颞叶癫痫的~1HMRS和MRI对比研究

目的　通过对顽固性颞叶癫痫病人的质子波谱 (1HMRS)和磁共振成像 (MRI)研究 ,探讨这两种方法对癫痫灶定位诊断的作用。方法　 2 2例无颞叶占位的癫痫病人和 3 0例健康志愿者分别进行了1HMRS采集和MRI扫描后海马结构定量研究 ,分析NAA/Cr Cho和DHF在癫痫组的改变及对癫痫组定侧定位的敏感性和特异性。结果　1HMRS可对 16例病人进行定侧诊断 ,并发现 10例有双侧颞叶病变。MRI可准确判断 10例海马萎缩。结论　1HMRS对颞叶癫痫定侧敏感性高于海马体积测量 ,并能发现双侧病变 ;MRI海马结构定量发现海马硬化特异性较高。     

颞叶癫痫1H-MRS变化分析

目的：探讨颞叶癫痫（TLE）1H-MRS的变化及定侧诊断价值。方法：采用1H-MRS对147例TLE内侧颞叶结构NAA/Cr、NAA/（Cr+Cho）、Cho/Cr、mI/Cr结果进行分析。结果：TLE组患侧NAA较对侧及对照组减低（P<0.05），Cho和mI未见统计学差异；存在侧别优势的TLE组NAA减低以患侧为著，与无侧别优势的TLE组不同；海马硬化组和隐源性TLE组NAA定侧诊断阳性率分别为70.45%和50%，1H-MRS与脑电图（EEG）一致性分别为66％和50%，海马硬化组1H-MRS与EEG在TLE定侧诊断上未见明显差异。结论：NAA可提供与TLE定侧相关信息，未发现Cho、mI对TLE的定侧诊断意义。     

3.0T磁共振波谱对颞叶癫痫的定侧诊断价值

目的：通过对颞叶癫痫的磁共振波谱研究,探讨3.0T超高场强MRS在颞叶癫痫的定侧诊断价值。方法对40例临床诊断颞叶癫痫患者及20例正常志愿者进行研究,所有实验对象行双侧海马的常规MRI和1H-MRS扫描,MR成像序列为轴位SE T1WI、T2WI,对双侧海马体部进行多体素波谱成像,将正常对照组MRS结果作为标准,评价颞叶癫痫患者MRS代谢物比值特点,分析MRS对颞叶癫痫定侧诊断价值。结果常规MRI诊断海马硬化共21例。癫痫组患侧、健侧与对照组间NAA/（Cho＋ Cr）、NAA/ Cho比值差异均有统计学意义（F分别=12.89、15.73,P均＜0.05）。癫痫组患侧与健侧、患侧与对照组NAA/（Cho＋Cr）、NAA/Cho差异均有统计学意义（q分别=7.32、8.47、7.33、8.47,P均＜0.05）;而癫痫组健侧与对照组差异无统计学意义（q分别=1.13、1.13,P均＞0.05）。结论常规MRI检查对颞叶癫痫的定侧具有一定的价值;3.0T超高场强MRS与常规MRI联合应用可以提高颞叶癫痫定侧的准确性。     

儿童颞叶癫痫的临床特点及MRS的定位诊断价值分析

目的:探讨儿童颞叶癫痫(TLE)的临床特点以及磁共振波谱分析(MRS)对儿童TLE病灶定位的诊断价值。方法:共选择2017年5月~2019年4月40例临床确诊为儿童TLE的临床资料作为研究(实验组),对患儿的病灶及海马组织标本进行病理检查,分析临床病理及发作特点。并选择同期40例健康志愿者作为对照(对照组),两组均行常规磁共振成像(MRI)和MRS,分析实验组患者、对侧及对照组的海马NAA/Cr、NAA/Cho和NAA/(Cho+Cr)比值。结果:病理结果显示,排在前3位的为FCDⅢb、低级别肿瘤、局灶性皮层发育不良。40例儿童TLE临床共发作70次,临床发作症状最多的为意识改变、口部自动症。常规MRI,健康志愿者无异常;儿童TLE双侧海马大小不对称,患侧海马体积缩小、颞角扩大共16例,患侧FLAIR序列海马信号增高共9例。MRS,TLE患侧的NAA/Cr、NAA/Cho、NAA/(Cho+Cr)值明显小于TLE对侧、健康者左侧、健康者右侧,差异有统计学意义(P<0.05);TLE对侧、健康者左侧、健康者右侧两两间比较无明显差异,无统计学意义(P﹥0.05)。结论:儿童TLE的诊断应依据临床发作特点及MRS综合分析,MRS能够无创并定量反映儿童TLE海马生化代谢异常,在TLE的术前定位中具有重要的诊断价值。     

1H-MRS评价颞叶癫痫患者杏仁核代谢物比值

目的 采用¹H-MRS探讨颞叶癫痫(TLE)患者双侧杏仁核的各代谢物比值改变.方法 对15例TLE患者(TLE组)和15名健康志愿者(正常对照组)行杏仁核¹H-MRS扫描,比较两组杏仁核的N-乙酰天门冬氨酸(NAA)/、NAA/Cr、NAA/Cho和Cho/Cr比值,分析TLE患者双侧杏仁核各代谢物比值与癫痫病程和发病年龄的相关性.结果 TLE组患侧杏仁核NAA/(Cho+Cr)和NAA/Cr比值与正常对照组比较均明显减低(P均 <0.05);TLE组患侧杏仁核NAA/(Cho+Cr)、NAA/Cr、NAA/Cho和Cho/Cr比值与TLE组对侧比较差异均无统计学意义(P均 >0.05);TLE组对侧杏仁核NAA/(Cho+Cr)、NAA/Cr和NAA/Cho比值与正常对照组比较均明显减低(P均 <0.05).TLE组双侧杏仁核NAA/(Cho+Cr)、NAA/Cr和NAA/Cho比值与癫痫病程及发病年龄均无相关性(P均 >0.05).结论 TLE患者双侧杏仁核存在显著的代谢异常,双侧杏仁核可能作为传导通路的一个环节,参与TLE的发病过程.     

颞叶癫痫患者的颞干MR扩散张量成像研究

目的 探讨颞叶癫痫(TLE)患者颞干扩散张量成像(DTI)参数的变化特点,并评价颞于DTI测量在TLE病灶定侧诊断中的辅助价值.方法 对临床诊断的42例发作间期TLE患者和32例正常志愿者行常规MRI和DTI检查,定量测量双侧颞干的平均扩散系数(DCavg)、部分各向异性(FA)、1-容积比(1-VR)和相对各向异性(RA)值并进行统计.结果 正常人双侧颞于之间的颞干DTI参数(DCavg、FA、1-VR和RA)均无显著性差异.TLE患者患侧颞干DCavg高于对侧颞干及正常人,而对侧颞干DCavg与正常人无显著性差异;患侧、对侧、正常人三组间FA、1-VR和RA存在显著性差异(患侧＜对侧＜正常人,P＜0.001).发作间期患者的颞于DTI参数值对TLE的定侧诊断准确率为71.4%(30/42).结论 TLE患者的颞干扩散运动变化有助于TLE的定侧诊断和对TLE继发白质损伤的认识.     

3.0TMR质子波谱成像诊断难治性颞叶癫痫海马硬化的价值

目的探讨3.0T MR质子波谱成像（proton magnetic resonance spectroscopy,1 H-MRS）在难治性颞叶癫痫海马硬化早期诊断中的应用价值。方法 64例难治性颞叶癫痫海马硬化患者（观察组）,行1 H-MRS检查,分析海马N-乙酰基天门冬氨酸（N-acetylaspartate,NAA）、胆碱复合物（choline,Cho）与肌酸复合物（creatine-phosphocreatine,Cr）波峰特点及NAA/（Cho＋Cr）比值,与21例体检健康者（对照组）进行比较。结果观察组1 H-MRS检查发现左侧海马异常10例,右侧异常7例,双侧异常47例;与对照组比较,观察组海马异常侧1 H-MRS图像主要表现为NAA波峰降低,Cr和Cho波峰增高;观察组海马单侧异常者患侧NAA/（Cho＋Cr）值（0.484±0.145）低于健侧（0.846±0.120）（P〈0.05）,双侧异常者主要异常侧NAA/（Cho＋Cr）值（0.382±0.115）低于对侧（0.563±0.167）（P〈0.05）;对照组双侧NAA/（Cho＋Cr）均值为0.843±0.122,高于观察组海马单侧异常者患侧、双侧异常者双侧（P〈0.05）。结论 1 H-MRS可反映神经元的丢失和/或胶质细胞增生,在难治性颞叶癫痫海马硬化早期诊断中有重要价值。     

抑郁症患者边缘系统-皮层-纹状体-苍白球-丘脑神经环路相关结构的磁共振成像研究

目的 联合应用磁共振的1H-MRS 和DTI 成像技术,探讨抑郁症患者边缘系统-皮层-纹状体-苍白球-丘脑神经解剖环路(LCSPT)中相关解剖结构的异常改变.方法 对抑郁症患者组(10 例)和正常对照组(13 例)均行1H-MRS 和DTI 检查.测量双侧海马结构、纹状体、丘脑及前额叶深部白质的N-乙酰天门冬氨酸(NAA)、胆碱复合物(Cho )和肌酸(Cr)的浓度以及平均弥散系数(ADC)和部分各向异性(FA).结果 与正常组对比,患者组海马结构Cho /Cr 升高,其FA 值与NAA /Cr 呈正相关,ADC 值与HAMD 评分呈负相关(P ＜0.05 );纹状体Cho /Cr 降低,FA 值升高(P ＜0.05 );前额叶深部白质的FA 值降低,其FA 值与Cho /Cr 呈正相关(P ＜0.05 );丘脑ADC 升高,Cho /Cr 与NAA /Cr 呈正相关,Cho /Cr 与HAMD 评分呈正相关(P＜0.05 ).结论 抑郁症患者LCSPT 神经环路中存在纹状体和前额叶白质的FA 值异常,同时存在纹状体、丘脑及海马结构代谢异常可能提示其神经纤维的连接及功能异常.     

1H-MRS观察帕金森病患者延髓及黑质代谢

目的 采用¹H-MRS分析帕金森病(PD)患者延髓及患侧黑质中主要代谢物的改变及其与临床病情的关系。 方法 选取PD患者17例(PD组),正常对照17名(正常对照组)。采用Philips 1.5T磁共振成像系统单体素¹H-MRS技术,选取延髓及患侧黑质作为感兴趣区进行MRS扫描,获取N-乙酰天门冬氨酸(NAA)、胆碱(Cho)、肌酸(Cr)峰下面积,计算NAA/Cr、Cho/Cr比值。 结果 PD组延髓和患侧黑质与正常对照组比较,NAA/Cr、Cho/Cr比值差异均无统计学意义。PD患者延髓NAA/Cr、Cho/Cr比值与临床指标未发现显著相关性。PD患者患侧黑质NAA/Cr比值与UPDRS评分(r=－0.686,P=0.007)及UPDRS运动评分(r=－0.724,P=0.004)显著负相关;Cho/Cr比值与UPDRS评分(r=－0.770,P=0.002)及UPDRS运动评分(r=－0.843,P<0.001)呈显著负相关。患侧黑质处NAA/Cr、Cho/Cr与H&Y分级呈显著负相关(r=－0.697、－0.715,P=0.012、0.009)。 结论 采用¹H-MRS检测延髓及患侧黑质NAA、Cho尚不能作为诊断PD的手段。检测患侧黑质代谢物改变能够反映患PD者病情进展情况。     

氢质子磁共振波谱对创伤性脑损伤的分析

目的探讨氢质子磁共振波谱(1Hmagneticresonancespectroscopy1HMRS)分析对创伤性脑损伤(traumaticbraininjuryTBI)受伤程度、预后预测的临床价值。方法对25例TBI患者和10例正常志愿者进行1HMRS检查,观察患者与正常对照组及患者患侧与正常侧间N-乙酰天门冬氨酸(NAA)、胆碱(Cho)肌酸(Cr)、乳酸(Lac)及NAA/Cr、NAA/Cho、Cho/Cr值的变化,分析这些指标与格拉斯哥昏迷评分(GCS)及格拉斯哥预后评分(GOS)的相关性;结果TBI患者较正常对照组及其患者患侧脑白质较对侧同一位置常规MRI检查表现正常脑白质(nomal-appearingwhitematterNAWM)的NAA/Cho、NAA/Cr值下降更明显,而Cho/Cr值上升更明显;出现Lac水平上升患者的GCS为重度,其预后不良,NAA/Cr、NAA/Cho、Cho/Cr值变化与TBI患者GCS、GOS存在相关性;结论1HMRS对脑外伤的程度及预后预测有重要价值。     

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。     

MRS在非海马硬化颞叶癫痫患者中的应用

目的 探讨MRS技术在非海马硬化颞叶癫痫患者中的应用价值。方法 回顾性分析于我院诊治为非海马硬化的单侧颞叶癫痫患者23例（病例组）,选取年龄与之相匹配的20名正常志愿者作为对照组,行常规MR平扫及MRS检查,分析颞叶癫痫患者患侧海马、健侧海马及对照组海马N-乙酰天门冬氨酸（NAA）/肌酸（Cr）、胆碱（Cho）/Cr值的差异;同时评价病例组中接受手术治疗的11例患者的病理及手术结果。结果 病例组患侧海马NAA/Cr值较健侧海马（t=-7.97,P<0.001）及对照组海马降低（t=-9.96,P<0.001）,病例组健侧海马NAA/Cr值与对照组比较差异无统计学意义（t=-1.21,P=0.12）。病例组患侧海马Cho/Cr与健侧（t=0.50,P=0.31）及对照组海马（t=-0.59,P=0.28）差异无统计学意义。11例行致痫侧颞叶切除患者的病理结果显示小范围少量的神经元损伤,神经胶质增生不明显。结论 MRS有助于临床对非海马硬化颞叶癫痫患者的致痫灶进行定侧及定位。     

正常中国人颞叶磁共振质子波谱研究

目的　探讨颞叶磁共振质子波谱 (1HMRS)的研究方法及正常中国人脑内物质含量的正常范围。方法　对 30例健康人进行1HMRS研究 ,观察NAA、Cr和Cho等各代谢产物波峰的特点 ,并对NAA/Cr Cho ,NAA/Cr及Cho/Cr各比值进行定量分析。结果　颞叶脑组织内NAA峰高于Cr峰和Cho峰。NAA/Cr Cho、NAA/Cr和Cho/Cr双侧没有显著性差异。结论　MRS是无创性研究活体脑组织代谢功能的方法 ,脑内物质正常范围的确定为发现癫痫病人脑代谢功能异常提供了客观的标准     

Quantitative analysis of temporal lobe white matter T2 relaxation time in temporal lobe epilepsy

The objective of this study was to assess temporal lobe white matter (WM) quantitatively using T2 relaxometry in patients with pharmacologically intractable temporal lobe epilepsy (TLE). T2 relaxometry was performed using a dual-echo sequence with 23 contiguous oblique coronal slices in 56 consecutive TLE patients and in 30 healthy subjects. Averages of six slices were chosen to calculate T2 relaxation time in the temporal lobe WM (WM-T2) and the hippocampus (Hippo-T2). Twenty-seven patients had unilateral hippocampal atrophy (HA), and twenty-nine patients had normal hippocampal volumes (NV) on volumetric MRI. Mean WM-T2 was increased ipsilateral to the seizure focus in TLE patients with HA and those with NV (P < 0.001). Contralateral mean WM-T2 was increased in left and right TLE with HA (P < 0.001) and in right TLE with NV (P = 0.001). There was a positive correlation between WM-T2 and Hippo-T2. Individual analysis showed a prolongation of WM-T2 in about 70% of TLE patients with HA and NV. In half of the patients, WM-T2 increase was bilateral and symmetric. However, in 33% of patients with NV and bilateral symmetric increase in Hippo-T2, WM-T2 provided a correct lateralization of the seizure focus. Regardless of the pattern of T2 abnormalities, that is, bilateral symmetric or ipsilateral, the majority of patients with HA became seizure-free after surgery, while those with NV did not have a favorable outcome. In patients with NV, WM-T2 measurement may provide additional lateralizing information compared to Hippo-T2.     

1H MRSI evidence of metabolic abnormalities in childhood-onset schizophrenia

In adult schizophrenia, magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) have revealed volumetric and metabolic defects in multiple brain regions, among them the anterior cingulate, frontal cortex, striatum, thalamus, parietal cortex, and frontal and parietal white matter. This study used proton magnetic resonance spectroscopic imaging ((1)H MRSI) to identify potential metabolic abnormalities in these regions in childhood-onset schizophrenia. (1)H MRSI was acquired at 1.5 T and 272 ms echo time in 11 children and adolescents with schizophrenia (aged 7-18 years; seven boys, four girls; all but two medicated) and 20 age-matched healthy controls (10 boys, 10 girls). Absolute levels of N-acetyl compounds (NAA), creatine plus phosphocreatine (Cr), and choline compounds (Cho) were compared among groups in each region. In schizophrenic patients relative to controls, Cr was 14.3% higher in superior anterior cingulate (mean of left and right hemispheres). Cho was higher in superior anterior cingulate (30.3%), frontal cortex (13.3%), and caudate head (13.5%). In the thalamus, there was also a diagnosis-by-gender interaction, whereby NAA was lower in patients for male but not for female subjects. Elevated Cr suggests abnormal local cell-energy demand and elevated Cho is consistent with a prior proposal that patients with early age-of-onset schizophrenia exhibit phospholipid membrane disturbances. Low NAA may reflect diminished neuronal integrity.     

Serial contrast-enhanced magnetic resonance imaging and spectroscopic imaging of acute multiple sclerosis lesions under high-dose methylprednisolone therapy

To evaluate biochemical changes in contrast-enhancing multiple sclerosis (MS) lesions, we examined 14 patients with relapsing-remitting MS at acute clinical exacerbation with the help of contrast-enhanced magnetic resonance imaging (MRI) and 1H magnetic resonance spectroscopic imaging (1H MRSI). Using a 1.5-tesla MR system (Magnetom Vision, Siemens, Germany), we followed 29 contrast-enhancing and 24 nonenhancing MS lesions as well as normal-appearing white matter (NAWM) before and during high-dose methylprednisolone (HDMP) therapy. Metabolite ratios of N-acetylaspartate (NAA), choline (Cho), creatine (Cr), and lactate (Lac) were calculated. A transient decrease in contrast enhancement under HDMP therapy was observed. Both groups of MS lesions showed significantly decreased NAA to Cr ratios compared to NAWM with no changes in time. Baseline 1H MRSI revealed significantly increased Cho to Cr ratios in the contrast-enhancing MS lesions (1.13 +/- 0.25) compared to the nonenhancing MS lesions (0.85 +/- 0.26, P < 0.001) and NAWM (0.97 +/- 0.22, P = 0.015). Both the contrast-enhancing and the nonenhancing MS lesions exhibited a significant increase in Cho to Cr ratios from the second to the third 1H MRSI. We identified resonances of lactate in both groups of MS lesions and NAWM without any significant group differences or changes over time. 1H MRSI provides additional information that help to estimate macrophages' activity, cell membrane activation, and neuronal impairment within MS lesions. We believe that combined contrast-enhanced MRI and 1H MRSI may help to further investigate inflammatory processes within active MS lesions and should be employed more frequently to the research on therapy effects in MS.