脑灌注磁共振成像观察内侧颞叶癫痫部分及继发全面发作

目的观察部分及继发全面发作内侧颞叶癫痫(mTLE)患者脑区灌注的差异,分析在继发全面发作中起作用的相关脑区,探讨继发全面发作的mTLE网络的相关脑区。方法选取51例mTLE患者,其中16例部分发作(PS组),35例部分发作继发全面发作(sGS组)。利用3.0T MR脉冲式动脉自旋标记(PASL)序列采集两组患者发作间期脑血流量(CBF)数据。采用体素依赖统计分析(VBA)技术对两组患者脑灌注存在差异的脑区进行评价;并基于此选取患侧颞叶、丘脑及额叶等区域作为ROI,分别评价两组患者各ROI间的CBF的相关性。结果与PS组相比(校正后,P<0.05),sGS组患者表现为发作间期患侧丘脑、基底核及部分默认模式网络区域如双侧楔前叶、前扣带回、后扣带回、内侧前额叶等CBF降低;sGS组患者患侧颞叶与额叶(r=0.50,P<0.05)、丘脑与额叶(r=0.36,P<0.05)的CBF均有明显相关性。结论丘脑在继发全面发作的癫痫活动传播中起重要作用;癫痫活动通过特定网络传播到远处脑区。部分发作继发全面发作mTLE患者相比部分性发作患者部分脑区功能受损更严重。

Difference of cerebral blood flow on mesial temporal lobe epilepsy patients in MR perfusion imaging between partial seizures and secondarily generalized seizures

Objective To observe the difference of cerebral blood flow (CBF) between partial seizures (PS) and secondarily generalized seizures (sGS) in mesial temporal lobe epilepsy (mTLE) patients, in order to analyze the associated regions of secondarily generalized seizures, as well as to evaluate the correlation of CBF among several regions in patients with sGS and mTLE network-related regions. Methods Fifty-one patients with mTLE were recruited, 16 showed only partial seizures (PS group) and 35 showed secondarily generalized seizures (sGS group). Data were acquired on a 3.0T MR scanner using pulsed-ASL sequence. The changes of whole brain CBF were evaluated by comparison between PS and sGS group using voxel-based analysis. Furthermore, the ipsilateral temporal lobe, thalamus and frontal lobe were selected as ROIs, and the correlations among these regions were evaluated based on analysis of ROIs. Results Compared with PS group (corrected, P<0.05), patients in sGS group showed decreased CBF in ipsilateral thalamus, basal ganglia and some default mode network regions, such as bilateral precuneus, anterior cingulate cortex, posterior cingulate cortex and mesial prefrontal cortex. CBF was significantly correlated between ipsilateral temporal lobe and frontal lobe (r=0.50, P<0.05), ipsilateral thalamus and frontal lobe (r=0.36, P<0.05) in patients with sGS. Conclusion The thalamus plays an important role in the spreading of seizures in patients with sGS. mTLE patients with sGS have abnormal function in more extensive regions. The seizures spread to region in the distance through a special network.