Transient MR signal changes in patients with generalized tonicoclonic seizure or status epilepticus: periictal diffusion-weighted imaging.
Transient MR signal changes in patients with generalized tonicoclonic seizure or status epilepticus: periictal diffusion-weighted imaging.
复制标题
全身性强直阵挛发作或癫痫持续状态患者的瞬时 MR 信号变化：发作周围弥散加权成像。
DOI：
--
复制
发表时间：
2001
期刊：
影响因子：
--
通讯作者：
E. Jeong
中科院分区：
文献类型：
--
作者：
Jeong;J. Chung;P. Yoon;Dong Ik Kim;Tae Sub Chung;Eun;E. Jeong
背景和目的
我们的目的是研究全身性强直阵挛发作或癫痫持续状态患者发作期MRI图像上的瞬时MR信号变化，并评价这些改变对于鉴别诊断和了解癫痫所致脑改变的病理生理机制的临床意义。
方法
对8例在全身性强直阵挛发作或癫痫持续状态后3天内获得的MR图像显示癫痫相关的MR信号改变的患者的记录进行了回顾。所有8名患者均获得了T1和T2加权图像。在最初的检查中，对5名患者进行了额外的弥散加权成像。在充分控制癫痫发作后，进行后续的磁共振成像。我们评估了T1和T2加权图像上的信号变化、病变位置和对比增强程度，以及扩散加权图像上的信号变化和表观扩散系数(ADC)。我们还比较了初始MR图像和后续MR图像的信号变化。
结果
最初的MR图像显示，所有8名患者的受累皮质回局部T2信号增强、肿胀和体积增大。7例患者病变位于皮质灰质或皮质下白质，1例位于右侧海马区。T1加权像显示同一部位信号降低(n=6)，脑回增强(n=4)。弥散加权图像显示同一部位信号增强，局灶性ADC降低。ADC值较对侧正常结构或正常对照降低6%~28%。随访5例患者的异常T2信号改变和肿胀完全消退，而另2例患者的肿胀消退并伴有同侧海马区残留的T2信号增强。对于两名患者中的一名，被诊断为海马体硬化。另1例患者新发T2信号增强。
结论
全身性强直阵挛发作或癫痫持续状态后发生的MR信号改变是发作期周T2加权和弥散加权图像上皮质灰质、皮质下白质或海马区信号一过性增强和肿胀。这些发现反映了癫痫发作引起的一过性细胞毒性和血管源性水肿。病变的可逆性和典型部位有助于排除致痫的结构性病变。
BACKGROUND AND PURPOSE
Our purpose was to investigate transient MR signal changes on periictal MR images of patients with generalized tonicoclonic seizure or status epilepticus and to evaluate the clinical significance of these findings for differential diagnosis and understanding of the pathophysiology of seizure-induced brain changes.
METHODS
Eight patients with MR images that were obtained within 3 days after the onset of generalized tonicoclonic seizure or status epilepticus and that showed seizure-related MR signal changes had their records retrospectively reviewed. T1- and T2-weighted images were obtained of all eight patients. Additional diffusion-weighted images were obtained of five patients during initial examination. After adequate control of the seizure was achieved, follow-up MR imaging was performed. We evaluated the signal changes, location of the lesions, and degree of contrast enhancement on T1- and T2-weighted images and the signal change and apparent diffusion coefficient (ADC) on diffusion-weighted images. We also compared the signal changes of the initial MR images to those of the follow-up MR images.
RESULTS
The initial MR images revealed focally increased T2 signal intensity, swelling, and increased volume of the involved cortical gyrus in all eight patients. The lesions were located in the cortical gray matter or subcortical white matter in seven patients and at the right hippocampus in one. T1-weighted images showed decreased signal intensity at exactly the same location (n = 6) and gyral contrast enhancement (n = 4). Diffusion-weighted images revealed increased signal intensity at the same location and focally reduced ADC. The ADC values were reduced by 6% to 28% compared with either the normal structure opposite the lesion or normal control. Follow-up MR imaging revealed the complete resolution of the abnormal T2 signal change and swelling in five patients, whereas resolution of the swelling with residual increased T2 signal intensity at the ipsilateral hippocampus was observed in the other two patients. For one of the two patients, hippocampal sclerosis was diagnosed. For the remaining one patient, newly developed increased T2 signal intensity was shown.
CONCLUSION
The MR signal changes that occur after generalized tonicoclonic seizure or status epilepticus are transient increase of signal intensity and swelling at the cortical gray matter, subcortical white matter, or hippocampus on periictal T2-weighted and diffusion-weighted images. These findings reflect transient cytotoxic and vasogenic edema induced by seizure. The reversibility and typical location of lesions can help exclude the epileptogenic structural lesions.
影响因子：
19.7
作者：
MOSELEY, ME;COHEN, Y;NORMAN, D
通讯作者：
NORMAN, D
影响因子：
19.7
作者：
Jack, CR;Rydberg, CH;Riederer, SJ
通讯作者：
Riederer, SJ