磁共振波谱分析在儿童难治性癫痫中的应用价值

Magnetic Resonance Spectroscopy in the Diagnosis of Epilepsy in Children

目的:评价磁共振波谱分析在儿童难治性癫痫灶诊断中的应用价值。方法:本组35例患儿中男21例、女14例,均行常规脑电图检查及长程视频脑电图监测,其中17例术中行皮层脑电图和深部电极脑电图监测。MRI及MRS检查采用1.5T超导MR扫描仪,先行常规T1WI、T2WI扫描,MRS检查采用多体素波谱采集序列,兴趣区为双侧海马头体部及海马外侧颞叶组织,原始数据经Function Tool软件后处理进行波谱分析。结果:35例中MRS表现无明显异常者6例;双侧海马硬化5例,MRS示双侧海马NAA峰值降低;单侧海马硬化9例,MRS示患侧NAA峰降低;软化灶10例,MRS示局部NAA峰消失;颞叶胶质增生5例,MRS示患侧NAA峰减低,Cr和Cho峰值升高。本组手术治疗17例中MRS定位于左侧海马10例、右侧海马7例,与术中深部电极脑电图监测结果一致。结论:MRS是目前唯一无创性检测活体器官内生化代谢物质的分析方法,不仅能早期诊断海马硬化,而且可进一步提高术前癫痫灶定位的准确性。

Objective： To evaluate the value of magnetic resonance spectroscopy （MRS） in the diagnosis of refractory epilepsy in children. Methods： Totally there were 35 cases, with male （ n = 21 ）, female （ n = 14 ）. Routine EEG, video-EEG and MRS were performed in all cases,intra-operative monitoring of cortical EEG and deep electrode EEG were performed in 17 cases. Routine MRI （T1 WI,T2WI） as well as muhi-voxel MRS were used with a 1.5T magnetic resonance scanner, the region of interest （ROD were the head and body of bilateral hippocampus and temporal lobe lateral to hippocampus. The original data were post-processed by function tool and analyzed. Results： Of the 35 cases, 6 cases were normal on MRS; 5 cases had bilateral hippocampal sclerosis,showing decrease of NAA peak on MRS; 9 cases had unilateral hippoeampal sclerosis,showing decrease of N AA at the diseased side;10 cases had cerebral-malacia of hippocampus, showing disappearance of NAA of the focus;5 cases had gliosis,showing decrease of NAA peak and ascendance of the peak of Cr and Cho. 17 of the 35 cases had surgery,the lesions were located by MRS as left side （n=10） and right side （n=7） ,which were in accordance with that of intraoperative monitoring findings of deep electrode EEG. Conclusion：MRS is an unique non-invasive technique to detect biochemistry metabolites of organ in vivo,not only can obtain early diagnosis of hippocampal sclerosis,but also can improve the accuracy of localization of epilepsy lesion before surgery.