~1H-MRS在颞叶癫痫中的定位诊断研究

目的:结合临床病史、长程视频脑电图及MRI所见,探讨氢质子磁共振波谱(1H-MRS)在颞叶癫痫(temporal lobe epilepsy,TLE)定位诊断中的应用价值。方法:分析经临床确诊的49例TLE患者和21例健康志愿者的头颅常规MRI平扫和海马1H-MRS图像资料。通过NAA、Cr和Cho的峰下面积来计算TLE患侧组、对侧组及对照组的NAA/(Cr+Cho)比值,作组间差异性比较。以对照组的NAA/(Cr+Cho)均值作为标准,判断1H-MRS在TLE定位诊断中的应用价值。结果:头颅常规MRI检出的11例TLE患者病变侧与临床诊断相一致,阳性率为22.4%。TLE患侧组、对侧组及对照组的NAA/(Cr+Cho)分别为0.42±0.08、0.55±0.08、0.74±0.11,多组间比较及组间两两比较的差异性均具有统计学意义(P<0.05)。病例组中仅2例单侧的NAA/(Cr+Cho)小于对照组的均值,其余47例双侧的NAA/(Cr+Cho)均小于对照组的均值。其中1HMRS提示病例组中左侧异常者25例,右侧异常者19例,不能定位者5例,阳性率为89.8%。其中,7例患者与临床的诊断不相符,把不能定位者和不相符者均当作不相符,符合率为75.5%。另外常规MRI提示异常的11例患者在1H-MRS上也发现了异常,且两者的定位结果相一致。结论:1H-MRS在TLE的定位诊断中具有较高的符合率及阳性率,应用价值值得肯定。

Application value of 1 H-MRS in location diagnosis of temporal lobe epilepsy

Objective:To evaluate the application value of proton magnetic resonance spectroscopy (1 H-MRS)with combina-tion of clinical history,long-term video electroencephalogram and magnetic Resonance Imaging (MRI)in the localization diagnosis of temporal lobe epilepsy (TLE).Methods:Analyze 49 cases clinically diagnosed TLE patients’and 21 healthy volunteers’head con-ventional MRI scan and hippocampus 1 H-MRS image data.Through metabolites of NAA,Cr and Cho area under the peak computing the NAA /(Cr + Cho)of the ipsilateral group of TLE,the contra-lateral subgroup of TLE and the control group.Then compare the difference between the groups.The mean NAA /(Cr + Cho)of the control group as the standard,determine the 1 H-MRS application value in the diagnosis of TLE.Results:The lesion side of the 1 1 TLE patients detected by head conventional MRI was consistent with the clinical diagnosis,the positive rate was 22.4%.NAA /(Cr +Cho)of the ipsilateral group of TLE,the contra -lateral subgroup of TLE and the control group was 0.42 ±0.08,0.55 ±0.08,0.74 ±0.1 1 respectively,and the differences comparison among groups and between the two groups were statistically significant (P <0.05).Only two cases unilateral NAA /(Cr + Cho)of patients group were less than the mean of the control group,and the remaining 47 cases bilateral NAA /(Cr + Cho)were less than the mean of the control group.25 cases showed the left side abnormal,19 cases the right side abnormal and 5 cases can not be located prompted by 1 H-MRS in the patients group,the positive rate was 89.8%.There were 7 cases which did not match with the clinical diagnosis.The case unable to locate and not matching with the clinical diagnosis were counted as not match,and the rate was 75.5%.There are 1 1 cases the conventional MRI and 1 H-MRS suggestive of abnormal,and the positioning results of the two were consistent.Conclu-sion:1 H-MRS has a high coincidence rate and positive rate in the localization diagnosis of temporal lobe epilepsy.The application value of 1 H-MRS in the localization of TLE epileptic foci should be affirmed.