TCA-fMRI技术在难治性癫痫致痫灶术前定位中的应用

目的探讨静息态功能性磁共振时间簇分析（TCA-fMRI）应用于难治性癫痫致痫灶术前定位的方法和价值。方法对11例难治性癫痫病人,在癫痫发作间期行静息态功能磁共振（fMRI）检查,应用TCA-fMRI技术计算与癫痫发作相关的脑内激活区（致区）,并分析比较该激活区与术中皮质电极定位致痫灶之间的吻合程度。结果 TCA-fMRI确定的激活区与术中皮质电极定位的致痫灶一致6例;激活区范围扩大3例,但最强激活区仍与皮质电极定位的癫痫灶一致;激活区较弥散2例。术后病理显示：胶质瘤3例,脑软化灶4例,灰质异位症2例,海绵状血管瘤1例,海马萎缩1例。随访1年,术后3个月、6个月及1年均复查脑电图,癫痫发作消失8例,明显减少3例;无严重并发症。结论静息态TCA-fMRI技术是一种新型、无创性的致痫灶定位方法,将静息状态下致痫灶异常放电所导致的血氧依赖水平变化在MRI三维结构图像上显示,能在术前精确定位致痫灶。

Application of temporal cluster analysis and functional MRI technique in localizing epileptic focus preoperatively

Objective To explore the method and value of resting functional magnetic resonance imaging with temporal clustering analysis（TCA-fMRI）in localizing epileptic focus preoperatively.Methods Resting-state fMRI examination was conducted in 11 patients with intractable epilepsy.TCA-fMRI technique was used to find out the activated brain regions relating to epileptic seizures.Then the consistency between activated regions found out by TCA-fMRI and epileptic focus localized by intraoperative cortical electrodes was analyzed.Results The activated regions and epileptic focus were consistent with each other in 6 cases.The activated regions extended in 3,but the strongest activated regions were still consistent with the epileptic focus by the electrode.The activated regions were diffuse in 2.The lesions were diagnosed by postoperative pathological analysis including 3 gliomas,4 encephalomalacia foci,2 gray matter heterotopias,1 cavernous hemangioma,1 hippocampal atrophy.During a follow-up of 1 year,re-electroencephalography on the 3rd month,6th month and 1 year showed epileptic seizures disappeared in 8 cases and significantly reduced in 3.No serious complication.Conclusions TCA-fMRI,an novel and non-invasive technology,which could showed blood oxygen level dependent changes caused by abnormal discharge of epileptic focus on three dimension MRI,can precisely detect epileptic focus preoperation.