLE. Conclusion: 1H MRS could contribute to the location of seizure focus and detection of bilateral abnormalities, consisting with the findings of EEG and PET and pathologic alterations very well. 1H MRS is a useful noninvasive diagnostic technique for preoperational evaluation of patients with TLE who are eligible for surgery.