Side matters: diffusion tensor imaging tractography in left and right temporal lobe epilepsy.
Side matters: diffusion tensor imaging tractography in left and right temporal lobe epilepsy.
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DOI：
10.3174/ajnr.a1650
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发表时间：
2009-10
期刊：
影响因子：
--
通讯作者：
Halgren E
中科院分区：
文献类型：
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作者：
Ahmadi ME;Hagler DJ Jr;McDonald CR;Tecoma ES;Iragui VJ;Dale AM;Halgren E
非侵入性成像在术前颞叶癫痫（TLE）患者的癫痫灶定侧中起着关键作用。我们的目的是评价弥散张量成像（DTI）纤维束成像在颞叶癫痫中的应用。入组21例TLE患者（11例右侧TLE，10例左侧TLE）和21例对照。1.5使用Tesla MR扫描仪获得每例受试者51个扩散梯度方向图像。追踪8对白色纤维束，计算纤维束各向异性分数（FA），并与对照组进行比较。分别对所有受试者和纤维束进行FA不对称性和判别函数分析（DFA）。与对照组相比，TLE患者的同侧五条纤维束FA减少。左侧TLE患者有6个同侧和4个对侧纤维束FA降低。与对照组相比，右侧TLE有4条同侧但无对侧纤维束FA减少。右侧FA的不对称性表现在右侧TLE的五个纤维束和左侧不对称性在左侧TLE的一个纤维束。使用钩束和海马旁纤维束，DFA在90%的所有病例中正确地将患者分为左侧与右侧TLE（在所有无海马硬化的患者中100%正确）。我们发现TLE患者的纤维束FA普遍减少，在癫痫病灶同侧最为明显。左颞叶癫痫患者有更大，更弥漫性的变化，而右颞叶癫痫患者表现出的变化，主要是同侧。疾病的偏侧化在很大程度上独立于常规MR成像上发现的可识别的海马病理学。
Non-invasive imaging plays a pivotal role in lateralization of the seizure focus in pre-surgical temporal lobe epilepsy (TLE) patients. Our goal was to evaluate the utility of diffusion tensor imaging (DTI) tractography in TLE. 21 TLE patients (11 right TLE, 10 left TLE), and 21 controls were enrolled. 1.5 Tesla MR scanner was used to obtain fifty-one diffusion gradient direction images per subject. Eight pairs of white matter fiber tracts were traced and fiber tract fractional anisotropy (FA) was calculated and compared to controls. Fiber tract FA asymmetry and discriminant function analysis (DFA) were evaluated in all subjects and fiber tracts respectively. Compared to controls, patients with TLE demonstrated decreased FA in five ipsilateral fiber tracts. Left TLE patients had six ipsilateral and four contralateral fibers tracts with decreased FA. Right TLEs had four ipsilateral but no contralateral tracts with decreased FA compared to controls. Right-sided FA asymmetry was demonstrated in the right TLEs for five fiber tracts and left sided asymmetry in the left TLEs for one fiber tract. DFA correctly categorized patients into left vs right TLE in 90% of all cases (100% correct in all patients without hippocampal sclerosis), using uncinate fasciculus and parahippocampal fiber tracts. We found widespread reductions in fiber tract FA in TLE patients that were most pronounced ipsilateral to the seizure focus. Left TLE patients had greater, more diffuse changes, whereas right TLE patients showed changes that were primarily ipsilateral. Disease was lateralized to a high degree independent of identifiable hippocampal pathology noted on conventional MR imaging.