基于体素的磁共振形态学测量分析法检测局灶性皮质发育不良的临床应用

Voxel-based morphometric MRI analysis on detection of focal cortical dysplasia

目的研究基于体素的磁共振形态学测量分析方法在检测局灶性皮质发育不良(focal cortical dysplasia,FCD)的应用价值。方法纳入北京天坛-丰台癫痫中心2015年至2016年期间病理确诊为Ⅰ型和Ⅱ型FCD的44例患者。对患者的头颅MRI用形态学测量分析程序(morphometric analysis program,MAP)进行处理,比较MAP中延伸图像、交界图像和厚度图像对FCD病变的检出率;并比较传统人工阅片与MAP辅助阅片检出率的差异。结果 MAP的交界图像和厚度图像对FCD病变的检出率要高于延伸图像。传统人工阅片和MAP辅助阅片均未检测出Ⅰ型FCD病变;但相对于前者,后者明显地提高了Ⅱ型FCD的检出率,尤其是ⅡA型FCD的检出率(P=0.03,P=0.05)。结论 MAP有助于在癫痫患者中筛选FCD,或对可疑的异常影像加以确认。但对于再次手术或者真正MRI阴性的FCD患者,MAP的作用并不明显。

Objective To evaluate the value of voxel-based morphometric MRI analysis on detection of focal cortical dysplasia（ FCD）. Method 44 patients with histopathologically confirmed type I FCD from 2015 to 2016 were included in this study. The FCD detection rates of extension,junction and thickness images derived by morphometric analysis program（ MAP） were compared,and the detection rates of conventional visual analysis and MAP-assistant analysis were also compared. Results The FCD detection rates of junction and thickness images were higher than that of extension image. Neither conventional visual analysis nor MAP-assistant analysis detected type ⅠFCD lesions. However,MAP-assistant analysis improved detection of type Ⅱ FCD lesions,especially type ⅡA lesions（ P = 0. 03,P = 0. 05）. Conclusion MAP was useful in FCD lesion screening and confirming questionable abnormalities for epilepsy patients,but it had less effects on patients with reoperation or patients with strictly MRI negative FCD lesions.