氢质子磁共振波谱用于颞叶癫痫致痫灶术前定位的研究

Study of the 1H-MRS in the Preoperative Localization of Temporal Lobe Epileptic Foci

目的:通过对颞叶癫痫(temporal lobe epilepsy,TLE)患者的氢质子磁共振波谱(1H-MRS)与术后病理对照分析,探讨1H-MRS用于TLE致痫灶术前定位的诊断价值。方法:对62例临床确诊的TLE患者术前行常规磁共振(MRI)、1H-MRS检查,分析TLE患者常规MRI图像及两侧海马区NAA/Cho、NAA/Cr、NAA/(Cho+Cr)的比值,对双侧海马区各代谢物比值行t检验,对比评价TLE患者双侧海马区代谢物变化;以海马区NAA/(Cho+Cr)比值作为TLE定位诊断的参考值,评价1H-MRS对TLE患者致痫灶定位的意义;常规MRI、1H-MRS诊断结果与术后病理对照,行Kappa一致性检验,对比评价常规MRI和1H-MRS对TLE致痫灶定位的价值。结果:(1)TLE患者致痫灶侧海马区和致痫灶对侧海马区的NAA/Cho、NAA/Cr、NAA/(Cho+Cr)值比较,差异均有统计学意义(t=3.292、4.798、5.297,P<0.05);(2)常规MRI、1H-MRS对TLE致痫灶定位结果与术后病理的一致性检验Kappa值分别为0.371、0.748,当NAA/(Cho+Cr)比值为0.66时,1H-MRS对TLE致痫灶定位诊断的准确性、敏感度、特异度、阳性预测值和阴性预测值依次为89%、95%、76%、91%和87%,而常规MRI检查依次为69%、69%、70%、79%和57%。结论:1H-MRS较常规MRI对TLE具有更高的定位诊断价值,联合多种检查方法综合分析才能进一步提高TLE患者致痫灶定位诊断的准确率和可靠性。

Objective： Comparative analysis of IH-MRS and postoperative pathology in patients with TLE, to investigate the value of tH-MRS in the diagnosis of TLE induced epileptic loci.Method： Preoperative conventional MRI and 1H-MRS were performed in 62 patients with clinically-diagnosed TLE, then analyzed the results of conventional MRI and the value of NAA/Cho, NAA/Cr, NAA/（Cho＋Cr） of bilateral hippocampal area, t test was performed to compare the ratio of each metabolite in the hippocampus, and the changes of the metaholites in the hippocampus of TLE patients were compared and evaluated.NAA/ （Cho＋Cr） ratio was used as the reference value of TLE in the diagnosis, and the significance of 1H-MRS in the localization of epileptic loci in patients with TLE was evaluated.Conventional MRI, 1H-MRS diagnostic results and postoperative pathological examination, line Kappa consistency test, comparative evaluation of routine MRI and TLE on the value of ~H-MRS in the localization of epileptic foci.Result： （1）Compared the NAMCho, NAA/Cr, NAA/（Cho＋Cr） of the lateral hippocampal area and the contralateral hippoeampus in the patients with TLE, there were significant differences（t=3.292, 4.798, 5.297, P〈0.05）.（2）Compared to postoperative pathology, the Kappa value of conventional MRI and 1H-MRS were 0.371, 0.748, used the value of NAA/（Cho＋Cr） 0.66 as the threshold, the sensitivity, specificity, positive predict value, negative predict value and accuracy of 1H-MRS for diagnosing hippocampal sclerosis were 95%, 76%, 87% and 89%, and conventional MRI respectively were 69%, 70%, 79%, 57% and 69%.Conclusion： 1H-MRS has higher value for localization of temporal lobe epileptic loci than MRI, combining with other techniques can further improve the accuracy and reliability of localizing the epileptic foci in patients with TLE.