伴海马硬化的颞叶内侧面癫痫围发作期SPECT脑血流灌注特点研究

SPECT peri-ictal cerebral perfusion changes in mesial temporal lobe epilepsy associated with hippocampus sclerosis

目的研究伴海马硬化的颞叶内侧面癫痫(MTLE-HS)表现为伴认知损害的局灶性癫痫发作时发作期和发作后期脑血流灌注随时间变化的特点。方法收集接受前颞叶切除手术,且术后病理检查证实为MTLE-HS的患者30例,随访3～10年。纳入的30例患者均记录到1次FIAS的癫痫发作,采集发作期/发作后期及发作间期的SPECT脑血流图像,使用统计参数成像(SPM)方法,将发作期或发作后期的图像减去发作间期的图像得到SPM-T统计图,分析发作期和发作后期脑血流灌注的特点,并画出具有统计学意义的感兴趣区(ROI)。随后计算出ROI脑血流信号改变值,分析该ROI脑血流信号改变与注射时间的相关性。结果发作期致痫灶同侧颞叶内侧和基底核区均表现为高灌注改变。前额叶、顶叶及前扣带回区发作期注射组均为低灌注改变;发作后期同侧颞叶在此期未及高灌注改变;前额叶、顶叶及前扣带回区仍表现为低灌注改变,但范围较发作期缩小。发作期注射组颞叶内侧和基底核区高灌注ROI脑血流信号改变与注射时间呈正相关(r=0.66,P<0.05),发作后期注射组前扣带回低灌注ROI脑血流信号改变与注射时间呈负相关(r=-0.66,P<0.05),但前额叶低灌注ROI脑血流信号改变与注射时间无相关性(r=0.55,P>0.05),发作后期病灶同侧颞叶低灌注ROI脑血流信号改变与注射时间呈负相关(r=-0.58,P<0.05)。结论 MTLE-HS脑血流灌注模态随时间动态变化,发作期高灌注随癫痫发作时间进展逐渐扩展,发作后期脑血流呈低灌注状态,提示脑血流灌注演变与癫痫传播相关。

Objective To investigate the temporal changes in cerebral blood flow during ictal and postictal focal impaired awareness seizures(FIAS) in mesial temporal lobe epilepsy associated with hippocampal sclerosis(MTLE-HS). Methods Thirty patients with temporal lobe epilepsy who underwent surgery with pathologically confirmed hippocampal sclerosis between 1995 and 2005 were enrolled. Thirty patients were recorded at least a FIAS seizure, SPECT images were collected during the ictal /postictal and interictal episodes. SPM-T map was obtained based on SPM method using ictal/potictal SPECT minus interictal SPECT. The characteristics of cerebral blood perfusion in the ictal and postictal groups were analyzed. The statistically significant brain regions of interest were drawn. The cerebral blood flow signal value of the brain regions of interest was then calculated, and the relationship between the signal change of the region of interest and the injection time was analyzed. Results During the ictal injection the ipsilateral temporal lobe and basal ganglia showed hyperperfusion. The frontoparietal cortex showed hypoperfusion in the whole ictal period;during the postictal injection the temporal lobe was hypoperfused;the frontoparietal cortex still showed hypoperfusion. Time-correlation analysis of cerebral blood flow changes showed that hyperperfusion in the mesial temporal lobe and basal ganglia were positively correlated with injection time(r=0.66, P<0.05);on the contrary, there was an negative correlation between hypoperfusion in the anterior cingulate gyrus and injection time(r=-0.66, P<0.05), but not in frontal lobe(r=0.55, P >0.05);hypoperfusion was shown in the ipsilateral temporal lobe during postictal period and the hypoperfusion was negatively correlated with the injection time(r=-0.58, P<0.05). Conclusion The cerebral blood hyper and hypo perfusion patterns of MTLE-HS changes with injection time shift. The dynamic perfusion changes show that the cerebral blood flow evolution is related to seizure propagation.