以癫痫为主要症状的结节性硬化症脑部致痫灶的影像特点

Image Characteristics of Lesions Caused by Tuburous Sclerosis Complex with Epilepsy as the Main Symptoms

目的探讨以癫痫为主要症状的结节性硬化症(TSC)患者脑部致痫灶的影像学特点。方法搜集16例临床诊断TSC患者,13例行脑部致痫灶外科手术治疗,总结TSC致痫灶的好发部位及影像学特点。结果 CT检出皮层结节21个,18个结节部分钙化。MRI检出皮质结节52个,表现为皮层局部脑回增厚、肥大,T1WI呈等或稍低信号,T2WI呈等或稍高信号,Flair呈稍高信号,DWI呈等信号,增强扫描不强化,结节的钙化部分在各序列均呈稍低信号。22个结节伴皮质下脑白质病变。结节位于额叶18个,颞叶13个,顶叶11个,枕叶7个,扣带回3个。手术共切除皮质结节24个,15个为部分钙化结节。10个结节伴皮质下脑白质病变。结节位于额叶10个,颞叶6个,左顶叶5个,枕叶2个,扣带回1个。结论皮质结节与癫痫发作密切相关,皮层局部脑回增厚、肥大伴皮质下白质病变及部分钙化是TSC致痫灶的影像特点,皮质结节分布较多的脑叶依次为额叶、颞叶、顶叶。致痫结节的确定需结合发作期和发作间期脑电图的异常放电区域与MRI皮质结节所在脑叶的一致性进行判断。

Objective To explore the imaging features of epileptic lesions in patients with epilepsy as the main symptom of tuberous sclerosis. Methods 16 cases of clinical diagnosis of tuberous sclerosis were collected. 13 patients underwent surgical treatment to remove the lesions leading to epilepsy. Summarizing the location and imaging characteristics of the cortical epileptic lesions. Results CT images showed 21 nodules,of which 18 nodules had partial calcification. MRI showed 52 cortical nodules which manifested as local cortical thickening and hypertrophy. The nodules showed isointense to slightly hypointense signal on T1WI and isointense to slightly hyperintense signal on T2WI as well as T2 FLAIR sequences,and isointense signal on diffusion weighted imaging（ DWI）. After contrast administration,the nodules did not enhance.The calcified parts of the nodules showed a slightly lower signal in each sequence. 22 nodules were associated with subcortical white matter lesions. 18 nodules were located in the frontal lobes,13 in the temporal lobes,11 in the parietal lobes,7in the occipital lobes and 3 in the cingulate gyrus. A total of 24 cortical nodules were surgically removed,of which 15 were calcified nodules. 10 nodules were associated with subcortical white matter lesions. 10 nodules located in the frontal lobes,6 in the temporal lobes,5 in the parietal lobes,2 in the occipital lobes,and 1 in the cingulate gyrus. Conclusion Cortical nodules are closely related to epilepsy. Cerebral cortex local thickening and hypertrophy associated with subcortical white matter lesions and partial calcification are the imaging features of epileptogenic lesions caused by TSC. The number of cortical nodules in descending order of distribution were frontal lobe,temporal lobe and parietal lobe. For determination of epilepsy nodules,there is need to consider the consistency of EEG abnormal discharge areas and the lobar location of MRI cortical nodules.