应用MRI海马体积测量评价颞叶癫癇、局灶性颞叶外癫癇和原发性癫癇大发作

目的：应用MRI体积测量评价颞叶癫癇、局灶性颞叶外癫痫和原发性癫癇大发作患者的海马体积改变，探讨海马硬化与癫癇发作的关系。材料和方法：74例癫癇患者和30例健康志愿者为研究对象，其中50例颞叶癫癇手术病理证实为海马硬化，6例局灶性颞叶外癫癇为临床诊断和证实，其余18例为原发性癫癇大发作。三组病例的平均病程无明显统计学差异。以正常对照组双侧海马体积的平均值减2倍标准差作为正常下限值来判断病例组双侧海马的绝对体积是否异常，绝对体积行标化处理。结果：50例颞叶癫癇患者中，33例（66％）的病侧海马体积小于正常，其中10例（20％）的对侧海马体积也小于正常。在6例局灶性颞叶外癫癇和18例癫痫大发作患者中，所有病例的双侧海马体积均在正常范围内。结论：颞叶癫癇具有特殊的病理改变，而有别于局灶性颞叶外癫癇和原发性癫癇大发作。MRI海马体积测量对探讨海马硬化与癫癇发作的关系具有很好的研究价值。     

应用MRI海马体积测量评价颞叶癫(癎)、局灶性颞叶外癫(癎)和原发性癫(癎)大发作

目的:应用MRI体积测量评价颢叶癫痢、局灶性颞叶外癫痢和原发性癫痢大发作患者的海马体积改变,探讨海屿硬化与癫痫发作的关系.材料和方法:74例癫癎患者和30例健康志愿者为研究对象,其中50例颞叶癫癎手术病理证实为海马硬化,6例局灶性颞叶外癫癎为临床诊断和证实,其余18例为原发性癫痫大发作.三组病例的平均病程无明显统计学差异.以正常对照组双侧海马体积的平均值减2倍标准差作为正常下限值来判断病例组双侧海马的绝对体积是否异常,绝对体积行标化处理.结果:50例颞叶癫癎患者中,33例(66%)的病侧海马体积小于正常,其中10例(20%)的对侧海马体积也小于正常.在6例局灶性颞叶外癫痢和18例癫癎大发作患者中,所有病例的双侧海马体积均在正常范围内.结论:颞叶癫癎具有特殊的病理改变,而有别于局灶性颞叶外癫痢和原发性癫癎大发作.MRI海马体积测量对探讨海马硬化与癫痢发作的关系具有很好的研究价值.     

癫痫病人MRI海马结构体积测定

目的测量正常成人及癫痫病人海马结构（ＨＦ）体积，探讨其在颞叶癫痫（ＴＬＥ）致痫灶定侧中的价值。材料与方法本组包括５２例正常成人及８９例癫痫病人，把病人分为三组：继发性癫痫４８例、特发颞叶外癫痫１５例、ＴＬＥ２６例，后者有２２例为顽固性癫痫。均作垂直于海马长轴的冠状位自旋回波（ＳＥ）序列Ｔ１加权像、ＴｕｒｂｏＳＥＴ２加权像，测量颞叶、ＨＦ体积和颞角、环池宽度，肉眼观察Ｔ２加权像海马信号强度改变。采用ＨＦ体积绝对值对ＴＬＥ定侧。结果获取了正常成人ＨＦ体积。２２例ＴＬＥＨＦ体积缩小，其中３例为双侧性；６例ＨＦ硬化经手术、病理证实，１例体积正常且致痫灶位于ＨＦ周围者ＨＦ硬化轻，８例其他类型癫痫病人ＨＦ体积略小，ＴＬＥ致痫灶定侧的敏感性为８５％，特异性为８７％。３例ＴＬＥ病人同侧前颞叶萎缩；部分ＴＬＥ病侧颞角、环池宽度增加；萎缩明显的ＨＦＴ２加权像信号弥漫性增高。结论ＨＦ体积缩小、Ｔ２加权像信号弥漫性增高是ＨＦ硬化萎缩的直接征象，与病变严重程度、致痫灶在颞叶的部位有关，前颞叶萎缩和颞角、环池增宽是ＨＦ硬化的辅助征象。ＨＦ萎缩不仅是颞叶癫痫的主要原因，也可能是其他类型癫痫发作的结果     

MRI海马结构体积分割分析对颞叶癫痫的诊断价值及临床相关性研究

目的　利用MRI体积分割分析的方法研究海马萎缩的不同形式 ,探讨颞叶癫痫的病因和发病机制 ,提高颞叶癫痫诊断的敏感性。方法　采用GE 1 5TSignaHorizonLX超导型磁共振机 ,行垂直于海马长轴的倾斜冠状面T1WI。将颞叶内侧结构分为杏仁核和海马头、体、尾部 4段 ,采用体积测量、逐层比较的方法对 5 0例病理诊断为海马硬化的颞叶癫痫患者行颞叶内侧结构体积分割分析 ,并比较各组间的临床特征及手术预后的差异。结果　 5 0例海马硬化患者中 ,海马弥漫萎缩者 2 2例(44 % ) ,同时伴杏仁核萎缩者 5例 (10 % )。海马局限性萎缩者 2 0例 (40 % ) ,无萎缩者 8例 (16 % )。 38例 (76 % )海马硬化萎缩累及海马体部 ,其次累及海马头部者 2 9例 (5 8% ) ,累及海马尾部者 2 4例(48% ) ,累及杏仁核者 8例 (16 % )。 10例患者MRI体积分割分析提示海马局限性萎缩而海马绝对体积正常。海马不同萎缩形式各组间的癫痫病程长短、发作频率及手术预后的差异具有显著性意义 (P<0 0 5 ) ;各组间的有无高热惊厥史、起病年龄及有无大发作史的差异不具有显著性意义 (P >0 0 5 )。结论　颞叶内侧结构体积分割分析能提高颞叶癫痫诊断的敏感性 ,对探讨颞叶癫痫的病因和发病机制提供帮助。     

难治性颞叶癫痫的临床研究:传统MRI及弥散加权成像的应用价值

目的:探讨发作间期传统磁共振成像及弥散加权成像的对颞叶癫痫的定侧价值及其对患者术后疗效的预测能力.方法:27例准备手术的难治性颞叶癫痫患者及19例健康对照者行常规MRI及DWI检查.测量并分析颞叶癫痫患者及对照组双侧海马的ADC值.影像所见与术后切除的脑组织病理结果相对照.结果:颞叶癫痫患者手术侧海马的ADC值显著高于对侧及健康对照者的同侧海马.利用右/左侧海马ADC比值定侧与手术侧一致的患者为21例(77.8%),而常规MRI定侧与手术侧一致的患者为18例(66.7%),两者没有显著的统计学差异(P>0.05).利用右/左侧海马的ADC比值能够定侧与不能定侧的两组癫痫患者术后疗效没有显著性差异(P>0.05).结论:常规MRI是一种术前发现海马硬化的敏感方法.海马右/左侧ADC比值确定颞叶癫痫发作侧的准确性很高,但对患者术后癫痫控制情况的预测能力欠佳.     

难治性颞叶癫痫海马和同侧前颞叶MRI特征及其与临床相关性

目的：探讨难治性颞叶癫痫海马硬化（HS）与同侧前颞叶 MRI特征及其与临床的相关性。方法：搜集经影像学或病理诊断为难治性颞叶癫痫 HS的34例患者的临床和影像资料,其中25例行手术治疗。34例中女15例,男19例,平均年龄（22．4±8．2）岁。观察海马及同侧前颞叶 MRI征象,根据海马及前颞叶 MRI 征象将34例分为同侧前颞叶正常组与前颞叶异常组,后者再分为同时出现灰白质分界模糊和颞叶萎缩组与仅出现一种征象组两亚组,比较各组间临床特征的差异。结果：34例中,22例（64．7％）出现 HS及同侧前颞叶异常,12例同侧颞叶正常。前颞叶异常组首次癫痫发作年龄低于前颞叶正常组（t＝－3．438,P＝0．002）,病程时间比前颞叶正常组长（t＝2．453,P＝0．020）。前颞叶同时出现灰白质分界模糊和颞叶萎缩组与仅存在一种征象组间临床特征无统计学差异。结论：难治性颞叶癫痫伴有前颞叶异常的颞叶癫痫多数首次发病年龄小,病程长,MRI特征与临床病情具有紧密的相关性,对于手术侧别选择意义重大。     

MRI测量颞叶癫痫患者海马体积与波谱分析

目的探讨利用磁共振图像判断海马萎缩在颞叶癫痫的意义,揭示颞叶癫痫病灶的质子磁共振波谱的变化特征。材料与方法对7例不同病程癫痫患者进行三维快速扰相位梯度回波序列(3D-FSPGR)和PRESS序列波谱采样,测量双侧海马的体积和海马区域的NAA／Cr、Cho／Cr比值,在同一患者左右侧进行对比。结果早期颞叶癫痫患者海马萎缩、NAA／Cr下降均不明显,Cho／Cr较对侧升高;发展到海马硬化阶段可以有海马萎缩、NAA／Cr下降和Cho／Cr升高;静息状态的癫痫患者有海马萎缩和NAA／Cr下降,但是Cho／Cr无升高表现。结论利用磁共振图像可以准确反映颞叶癫痫患者海马体积的变化;1H-MRS可以反映癫痫患者海马区域的代谢变化,为癫痫的定位提供信息。     

磁共振质子波谱在颞叶癫痫诊断中的应用

目的　评价磁共振质子波谱 (1HMRS)诊断颞叶癫痫的价值。方法　对 30例颞叶癫痫患者和 30例健康志愿者用 2 0T场强的MR成像系统分别进行双侧颞叶的质子波谱采集 ,定量分析N 乙酰天门冬氨酸 (NAA)、肌酸 (Cr)和胆碱复合物 (Cho)等代谢产物的变化。结果　癫痫病人NAA峰降低。以NAA/ (Cr Cho)值为判断标准 ,2 5例病人可以定侧诊断 ,敏感性 83% ,并发现 14例双侧病变 ,占 47%。结论　1HMRS可无创性探测脑组织内生化改变 ,对癫痫灶的定侧诊断具有很高的价值     

磁共振多种成像方法在颞叶癫痫的综合诊断

目的 应用MR不同成像方法探讨MRI对颞叶癫痫的诊断价值。资料与方法 设对照组40例，颞叶癫痫组(TLE)20例，颞叶外癫痫组(ELE)21例。应用MRI测量并比较对照组及TLE、ELE组间海马结构(HF)体积差异，行TLE组致痫侧评判。应用扩散加权成像(DWI)测量并比较对照组与TLE患侧、对侧、ELE组间表观弥散系数(ADC)值差异。应用1H MRS对各组分别进行单体素波谱(SVS)和化学位移成像(CSI)，SVS时比较TLE患侧、对侧及对照组各代谢物比值差异，对TLE组行致痫灶定侧诊断。CSI时分析HF从前到后NAA／(Cho Cr)的变化规律。结果TLE组患侧HF体积、NAA／(Cho Cr)值下降，ADC值升高，与对照组差异有显著性。定量MRI、SVS对TLE组定侧敏感性分别为70％、85％，特异性分别为87．5％、95％。CSI示HF的NAA／(Cho Cr)与HF部位间呈直线相关关系，TLE时前部改变较后部大。结论 定量MRI、SVS可帮助TLE致痫灶定侧，SVS更敏感、特异，两者结合后价值更大。CSI显示HF从前到后代谢物浓度渐变现象，TLE组头部改变较尾部大。DWI可作为MRI诊断颞叶癫痫的补充。     

无癫痫发作的颞叶内侧硬化的MRI分析

目的：评价颞叶癫痫颞叶切除的关键是MRI确认颞叶内侧硬化(MIS)。本文目的是评价无颞叶癫痫发作个体出现MIS的几率。方法：回顾性复习了我院2年间进行头颅MRI检查的病人，要求病人满足下列标准：①年龄从5岁～50岁；②没有癫痫发作史、精神性疾病、滥用酒精史，③没有癫痫家族史。所作MRI检查需满足下列标准：①因非特异性症状(头疼、眩晕等)或因除外脑转移瘤或因脑动脉瘤等进行检查；②在非特异性地检查颞叶内侧结构时，MRI常规读片为“正常”。所有病人在1．5TMR机进行了横断面、矢状面、冠状面的T1WI和T2 WI MRI检查。MIS的MRI诊断标准需满足下列标准：①海马萎缩；②T2WI海马信号增高。结果：在212例中，148例(70％)内侧颞叶结构正常，64例(30％)内侧颞叶结构异常。其中30例(14．1％)表现为双侧颞叶内侧不对称或T2WI海马高信号的病人中，19例(8．9％)只有海马萎缩，3例(1．4％)只有T2WI海马高信号，8例(3．8％)既有海马萎缩又有T2WI海马高信号，符合MIS的MRI诊断标准。结论：MRI显示MIS存在‘假阳性’，只有与临床其他检查相结合才有意义。     

颞叶癫痫的MRI研究

研究颞叶癫痫患者的ＭＲＩ表现，并测量ＴＬＥ患者海马结构的体积以确定癫痫灶的侧别。在１．０ＴＭＲ机对３８例ＴＬＥ患者进行研究，用正中矢状面定位，作平行于脑干的倾斜冠状面Ｔ１和Ｔ２加权像。在所有的倾斜冠状面Ｔ１加权像上手工描出ＨＰＦ的边界，把所有层在的体积相加即得到ＨＰＦ的体积，并进行标准处理以消除头颅大小的影响。     

颞叶癫痫的MRI研究

目的：探讨颞叶癫痫的ＭＲＩ 表现及其诊断价值。材料和方法：对临床诊断为颞叶癫痫４３ 例患者,行自旋回波横断面、冠状面和矢状面ＭＲＩ 研究。结果：４３ 例中,３５ 例颞叶发现有异常ＭＲ 信号,并经手术病理证实。８ 例颞叶无异常发现。术前ＭＲＩ 定位诊断正确率为１００ ％ ,定性诊断正确率为８２ ．９ ％ 。３５ 例中,９ 例胶质细胞增生,Ｔ１ ＷＩ上无明显信号异常,Ｔ２ 加权图像上呈无占位效应的高信号;１５ 例胶质瘤, 表现为病灶呈长Ｔ１ 长Ｔ２ 信号, 并伴有不同程度的占位效应,灶周水肿不明显;７ 例胆脂瘤,表现为Ｔ１ ＷＩ 上呈高于脑脊液的低信号,Ｔ２ ＷＩ 上均呈高于脑脊液的高信号;４ 例海绵状血管瘤,Ｔ１ ＷＩ 上呈等高混合信号,Ｔ２ ＷＩ 上呈明显高信号,周边有低信号环与脑实质相隔。结论：ＭＲＩ 对确定颞叶癫痫病灶的部位和病因具有重要价值。     

MRI在颞叶癫痫的应用

颞叶癫痫(temporal lobe epilepsy,TLE)占顽固性癫痫的 70%～80%.常见病因有海马硬化(hippocampal sclerosis,HS)、皮质发育不良(malformation of cortical development,MCD)、脑肿瘤、脑血管病等,病理证实海马硬化同时可合并颞叶其他部分的病变,即双重病变(dual pathology,DP),其中海马硬化合并MCD最常见.手术切除致痫灶对TLE患者有良好的治疗效果.目前公认常规MRI检测TLE器质性病变最敏感、最有价值,然而事实上只有20%～30%的TLE患者MRI可见器质性病变.随着MRI技术的飞速发展,功能MRI的出现为TLE(特别是常规MRI阴性的TLE)潜在病因、病理及诊断、治疗研究开辟了更广阔的天地.本文就MRI的形态及功能成像在TLE中的应用展开综述.     

Craniopharyngioma in the Temporal Lobe: A Case Report

Herein, we report on an unusual case of craniopharyngioma arising in the temporal lobe with no prior history of surgery and with no connection to the craniopharyngeal duct. MR images showed a cystic tumor with a small solid portion. To the best of our knowledge, this is the first case of a craniopharyngioma occurring in the temporal lobe.     

Time-Shift Homotopic Connectivity in Mesial Temporal Lobe Epilepsy

BACKGROUND AND PURPOSE:Voxel-mirrored intrinsic functional connectivity allows the depiction of interhemispheric homotopic connections in the human brain, whereas time-shift intrinsic functional connectivity allows the detection of the extent of brain injury by measuring hemodynamic properties. We combined time-shift voxel-mirrored homotopic connectivity analyses to investigate the alterations in homotopic connectivity in mesial temporal lobe epilepsy and assessed the value of applying this approach to epilepsy lateralization and the prediction of surgical outcomes in mesial temporal lobe epilepsy.MATERIALS AND METHODS:Resting-state functional MR imaging data were acquired from patients with unilateral mesial temporal lobe epilepsy (n = 62) (31 left- and 31 right-side) and healthy controls (n = 33). Dynamic interhemispheric homotopic architecture seeding from each hemisphere was individually calculated by 0, 1, 2, and 3 repetition time time-shift voxel-mirrored homotopic connectivity. Voxel-mirrored homotopic connectivity maps were compared between the patient and control groups by using 1-way ANOVA for each time-shift condition, separately. Group comparisons were further performed on the laterality of voxel-mirrored homotopic connectivity in each time-shift condition. Finally, we correlated the interhemispheric homotopic connection to the surgical outcomes in a portion of the patients (n = 20).RESULTS:The patients with mesial temporal lobe epilepsy showed decreased homotopic connectivity in the mesial temporal structures, temporal pole, and striatum. Alterations of the bihemispheric homotopic connectivity were lateralized along with delays in the time-shift in mesial temporal lobe epilepsy. The patients with unsuccessful surgical outcomes presented larger interhemispheric voxel-mirrored homotopic connectivity differences.CONCLUSIONS:This study showed whole patterns of dynamic alterations of interhemispheric homotopic connectivity in mesial temporal lobe epilepsy, extending the knowledge of abnormalities in interhemispheric connectivity in this condition. Time-shift voxel-mirrored homotopic connectivity has the potential for lateralization of unilateral mesial temporal lobe epilepsy and may have the capability of predicting surgical outcomes in this condition.

Interhemispheric communication and coordination facilitate information processing in the human brain.^1,2 Thus homotopic connections represent a fundamental characteristic of brain anatomy and function^3,4 and have been considered an important indicator for depicting the physiologic and pathologic features of the brain. On the basis of resting-state functional MR imaging measurements, an approach based on voxel-mirrored homotopic connectivity (VMHC) quantifies the interhemispheric homotopic connections by measuring the functional connectivity between each voxel in 1 hemisphere and its mirrored counterpart.⁵ Zuo et al⁵ found age-related increases in interhemispheric functional connectivity in the primary sensorimotor areas and decreases in the higher order processing areas, which provided insight into the evolution of brain development. Studies have also revealed specific alterations of homotopic connection in a cohort of brain diseases.^6–8 Decreased VMHC in schizophrenia has been suggested to reflect the substantial impairment of interhemiespheric coordination in these patients.⁶ Anderson et al⁷ found homotopic connectivity alterations related to behavioral and developmental abnormalities in autism.⁷ More recently, studies have further correlated functional homotopic connectivity with microstructural impairment in multiple sclerosis⁸ and idiopathic generalized epilepsy.⁹In contrast to the brain disorders featuring abnormal connection pathways as mentioned above,^6,8 mesial temporal lobe epilepsy (mTLE) is a location-related disease characterized by hippocampal sclerosis.¹⁰ Unilateral mTLE can cause bilateral and distributed brain impairments due to seizure propagation via the mesial temporal epileptic network.^11–13 Resting-state fMRI studies have shown asymmetric connections between bihemispheres^14–16 and decreased connectivity between bilateral hippocampi in mTLE.^17,18 These findings suggest that there are intra- and interhemispheric connection abnormalities in unilateral mTLE. However, neither the homotopic alterations of whole-brain functional connectivity nor the relationship between asymmetric lesions and interhemispheric communication in this disease has been investigated.fMRI-based VMHC provides a feasible way to observe the whole-brain homotopic connectivity alterations in mTLE. However, the conventional nondirectional functional connectivity measure, as used in VMHC, cannot detect the connection abnormalities resulting from deficits of the seed or target region. Recently, Lv et al¹⁹ proposed a time-shift (ts) analysis for resting-state functional connectivity. They quantified the temporal shift correlation between time courses of each voxel and global mean signal¹⁹ and correlated the time shifts with the extent and degree of perfusion delay in patients with stroke.^19,20 In addition, our previous study used time-shift correlation analysis to demonstrate the sequential effects of epileptic discharges on intrinsic network connectivity in children with absence epilepsy.²¹ Thus, time-shift delays in resting-state spontaneous connectivity were assumed to reflect brain hemodynamics and could measure the degree of brain injury; time-shift analysis also provides directional information as a measure of functional connectivity.²¹ In the current work, we combined the time-shift connectivity with the VMHC technique and applied them to resting-state fMRI data from patients with unilateral mTLE. We hypothesized that this strategy would allow us to assess the whole-brain homotopic connection impairments resulting from different hemispheres and may potentially be a tool for epileptic focus lateralization and surgical outcome prediction in mTLE.     

提高颞叶内侧癫痫手术疗效的研究进展

外科手术是难治性颞叶癫痫安全有效的标准治疗方式。其中颞叶内侧癫痫(Mesial temporal lobe epilepsy MTLE)是最常见、最适合外科手术治疗的癫痫综合征,术后癫痫发作控制满意率(Engel I、II级)可达70%以上,大部份患者的生活质量得到显著改善。随着近年来神经影像学、神经电生理学等诊断技术的迅猛发展,既往许多潜在的适宜手术治疗的MTLE患者得到确诊并接受手术治疗,但术后患者近期及远期疗效并未得到显著提高。本综述立足于近年国外神经影像学、神经病理学及实验室基础性的研究结果,探讨影响MTLE术后疗效的相关因素及其临床意义。     

颞叶躯体感觉中枢功能磁共振研究

目的利用血氧水平依赖功能磁共振成像观察正常人在躯体感觉刺激时中枢的兴奋情况。方法研究包括30名正常志愿者。功能成像采用组块设计。在任务刺激中通过专用电刺激仪刺激手部皮肤,刺激持续时间1000ms、间隔1000ms。用SPM99专业图像处理软件处理所得图像。结果体感刺激明显激活位于两侧中央前、后回的第一、第二躯体感觉皮层和颞上回。额叶、缘上回和小脑亦可见散在激活区。刺激手对侧半球激活强度比同侧大。双手刺激的激活无显著性差异。结论体感刺激激活两侧第一、第二躯体感觉皮层。颞叶和其他脑功能区参与处理体感刺激。     

颞叶癫痫~1H-MRS和DWI的变化及其相关性研究

目的 探讨~1H-MRS和DWI在反映海马硬化病理结构改变中的价值.方法 采用3.0T磁共振扫描仪对12例伴有单侧海马硬化的发作间期颞叶癫痫(TLE)患者及12例正常对照者行单体素~1H-MRS及DWI检查.比较海马N-乙酰天门冬氨酸/肌酸+胆碱[NAA/(Cr+Cho)]值,表观弥散系数(ADC)值在患侧、对侧和对照组之间的差异,分析NAA/(Cr+Cho)和ADC值之间的相关性.结果 TLE患者患侧海马NAA/(Cr+Cho)值低于对侧海马及对照组;发作间期海马ADC值高于对侧海马及对照组;患侧海马NAA/(Cr+Cho)和ADC值之间存在相关性(r=-0.79,P=0.002).结论 TLE患者患侧发作间期海马NAA/(Cr+Cho)值降低,ADC值升高,两者之间呈显著的负相关;~1H-MRS联合DWI可在活体无创反映海马硬化的病理结构改变.     

右颞叶横纹肌样脑膜瘤1例

患者女,38岁.因"反复头晕伴四肢抽搐半年,加重1个月"入院,每次发作约2 min,每月发作约1～2次,发作时无恶心、呕吐等不适.近1个月来加重,余无特殊.查体无阳性发现.MRI示右侧颞叶占位性病变,胶质瘤(III～IV级)与炎性病变鉴别.