儿童局灶性颞叶癫痫：3.0T ~1H-MRS及MR海马容积分析

3.0T ~1H-MRS and MRI volumetry analysis in the hippocampus of children with focal temporal lobe epilepsy

目的:探讨3.0T氢质子磁共振波谱(1H-MRS)与磁共振容积测量(vMR)对儿童局灶性颞叶癫痫(fTLE)的诊断价值及临床相关因素分析。材料与方法:对30例经24小时动态脑电图确诊的fTLE患儿(年龄5～14岁,平均8.5岁)行3.0T1H-MRS分析及vMR测量,并以随机的30名儿童(年龄5～14岁,平均8.8岁)对照,计算患者组双侧海马区代谢产物氮-乙酰天门冬氨酸(NAA)/肌酸(Cr)及海马容积、对照组任一侧海马NAA/Cr及容积,比较患儿病灶侧与病灶对侧、病灶侧与对照组、病灶对侧与对照组之间有否差异。分析癫痫发作频率等临床相关因素与海马萎缩的相关性。结果:患儿病灶侧海马区NAA/Cr(1.47±0.24)较病灶对侧(1.79±0.35)及对照组(1.81±0.27)明显减低,而病灶对侧NAA/Cr与对照组差异不明显;患儿病灶侧海马容积[(2.75±0.35)cm3]较病灶对侧[(3.06±0.46)cm3]和对照组[(3.11±0.17)cm3]亦明显减小(以对照组NAA/Cr值及海马容积参考值范围为标准)。此外,fTLE患儿癫痫发作频率与病灶侧海马容积缩小不具有相关性,而热惊厥史对海马体积具有显著影响。结论:3.0T1H-MRS及vMR测量对儿童fTLE病灶具有定位作用,并且能够定量反映患儿海马代谢异常及形态学改变,是为临床诊治提供可靠依据的无创性检查手段。

Objective：To study the diagnostic value of quantitative proton magnetic resonance spectroscopy（1H-MRS） and volumetric MR（vMR） in the hippocampus of children on focal temporal lobe epilepsy（fTLE）,and analyse the relationship between the volume change of the hippocampus and clinical factors.Methods：3.0T 1H-MRS and vMRI were used to study 30 children（mean age 8.5 years,age 5 to 14 years） with unilateral fTLE,proven by 24 hours active electroencephalogram,and 30 random healthy children（mean age 8.8 years,age 5 to 14 years） served as controls.The spectral resonance lines of N-acetylaspartate（NAA）/creatine（Cr） and volume of the hippocampus were calculated quantitatively on both hippocampal regions of children patients and either side of control group,and then compared among the lesion group,the contralateral group and control group.Explore the relationship between the hippocampus shrink and the seizure frequency etc.Results：The mean concentration of NAA/Cr was significantly decreased in the focus side（1.47±0.24） compared with the nonfocus side（1.79±0.35） and the controls（1.81±0.27）,but nonsignificantly between the nonfocus side and controls.Moreover,the mean hippocampal volume of focus side of patients（2.75±0.35）cm3 was significantly reduced compared with that of nonfocus side（3.06±0.46）cm3 and the controls（3.11±0.17）cm3,reference ranges of NAA/Cr and hippocampal volume in control group as standard.Furthermore,seizure frequency has no relation with hippocampus volume shrink in fTLE children.The degree of hippocampus volume reduction was not related with the seizure frequency,but the history of febrile convulsions had significant influence on the hippocampus.Conclusions：3.0T 1H-MRS and vMRI could be useful for localization in the region of hippocampal lesions,and quantify biochemical metabolic disorders and morphological changes.They could be a complementary modality to provide the reliable information for diagnosis and treatment in fTLE children.