局灶性脑皮质发育不良病理分型的MRI特点

MRI characteristics of focal cortical dysplasia

目的探讨不同病理分型的局灶性脑皮质发育不良(FCD)的 MRI 特点。方法回顾分析行癫痫手术治疗后病理符合 FCD 患者的临床资料,所有患者术前均行 MR 检查。根据 Palmini的 FCD 分型标准,分型后分别总结患者的 MRI 特点。结果共28例患者符合标准,其中 FCD Ⅰ型与Ⅱ型各14例。FCD Ⅰ型患者中,9例病灶位于颞叶,6例合并海马硬化。其中 MRI 表现异常者8例,表现为灰白质交界不清,局部皮层增厚、形态异常等特征;FCD Ⅱ型患者中,病灶位于额叶7例,2例合并海马硬化。其中 MRI 表现异常者11例,多表现为脑回形态异常,液体抑制反转恢复序列(FLAIR)、T_2WI 上白质信号增高,以及白质内条带状异常增高信号向脑室方向延伸等特点。结论不同病理分型的 FCD 在 MRI 上表现的特点有所不同,了解这些特点有助于提高癫痫外科术前评估的准确性以及对手术预后的判断。

Objective To summarize the MRI characteristics of focal cortical dysplasia （FCD）. Methods Patients with FCD proved histopathologically underwent MR imaging and surgical resection for intractable epilepsy. MRI characteristics of FCD were summarized according to the Palmini classification. Results There were 14 patients with type Ⅰ FCD and 14 with type Ⅱ FCD. In type Ⅰ FCD patients, 8 patients had abnormal MRI appearances such as cortical-white matter junction blurring and focal cortical thickening, and the temporal lobe was the most frequently affected area （9/14）. Hippocampal Sclerosis （HS） was seen in 6 type Ⅰ FCD patients. The MRI abnormalities can be seen in 11 type Ⅱ FCD patients, of which 7 cases with frontal lobe seizure. Only 2 cases of HS were foud in type Ⅱ FCD. Cortical thickening, high signal of white matter on T2WI and FLAIR, high signal band in the white matter from the surface to the ventricle were the most common MRI characteristics of type Ⅱ FCD. Conclusion Two types of FCD have different MRI features which is helpful to improve the accuracy of presurgical planning and determine the prognosis of epilepsy surgery.