磁共振影像中海马头部浅沟消失对海马区结构硬化的评估

背景MRI是目前发现检查癫痫患者海马硬化的最重要方法,主要表现为海马部位的信号异常,除此以外,MRI其他的征象对海马硬化也有提示作用.目的通过对颞叶癫痫患者的MRI信号分析,探讨海马头部浅沟消失对癫痫患者海马硬化评估的价值.设计非随机,盲法(数据收集者、结果评价者),空白对照临床实验.单位两所大学医院的放射科.对象1996-09/2002-12在上海第二医科大学附属新华医院放射科确诊为颞叶癫痫患者18例.同期选择以头痛症状来本院进行MRI检查,排除脑部存在异常的18例年龄相匹配的检查者作对照组.方法有16例癫痫患者和18例对照组MRI检查机型为GE1.5T Horizon LX全身MR机,另2例癫痫患者采用GE1.5T Signa全身MR机.由2位熟悉海马解剖,但不知具体临床和手术情况的放射科医生分析记录两组36例的72个海马头部浅沟有无消失,并将其分为3个级别消失、几乎消失和存在,同时分析记录海马有无萎缩性改变和信号异常.主要观察指标头部浅沟的显示情况,海马头部大小和信号改变情况.结果18例海马硬化患者中,16例硬化侧海马头部浅沟消失,1例硬化侧海马头部浅沟明显变浅,几乎消失,1例硬化侧海马头部浅沟存在.硬化侧海马头部均有萎缩,并在T2WI和液体衰减恢复(FLAIR)成像呈高信号.海马头部浅沟消失对海马硬化诊断的敏感性为89%(16/18),特异性为100%.结论海马头部浅沟消失是诊断海马硬化的一个可靠征象,结合患侧海马有萎缩性改变和T2加权成像信号增高,可肯定诊断海马硬化.

Loss of visualization of digitations of hippocampal head in MRI in the evaluation of hippocampal sclerosis

BACKGROUND: At present, MRI is the key method to examine the hippocampal sclerosis of the patients with epilepsy. The main results are the abnormal signals of hippocampus, in addition, other symbols of MRI can also suggest the hippocampal sclerosis.OBJECTIVE: To study the significance and value of the loss of visualization of digitations of hippocampal head in diagnosis of hippocampal sclerosis through the analysis of MRI on patients with temporal lobe epilepsy.DESIGN: Non-randomized, blind procedure(data selection, result evaluation), blank controlled and clinical experiment.SETTING: Departments of radiology in two universities.PARTICIPANTS: Between September 1996 and December 2002, 18 patients with temporal lobe epilepsy were selected from the Department of Radiology,Xinhua Hospital Affiliated to Shanghai Second Medical University. Meanwhile,patients with headache were diagnosed with MRI. Eighteen healthy people,whose ages were matched, were as control group.METHODS: Among 18 patients, MRI of 16 patients and 18 people in the control group were performed with a GE 1.5T Horizon MR unit and another 2with a GE 1.5T Signa whole body MR unit. With the double blind procedure, whether the digitations of hippocampal head of 72 hippocampal heads of 36 people in both patient and control groups exist or not was recorded by two radiologists with knowledge of hippocampal dissection but without knowing the condition of clinical operation. The results were divided into 3 levels:loss, poorly visible and existing, and hippocampal atrophy and abnormal signals were also recorded.MAIN OUTCOME MEASURES: Image condition of digitations of head,size of hippocampal head and changes of signal.RESULTS: Of 18 patients with hippocampal sclerosis, the abnormal findings included smooth and the loss of visualization of digitations of hippocampal heads seen in 16 patients, poorly visible of digitations of hippocampal head in one patient, and existence of digitations of hippocampal head in one patient. Hippocampal atrophy and high signals on T2-weighted images and fluid-attenuated inversion recovery imaging were seen in all patients. The sensitivity of loss of digitations of hippocampal heads for diagnosis of hippocampal sclerosis was 88.9% (16/18), and the specificity was 100%.CONCLUSSION: The loss of visualization of digitations of hippocampal head is a sensitive indicator for the diagnosis of hippocampal sclerosis. Atrophic changes of hippocampus combining with the increase of T2-weighted signal can definitely diagnose the hippocampal sclerosis.