Proton magnetic resonance spectroscopic imaging and magnetic resonance imaging volumetry in the lateralization of temporal lobe epilepsy: A series of 100 patients
Proton magnetic resonance spectroscopic imaging and magnetic resonance imaging volumetry in the lateralization of temporal lobe epilepsy: A series of 100 patients
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DOI：
10.1002/ana.410420510
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发表时间：
1997-11-01
影响因子：
11.2
通讯作者：
Arnold, DL
中科院分区：
文献类型：
--
作者：
Cendes, F;Caramanos, Z;Arnold, DL
手术是治疗耐药颞叶癫痫的一种安全有效的方法。然而，双侧脑电图（EEG）异常经常存在，使手术前侧化困难。新的磁共振（MR）技术可以提供帮助；质子磁共振波谱成像（MRSI）可以根据神经元标记物n -乙酰天冬氨酸的减少信号来检测和量化局灶性神经元损伤或功能障碍，而磁共振成像（MRT）基于杏仁核-海马体积（MRnTol）的测量可以提高这些结构萎缩的检测。我们对100名医学上难治性TLE患者进行了质子核磁共振成像和核磁共振成像，通过广泛的脑电图调查来确定这些技术与侧化的一致程度。我们发现EEG， MRSI和MRIVol的结果高度一致。100例患者中，MRSI异常99例（双侧54%）。98例患者中有86例MRIVol异常（28%为双侧）。我们在单独使用MRIVol的患者中获得了83%的侧侧化，单独使用MRSI的患者中获得了86%的侧侧化，MRSI和MRIVol联合使用的患者中获得了90%的侧侧化（与EEG的93%侧侧化相比）。12例MRIVol正常的患者MRSI异常。在绝大多数患者中，质子MRSI和MRIVol的结合可以准确、无创地侧向定位TLE。通过减少对脑电图的依赖，这些成像技术可以减少长时间的术前评估，并使更多的患者可以进行癫痫手术。
Surgery is a safe and effective treatment for drug-resistant temporal lobe epilepsy (TLE). However, bilateral electroencephalographic (EEG) abnormalities are frequently present, making presurgical lateralization difficult. New magnetic resonance (MR) techniques can help; proton magnetic resonance spectroscopic imaging (MRSI) can detect and quantify focal neuronal damage or dysfunction based on reduced signals from the neuronal marker N-acetylaspartate, and magnetic resonance imaging (MRT)-based measurements of amygdala-hippocampal volumes (MRnTol) can improve the detection of atrophy of these structures. We performed proton MRSI and MRIVol in 100 consecutive patients with medically intractable TLE to determine how well these techniques agreed with the lateralization by extensive EEG investigation. We found that the EEG, MRSI, and MRIVol findings were highly concordant. The MRSI was abnormal in 99 of 100 patients (bilateral in 54%). The MRIVol was abnormal in 86 of 98 patients (bilateral in 28%). We obtained lateralization in 83% of patients using MRIVol alone, in 86% using MRSI alone, and in 90% by combining MRSI and MRIVol (vs 93% lateralization by EEG). MRSI was abnormal in 12 patients with normal MRIVol. The combination of proton MRSI and MRIVol can lateralize TLE accurately and noninvasively in the great majority of patients. By reducing reliance on EEG, these imaging techniques could reduce prolonged presurgical evaluation and make seizure surgery available to more patients.