Longitudinal Qualitative Characterization of MRI Features After Laser Interstitial Thermal Therapy in Drug-Resistant Epilepsy
Longitudinal Qualitative Characterization of MRI Features After Laser Interstitial Thermal Therapy in Drug-Resistant Epilepsy
复制标题
DOI：
10.2214/ajr.16.16144
复制
发表时间：
2017-01-01
影响因子：
5
通讯作者：
Gorniak, Richard J.
中科院分区：
文献类型：
--
作者：
Atsina, Kofi-Buaku;Sharan, Ashwini D.;Gorniak, Richard J.
目标。激光间质热疗(LIT)是一种在实时磁共振测温下消融脑组织的方法，近年来越来越多地被用于治疗非恶性病变。本研究的目的是纵向分析耐药癫痫患者LITT后的MRI表现，主要是在内侧颞叶硬化症的背景下。对23例连续接受LITT的患者的MR影像进行了回顾。所有患者在消融后立即获得图像。多名患者在治疗后的不同时间点进行了随访成像，时间从术后第7天到1539天。结果：LITT后即刻，MR图像显示消融部位有环状强化病变，周围有轻微的水肿。7幅图像显示同侧脉络丛增强。亚急性期图像显示轻度水肿增加，增强程度相似。过渡期图像显示水肿减轻并有不同程度的强化。慢性期的影像显示有或无空洞形成或仅有空洞形成的微小胶质细胞增生症，或减少或无强化。结论：本报告描述了难治性癫痫患者LITT后影像表现的时间进程。典型的阶段包括边缘强化的病变和轻微的水肿期，接着是水肿期，到最终的神经胶质增厚和无强化的空洞形成。放射科医生需要熟悉消融后的发现，以最大限度地减少误诊，防止不必要的检查。
OBJECTIVE. Laser interstitial thermal therapy (LITT), a method for ablating brain tissue under real-time MR thermometry, has been used more frequently in recent years to treat nonmalignant lesions. The purpose of this study is to longitudinally characterize MRI features after LITT in patients with drug-resistant epilepsy, primarily in the setting of mesial temporal sclerosis.MATERIALS AND METHODS. MR images from 23 consecutive patients who underwent LITT were retrospectively reviewed. All patients had images obtained immediately after the ablation. Multiple patients had follow-up imaging at various time points after treatment, from postoperative days 7 through 1539. A total of 54 MRI studies were reviewed.RESULTS. Immediately after LITT, MR images showed a ring-enhancing lesion at the ablation site with minimal surrounding edema. Seven images showed increased enhancement of the ipsilateral choroid plexus. Images in the subacute phase showed a mild increase in edema with similar enhancement. Images in the transitional phase showed a decrease in edema with variable enhancement. Images in the chronic phase showed minimal gliosis with or without cavity formation or cavity formation alone, with either decreased or no enhancement.CONCLUSION. This report describes the time course of the imaging findings after LITT for drug-resistant epilepsy. The typical stages include rim-enhancing lesion with minimal edema, followed by an increase in edema, to eventual gliosis and nonenhancing cavity formation. Radiologists need to be familiar with the postablation findings to minimize misdiagnosis and prevent unnecessary workup.