基于自动脑分割技术对颞叶癫痫伴海马硬化患者脑体积的不对称性分析及其应用价值

Analysis of brain volume asymmetry and clinical application in patients with temporal lobe epilepsy with hippocampal sclerosis based on automatic brain segmentation

目的利用自动脑分割技术分析颞叶癫痫伴海马硬化(TLE-HS)患者脑体积的不对称性,并探讨该技术在TLE-HS的诊断及对致痫灶定侧中的应用价值。方法回顾性收集2019年4月至2020年10月就诊于郑州大学第一附属医院的TLE-HS患者28例,其中男15例,女13例,年龄18~63(30±12)岁,根据病灶侧别分为左侧TLE-HS(LTLE-HS)组11例和右侧TLE-HS(RTLE-HS)组17例;招募对照者28名,年龄18~49(29±10)岁。所有受试者进行三维T_(1)加权像(3D T_(1)WI)扫描。回顾性分析LTLE-HS和RTLE-HS和对照者左右侧脑结构体积的差异,并使用Pearson相关系数评价左右侧体积的相关性,用效应值评价左右侧体积平均值的差。另计算每组左右侧体积的不对称指数(AI)并比较三组间的差异。结果对照者、LTLE-HS、RTLE-HS组脑内各结构左右侧标准体积均具有不对称性,在LTLE-HS组和RTLE-HS组中患侧海马体积均小于对侧海马体积(分别为0.20%±0.03%比0.24%±0.02%,0.21%±0.03%比0.25%±0.02%;均P<0.001),LTLE-HS组患侧颞叶灰质和颞叶白质体积小于对侧(4.41%±0.38%比5.01%±0.43%,1.83%±0.22%比2.22%±0.14%;均P<0.001)。对照者、LTLE-HS、RTLE-HS三组左右侧体积呈中-强度的线性相关(0.553<r<0.964,均P<0.05)。三组均显示扣带回的效应值最大(效应值分别为:对照者3.07、LTLE-HS组4.85、RTLE-HS组4.22)。三组间海马、颞叶灰质、颞叶白质的AI值差异具有统计学意义(分别为-1.48±8.64比15.91±10.15比-17.59±10.00、7.46±2.67比12.67±6.67比3.67±6.15、6.53±3.71比19.91±9.85比1.57±8.38;均P<0.001)。结论自动脑分割技术体积测量可在颞叶癫痫术前评估中发挥重要作用,脑体积的不对称性对致痫灶定侧及范围确定有一定的应用价值。

Objective To analyze whole brain structural volume asymmetry in temporal lobe epilepsy with hippocampal sclerosis(TLE-HS)using automated brain segmentation technology,and to investigate the application value of this technology in the diagnosis of TLE-HS and the performance in determining the location the lateralization of epileptogenic focus.Methods Twenty-eight patients with TLE-HS were enrolled in the First Affiliated Hospital of Zhengzhou University from April 2019 to October 2020,including 13 females and 15 males,aged ranged from 18 to 63(30±12)years,and these patients were divided two group according to the epilepsy lateralization,left TLE-HS(LTLE-HS)group(n=11),right TLE-HS(RTLE-HS)group(n=17)and 28 normal controls[aged ranged from 18 to 49(29±10)years].All of these subjects underwent three-dimensional T_(1)weighted image(3D T_(1)WI).The differences of brain structure and volumes in LTLE-HS,RTLE-HS and normal controls group were retrospectively analyzed,and Pearson′s correlation coefficient was used to evaluate the left and right volume correlations,and effect size was used for evaluating the differences in left and right volume averages.The asymmetry index(AI)of the left and right lateral volumes in each group was also calculated and compared among the three groups.Results Standard volumes of all structures within the brain were asymmetric in the normal controls,LTLE-HS,and RTLE-HS groups,with smaller volumes of ipsilateral hippocampus than contralateral hippocampus in both the LTLE-HS and RTLE-HS groups(0.20%±0.03%vs 0.24%±0.02%,0.21%±0.03%vs 0.25%±0.02%respectively;both P<0.001),and smaller volumes of gray and white matter of the ipsilateral temporal lobe than contralateral in the LTLE-HS group(4.41%±0.38%vs 5.01%±0.43%,1.83%±0.22%vs 2.22%±0.14%;both P<0.001).There was a moderate to strong linear correlation(0.553<r<0.964,all P<0.05)between left and right lateral volumes in the normal controls,LTLE-HS,and RTLE-HS groups.All three groups showed the largest effect sizes in the cingulate gyrus(The effect sizes were 3.07,4.85 and 4.22 in control,LTLE-HS and RTLE-HS,respectively.).The AI values of the hippocampus,temporal lobe gray matter,and temporal lobe white matter were statistically different among the three groups(-1.48±8.64 vs 15.91±10.15 vs-17.59±10.00,7.46±2.67 vs 12.67±6.67 vs 3.67±6.15,6.53±3.71 vs 19.91±9.85 vs 1.57±8.38;all P<0.001).Conclusion Volumetric measurements by automated brain segmentation techniques can play an important role in preoperative assessment of TLE,and the asymmetry of brain volume may be of value in determining the localization and extent of the epileptogenic focus.