磁共振成像和质子磁共振波谱对颞叶癫痫患者手术预后的评价作用

目的 探讨海马磁共振成像(MRI)、MRI体积测量和质子磁共振波谱(^1H MRS)对颞叶癫痫患者手术预后的评价作用。方法 复旦大学附属华山医院手术的50例顽同性颞叶癫痫患者为研究对象,术前常规MRI扫描除外肿瘤和血管畸形等脑部结构性病变。行垂直于海马长轴的倾斜冠状面T1、T2加权及液体衰减反转恢复序列扫描和双侧海马体积测量;38例行^1HMRS扫描。患者均行单侧前颞叶手术,手术病理示不同程度海马硬化。手术预后分为3级,I级预后归入预后良好组,Ⅱ级和Ⅲ级预后归入预后不良组。将各检查结果与手术预后行相关性分析。结果 50例患者中海马MRI扫捕阳性的占84％,表现为海马萎缩、信号增高或内部结构细节丢失。MRI阳性组中98％,预后良好,MRI阴性组中38％预后良好,MRI阳性组和MRI阴性组间的手术预后差异有显著意义(x^2=23．00,P=0．000)。在右颞手术者中,预后不良组的手术侧海马体积大于预后良好组;而在左颞手术者中,预后不良组的手术对侧海马体积小于预后良好组,统计学检验都有显著性意义。二组病例的双侧海马体积差值(DHF)均与预后有关,预后良好组的DHF值大于预后不良组。38例行^1HMRS检查,其预后不良组的病侧NAA／(cr Cho)平均比值高于预后良好组,而对侧NAA／(Cr Cho)平均比值却低于预后良好组。但统计学检验无显著意义。MRS单侧异常者中90％预后良好,双侧异常者中77％预后良好,但卡方检验显示各组间手术预后的差异无显著意义(x^2=0．493,P=0．781)。结论 海马MRI扫描、MRI体积测量和^1HMRS对颞叶癫痫患者的手术预后具评价作用。术前将多种非侵袭性的检查手段结合起来,有助于手术病例的合理选择及手术预后的提高。

Prognostic value of MRI and 1H MRS in patients with temporal lobe epilepsy

OBJECTIVE: To evaluate the prognostic value of hippocampal MRI scan, MRI volumetry and 1H MRS in patients with temporal lobe epilepsy (TLE). METHODS: 50 intractable TLE patients operated in Huashan hospital were studied. Before surgery, traditional MRI scans were used to exclude tumor and vascular malformation of the brain. All patients were examined by tilted coronal images which were perpendicular to the long axis of the hippocampus, using T1-weighted, T2-weighted and FLAIR sequence. MRI volumetric measurement of both hippocampal formation were performed. 38 patients also took 1H MRS scan. Unilateral anterior temporal lobectomy was performed in all patients and pathology showed different degrees of hippocampal sclerosis. The prognosis was categorized into three grades with grade I being assigned to the group of good outcome, and grade II and III being assigned to the bad outcome group. Correlative analysis between the results of several examinations and the prognosis were performed respectively. RESULTS: MRI-positive cases with hippocampal scans were about 84% of the 50 cases. Hippocampal atrophy, increase of signal intensity or the loss of internal morphological structure were detected. 98% of the MRI-positive patients had good outcome, and 38% of the MRI-negative patients had good outcome. The prognosis between MRI-positive group and MRI-negative group had significant difference (chi(2) = 23.00, P = 0.000). Among the right-side operated cases, the average hippocampal volume on the operated side of the bad outcome group was larger than that of the good outcome group. While among the left-side operated cases, the hippocampal volume on the non-operated side of the bad outcome group was smaller than that of the good outcome group. Significant differences were found in statistics respectively. In both groups, prognosis was found to be statistically related to the DHF value (difference of bilateral hippocampal volume). The DHF value of the good outcome group was larger than that of the bad outcome group. 38 patients took 1H MRS examination. The average NAA/(Cr + Cho) ratio on the operated side of the patients in the bad outcome group was greater than that of the good outcome group. The average NAA/(Cr + Cho) ratio on the contralateral side of the patients in the bad outcome group was lower than that of the good outcome group. But no significant differences were found in statistics respectively. 90% cases of MRS unilateral abnormalities had good outcome, while 77% cases of MRS bilateral abnormalities had good outcome. But no statistically significant difference was found among different groups (chi(2) = 0.493, P = 0.781). CONCLUSION: Hippocampal MRI scan, MRI volumetry and 1H MRS may be used as prognostic tools in TLE patients before surgery. The combination of several noninvasive methods before surgery can help choose suitable patients for surgery, and, as a result, improve surgical outcome.