局灶性脑皮质发育不良Ⅲ型与“双重病理”的MRI特征

The Feature of MRI in Focal Cortical Dysplasia( FCD) Type Ⅲ and FCD Type “Dual Pathology”

目的探讨局灶性脑皮质发育不良(FCD)Ⅲ型及FCD"双重病理"的MRI特征。方法回顾性分析经病理证实的26例FCDⅢ型及12例"双重病理"的发生部位、皮质发育不良及合并病灶的MRI征象,分析FCD两种类型与预后的相关性。结果 (1)分布:FCDⅢ型主要位于颞叶,FCD"双重病理"多位于颞叶外(P=0.025)。(2)29例显示皮层发育不良(Ⅲ型24例,"双重病理"5例),皮质发育不良的MRI异常显示率在FCDⅢ型及"双重病理"间差别有统计学意义(P=0.003)。(3)皮质发育不良MRL征象:灰白质分界不清21例(Ⅲ型15例,"双重病理"6例);皮层局灶性增厚11例(Ⅲ型6例,"双重病理"5例);白质高信号18例(Ⅲ型10例,"双重病理"8例);白质内向脑室方向延伸的锥形异常增高信号("Transmantle征")15例(Ⅲ型11例,"双重病理"4例)。灰白质分界不清、皮层局灶性增厚、白质高信号及"Transmantle征"在两种病理类型的出现率差异均无统计学意义(P=0.658,0.246,0.113,0.600)。(4)预后:29例有效,FCDⅢ型组与FCD"双重病理"组疗效有统计学差异(P=0.003),FCDⅢ型疗效优。结论 FCDⅢ型与FCD"双重病理"MRI表现与病理类型相关,合并病灶具特征性,而皮质发育不良的系列MRI征象差异不显著。了解这些特点有助于FCD新分型的早期诊断、术区界定及预后评估。

Objective To explore the MR features of focal cortical dysplasia（ FCD） type Ⅲ and FCD type＂dual pathology＂. Methods The MRI of 26 cases of FDC type Ⅲ and 12 cases of FCD type＂dual pathology＂which have been diagnosed by pathology were investigated retrospectively. All lesions location,the MR features of focal cortical dysplasia and the combined lesions were observed,and the difference of the prognosis of these two FCD subtypes were evaluated.Results（ 1） Lesion location： There were more FCD type＂dual pathology＂located in extra temporal lobe（ P = 0. 025）,FCD type Ⅲ were in temporal lobe at most.（ 2） The MR signs of focal cortical dysplasia could be seen in 29 cases（ 24 cases of FCD type Ⅲ,5 cases of FCD type ＂dual pathology＂）,and there was statistically significant difference in these two FCD types（ P = 0. 003）.（ 3） MR features of focal cortical dysplasia： The blurring of grey white matter junction has been found in 21 cases（ 15 cases of FCD type Ⅲ,6 cases of FCD type＂dual pathology＂）,11 cases with focal cortical thickening（ 6 cases of FCD type Ⅲ,5 cases of FCD type＂dual pathology＂）,18 cases with increased signal intensity of white matter（ 10 cases of FCD type Ⅲ,8 cases of FCD type＂dual pathology＂）,and a cone shape increased signal intensity of subcortical white matter（ Transmantle sign） has been found in 15 cases（ 11 cases of FCD type Ⅲ,4 cases of FCD type＂dual pathology＂）. There was no statistically significant difference in these two types of FCD（ P = 0. 658,0. 246,0. 113,0. 600）in the sign of blurring of grey white matter junction,focal cortical thickening,increased signal intensity of white matter and＂Transmantle＂sign.（ 4） Prognosis： 29 cases had significant prognosis. There was significant difference between these two types of FCD（ P = 0. 003）,and surgical effect of FCD Ⅲ type was better than FCD type＂dual pathology＂. Conclusion There is close relation between the pathology and the MR characteristics of FCD type Ⅲ and FCD type ＂dual pathology＂.The combined lesions of these two FCD subtypes are characteristic,but there is no significant difference in the MR signs of focal cortical dysplasia between these two FCD subtypes. The understanding of these features may contribute to early diagnosis,operative region designation and prognosis evaluation.