儿童颞叶癫痫的临床特点及MRS的定位诊断价值分析

Clinical Characteristics of Children with Temporal Lobe Epilepsy and Analysis of the Value of MRS Localization Diagnosis

目的:探讨儿童颞叶癫痫(TLE)的临床特点以及磁共振波谱分析(MRS)对儿童TLE病灶定位的诊断价值。方法:共选择2017年5月~2019年4月40例临床确诊为儿童TLE的临床资料作为研究(实验组),对患儿的病灶及海马组织标本进行病理检查,分析临床病理及发作特点。并选择同期40例健康志愿者作为对照(对照组),两组均行常规磁共振成像(MRI)和MRS,分析实验组患者、对侧及对照组的海马NAA/Cr、NAA/Cho和NAA/(Cho+Cr)比值。结果:病理结果显示,排在前3位的为FCDⅢb、低级别肿瘤、局灶性皮层发育不良。40例儿童TLE临床共发作70次,临床发作症状最多的为意识改变、口部自动症。常规MRI,健康志愿者无异常;儿童TLE双侧海马大小不对称,患侧海马体积缩小、颞角扩大共16例,患侧FLAIR序列海马信号增高共9例。MRS,TLE患侧的NAA/Cr、NAA/Cho、NAA/(Cho+Cr)值明显小于TLE对侧、健康者左侧、健康者右侧,差异有统计学意义(P<0.05);TLE对侧、健康者左侧、健康者右侧两两间比较无明显差异,无统计学意义(P﹥0.05)。结论:儿童TLE的诊断应依据临床发作特点及MRS综合分析,MRS能够无创并定量反映儿童TLE海马生化代谢异常,在TLE的术前定位中具有重要的诊断价值。

Objective:To investigate the clinical features of temporal lobe epilepsy(TLE) in children and the diagnostic value of brain magnetic resonance spectroscopy(MRS) in the localization of TLE lesions in children.Methods:The clinical data of 40 clinically diagnosed children with TLE from May 2017 to April 2019 were selected as the study(experimental group). The clinical and pathological features of the temporal cortex and hippocampus were analyzed. 40 healthy volunteers were selected as the control group(control group). Routine magnetic resonance imaging(MRI) and MRS were performed in both groups. The hippocampus NAA/Cr, NAA/Cho and NAA were analyzed in the experimental group, contralateral and control groups./( Cho + Cr) ratio.Results:Pathological results showed that the top 3 were FCDIIIb, low-grade tumors, and focal cortical dysplasia. Forty children with TLE had a total of 70 clinical episodes, and the most common clinical symptoms were consciousness changes and oral autopsy. Conventional MRI showed no abnormalities in healthy volunteers;the size of hippocampus in children with TLE was asymmetrical, the volume of hippocampus in the affected side was reduced, the angle of the hippocampus was enlarged in 16 cases, and the hippocampal signal in the FLAIR sequence was increased in 9 cases. The values of NAA/Cr, NAA/Cho, and NAA/(Cho+Cr) on the affected side of MRS and TLE were significantly lower than those on the opposite side of TLE, on the left side of healthy subjects, and on the right side of healthy subjects. The difference was statistically significant(P<0.05);TLE There was no significant difference between the contralateral side, the left side of the healthy person and the right side of the healthy person, and there was no statistical significance(P>0.05).Conclusion:The diagnosis of TLE in children should be based on the characteristics of clinical onset and comprehensive analysis of MRS. MRS can non-invasively and quantitatively reflect the abnormal metabolism of TLE hippocampus in children, and has important diagnostic value in preoperative localization of TLE.