磁共振波谱联合视频脑电图对伴海马硬化的内侧颞叶癫痫的诊断价值

The Diagnostic Value of MRS Combining V-EEG in Mesial Temporal Lobe Epilepsy

目的:探讨磁共振波谱(MRS)结合视频脑电图(V-EEG)对内侧颞叶癫痫(MTLE)的定位诊断价值,分析不同疗效MTLE患者MRS的特点。方法:将52例入组前V-EEG监测有发作间期异常放电的MTLE患者根据国际抗癫病联盟对耐药性癫病的定义分为耐药组(n=18)和有效组(n=34),根据V-EEG异常放电部位再分为单侧放电组和双侧放电组,收集同期20例健康体检者作为对照组;MTLE患者行V-EEG检查,所有被检者均行头颅MRI扫描及双侧海马体MRS检查,记录MTLE患者发作间期V-EEG及影像学表现,比较耐药组和有效组患者V-EEG与MRS检查单双侧异常放电的一致性;分析3组受检者双侧海马体的代谢物肌酸(Cr)、胆碱(Cho)、N-乙酰天门冬氨酸(NAA)峰值,比较NAA/Cr、NAA/Cho及NAA/(Cr+Cho)比值的变化。结果:MTLE患者头颅MRI检出颞叶异常改变30例,检出率58%;MRS检查检出异常46例,检出率88%,有16例MRS发现异常改变的患者MRI检查为阴性;耐药组和有效组V-EEG和MRS检出单侧异常放电的一致性分别为83.3%和78.6%,V-EEG和MRS检出双侧异常放电的一致性分别为100.0%和33.3%,有效组双侧一致性较差;与对照组比较,有效组和耐药组NAA/Cr、NAA/Cho及NAA/(Cr+Cho)的比值降低(P<0.05);耐药组NAA/Cr、NAA/Cho及NAA/(Cr+Cho)的比值虽较有效组低,但仅NAA/Cr比值比较,差异有统计学意义(P<0.05)。结论:V-EEG联合MRS检查对单侧MTLE初步定位具有较高的价值,耐药性MTLE患者更易出现NAA/Cr比值的降低。

Objective： To analyze the characteristics of MRS on mesial temporal lobe epilepsy（ MTLE）,to explore the diagnostic value of MRS combined with V-EEG on locating MTLE. Methods：52 MTLE patients with interictal abnormal discharge under V-EEG monitoring were divided into drug sensitive group（ 34）,drug resistance group（ 18）,unilateral discharge group and bilateral discharge group were further divided according to the abnormal discharge location of V-EEG; 20 volunteers as control group. All the MTLE underwent V-EEG test; all patients were scanned by magnetic resonance imaging（ MRI）,and bilateral hippocampal MRS examination; recording MTLE patients interictal VEEG imaging manifestation,and comparing consistency of V-EEG and MRS test on left/right side and uni/bilateral of drug resistance group and drug sensitive group. Analyzing Cr,Cho,NAA peak value,comparing ratio changes of NAA/Cr,NAA/Cho and NAA/（ Cr ＋ Cho）. Results： MTLE patients cranium MRI test discovered 30 temporal lobe abnormal changes,detection rate was 58%; MRS test discovered 46 abnormal cases,detection rate was 88%,of which 16 MRS tested abnormal changes patients with MRI negative results; both groups V-EEG manifestation was 40 cases of unilateral abnormal discharge（ 77%）,which was higher than 12 cases of bilateral abnormal discharge（ 23%）. Consistency of V-EEG unilateral abnormal discharge and MRS unilateral abnormal discharge of drug resistance group and drug sensitive group were 83. 3% and 78. 6% respectively; consistency of V-EEG bilateral abnormal discharge and MRS bilateral abnormal discharge of both groups were 100. 0% and 33. 3%;in drug sensitive group bilateral consistency was weaker. Comparing with control group,ratio of NAA/Cr,NAA/Cho and NAA/（ Cr ＋ Cho） of drug resistance group and drug sensitive group decreased（ P〈0. 05）; even though NAA/Cr,NAA/Cho and NAA/（ Cr ＋ Cho） ratio of drug resistance group was lower than the other group,comparing only NAA/Cr ratio,the differences were statistically significant（ P〈0. 05）. Conclusion： V-EEG combined with MRS test showed relatively high diagnostic value on preliminary location of unilateral MTLE,drug resistance MTLE patients were prone to show symptoms of bilateral hippocampus MRS abnormal and lowered NAA/Cr ratio.