MRI在难治性颞叶癫痫定侧诊断中的价值研究

The Diagnostic Value of MRI in the Localization of Intractable Temporal Lobe Epilepsy

目的探讨磁共振(MRI)脑显像对颞叶癫痫致痫灶定侧的诊断价值。方法对21例健康志愿者及78例资料完整的难治性颞叶癫痫(TLE)患者进行回顾性分析,对常规MRI、氢质子磁共振波谱(1HMRS)检查及二者联合诊断在TLE定侧中的诊断准确率进行比较评价。结果常规MRI检查及1H-MRS检查分别准确定侧诊断26及46例患者。经统计学分析,致痫灶侧NAA/(Cho+Cr)值低于健侧,并低于健康志愿者双侧颞叶相应比值,有诊断学意义。可以认为常规MRI与1H-MRS(χ2=10.317,P=0.001)、两者联合(χ2=12.443,P<0.001)差异均有统计学意义;尚不能认为1H-MRS与两者联合(χ2=0.107,P=0.744)间差异有统计学意义。结论常规MRI及1H-MRS在颞叶癫痫定侧诊断中具有较大临床应用价值,二者联合应用可提高癫痫定侧准确率,在利用MRI对颞叶癫痫进行定位诊断时应尽量在常规MRI检查的基础上加行1H-MRS检查。

Objective To evaluate the value of MRI in the localization of temporal lobe epileptic focus. Methods 21 healthy volunteers and 78 patients diagnosed as TLE were all examined by conventional MRI and 1H-MRS. The accuracies of these two methods and combined application of the two methods were compared. Results We accurately diagnosed 26 and 46 patients using the routine MRI and 1H-MRS examination respectively. After statistical analysis, we found the ratio of NAA/（Cho＋Cr） was lower than that of the healthy side and corresponding value in healthy volunteers. As a result, we found the difference between conventional MRI and 1H-MRS（χ2=10.317,P=0.001）, combined application（χ2=12.443,P〈0.001） was statistically significant. We could not find the difference between the 1H-MRS and the combined application were statistically significant（χ2=0.107,P=0.744）. CCoonncclluussiioonn Conventional MRI and 1H-MRS have great clinical application value in diagnosis of temporal lobe epilepsy, but the conventional MRI and 1H-MRS examination should be carried out at the same time owing to the accuracy of 1H-MRS was significantly higher than that of conventional MRI.