三维动脉自旋标记灌注成像对致痫性局灶性皮层发育不良的术前评价

Presurgical evaluation of epilepsy patients of focal cortical dysplasia with 3D pseudo-continuous arterial spin labeling MRI perfusion

目的探讨三维准连续式动脉自旋标记灌注成像(3Dp CASL)对致痫性局灶性脑皮层发育不良(FCD)的术前定位作用。方法回顾性分析20例经手术病理证实的FCD致癫痫患者的ASL资料。获取病灶区CBF,并与对侧进行比较,并结合常规MRI、视频脑电图(VEEG)及PET/CT检查进行分析。结果所有患者均行常规MRI、3Dp CASL扫描、VEEG和PET/CT检查。病变多位于皮层下灰白质交界区,以额颞叶为多(其中额叶8例,颞叶7例)。MRI表现为T1WI呈稍低信号,T2FLAIR呈放射带状、片状高信号,周边境界欠清晰。4例患者的FCD于T2FLAIR呈小片状稍高信号,3Dp CASL未见异常灌注信号,后经PET/CT证实3例患者代谢减低,1例可疑。ASL证实CBF降低14例,与对侧比较差异有统计学意义(P<0.05);CBF增高2例。10例患者经术中Eco G确认致痫灶。结论致痫性FCD的影像学具有特征性;ASL检查有助于术前病灶的定位,与VEEG、PET/CT及Eco G检查互补可提高MRI诊断的准确性。

Objective To explore the preoperative evaluation of the focal cerebral cortical dysplasia （FCD） using three dimensional pseudo-continuous arterial spin labeling. Methods The ASL data of 20 patients with pathologically confirmed FCD were analyzed retrospectively. The regional CBF was obtained and compared with contralateral. Combined with conventional MRI, video electroencephalogram （VEEG） and PET/CT imaging results were analyzed. Results All patients underwent routine MRI scan,3DpCASL and all cases with VEEG and PET/CT examination. The lesions often located in the subcortical gray matter junction, especially in the frontal and temporal lobes （8 cases in frontal lobe ,7 cases in temporal lobe）. MRI performance showed a slightly lower signal on T1 image, T2FLAIR displayed radiation strip and sheet high signal, the surrounding state is not clear,4 cases of FCD in T2FLAIR showed a small piece of slightly higher signal ,3DpCASL with no abnormal perfusion, 3 cases confirmed by PET/CT with metabolic reduction, between them, and suspected in 1 cases. ASL confirmed that CBF was reduced in 14 cases, and compared with the control group was statistically significant （ t = - 2. 17, P 〈 0.05 ） , CBF increased in 2 cases, all cases were confirmed by VEEG and PET/CT, and 10 cases with EcoG examination. Conclusion The imaging features of FCD with epilepsy are characteristic, and ASL is helpful to observe the location of the lesions before operation, and it can improve the accuracy of the MRI examination with VEEG,PET/CT and EcoG.