皮质发育畸形术前定位致灶的静息态功能MRI初步研究

A Plot Study of Resting State-f MRI: Preoperative Localization of Epileptogenic Zone in Epilepsy with Malformations of Cortical Development

目的探讨基于局部一致性(Re Ho)、低频振幅(ALFF)和低频振幅分数(f ALFF)的静息态功能MRI(RS-f MRI)是否具有术前定位皮质发育畸形(MCD)患者致灶的能力。方法 MCD患者10例行RS-f MRI检查,静息态数据经预处理和分析后得到的Re Ho、ALFF和f ALFF激活图,与视频脑电图(VEEG)、正电子发射断层显像(PET)、MRI及综合评估的致灶结果比较。比较患者术后结果与静息态异常激活图结果。结果 RS-f MRI致灶定位结果分别与6例VEEG、8例PET、6例MRI以及7例最终综合评估的致灶定位结果一致。6例接受手术治疗的患者(包括2例MRI检查阴性)均发现异常的局部激活图,术后经病理证实为皮质发育畸形(2例灰质异位和4例局灶性皮质发育不良)。结论基于Re Ho、ALFF及f ALFF分析方法的RS-f MRI具有定位MCD患者致灶的能力。

Objective To investigate whether resting state-fMRI （RS-fMRI） based on local consistency （ReHo）, amplitude low-frequency fluctuate （ALFF） and fALFF can add meaningful information on preoperative localization of epileptogenic zone in patients with malformations of cortical development （MCD）. Methods Ten epilepsy patients with MCD were studied with RS-fMRI using a 3.0 T scanner. The resting state data were preprocessed and analyzed using SPM8 and REST to generate the activation map. Abnormal ReHo, ALFF and fALFF related blood oxygen level dependent （BOLD） signal changes were compared to video EEG （VEEG）,PET,MRI findings and the final result of a comprehensive evaluation-defined epileptogenic zone. For operated patients, postoperative resection and histology were compared to BOLD responses. Results The results of spike localization of RS-fMRI were consistent with VEEG, PET, MRI findings and final comprehensive evaluation-defined epileptogenic zone in 6, 8, 6, 7 of 10 investigations. Six operated patients （including two negative results of MRI examination） revealed local abnormal changes but not visible on structural MRI, which was confirmed cortical malformations by pathology after operation （2 heterotopia and 4 cortical dysplasia）. Conclusion RS-fMRI may help to delineate the epileptic focus in epilepsy patients with MCD.