扩散峰度成像对特发性全身性癫痫白质改变的研究

Study of white matter changes in idiopathic generalized epilepsy using diffusion kurtosis imaging

目的:探讨扩散峰度成像(DKI)对特发性全身性癫痫(IGE)患者脑白质细微结构的改变特征,并分析其与癫痫患者生活质量评分(QOLIE-31)的相关性。方法:招募20例IGE患者作为IGE组,19名性别、年龄及教育程度与IGE组相匹配的志愿者作为健康对照(HC)组,分别采集其全脑结构像3D T1WI、T2WI FLAIR和DKI数据,计算DKI各参数值:各向异性分数(FA)、平均扩散系数(MD)、轴向扩散系数(AD)、径向扩散系数(RD)、平均扩散峰度(MK)、轴向扩散峰度(AK)、径向扩散峰度(RK)、扩散峰度各向异性(FAK),采用两样本t检验比较组间DKI各参数差异。采用Pearson相关分析对差异有统计学意义的脑白质DKI参数与QOLIE-31评分进行相关性分析。结果:与HC组相比,IGE组左侧下纵束FAK升高(t=-2.31,P=0.032);左侧上辐射冠(t=-2.69,P=0.010)、左侧上额枕束(t=-2.85,P=0.007)、右侧上额枕束(t=-2.77,P=0.008)MD升高;右侧下纵束(t=2.04,P=0.048)、左侧前辐射冠(t=3.01,P=0.004)、左侧上辐射冠(t=2.58,P=0.014)、左侧上额枕束(t=2.29,P=0.027)、穹隆(t=3.39,P=0.001)AK值降低;左侧钩束(t=2.59,P=0.013)RK值降低;右侧上辐射冠(t=2.15,P=0.038)及左侧钩束(t=3.23,P=0.004)MK值降低。余扩散参数差异无统计学意义(P>0.05)。IGE患者穹隆的AK值与QOLIE-31评分呈正相关(r=0.46,P=0.044)。结论:采用DKI技术可以无创定量地发现IGE患者存在多个不对称脑白质纤维束细微结构的改变,有可能提供与癫痫电生理学互补或更丰富的信息。部分脑白质DKI参数与QOLIE-31评分具有相关性,提示脑白质微观结构的损伤对IGE患者的生活质量有一定影响。

Objective:To investigate the characteristics of white matter microstructures in patients with idiopathic generalized epilepsy(IGE)by diffusion kurtosis imaging(DKI),and to analyze its correlation with the score of quality of life(QOLIE-31)in patients with epilepsy.Methods:20 IGE patients were recruited as the IGE group,and 19 volunteers with gender,age and education matching to the IGE group were recruited as the healthy control(HC)group.Data of the whole brain structure such as 3D T1,T2 FLAIR and DKI were collected.And the values of DKI parameters were calculated:fractional anisotropy(FA),mean diffusivity(MD),axial diffusivity(AD),radial diffusivity(RD),mean kurtosis(MK),axial kurtosis(AK),radial kurtosis(RK)and fractional anisotropy of kurtosis(FAK).T-test of two samples was used to compare the differences of DKI parameters between groups.Pearson correlation analysis was used to analyze the correlation between the white matter DKI parameters with statistically significant differences and QOLIE-31 score.Results:Compared with the HC group,FAK of the left lower longitudinal fascicle(t=-2.31,P=0.032)was increased;MD of the left superior radiating crown(t=-2.69,P=0.010),the left superior frontal occipital tract(t=-2.85,P=0.007)and the right superior frontal occipital tract(t=-2.77,P=0.008)increased;AK values of right inferior longitudinal cord(t=2.04,P=0.048),left anterior radiating coronae(t=3.01,P=0.004),left superior radiating coronae(t=2.58,P=0.014),left superior frontal occipital cord(t=2.29,P=0.027)and vault(t=3.39,P=0.001)decreased;RK value of the left uncinus tract(t=2.59,P=0.013)decreased;MK values of the right upper radiating crown(t=2.15,P=0.038)and the left unchula tract(t=3.23,P=0.004)decreased in the IGE group.There was no significant difference in residual diffusion parameters(P>0.05).In IGE patients,the AK value of the dome was positively correlated with the QOLIE-31 score(r=0.46,P=0.044).Conclusion:DKI can be used to quantitatively and noninvasively detect the subtle structural changes in multiple asymmetric white matter fiber bundles in IGE patients,potentially providing complementary or richer information to epilepsy electrophysiology.Some white matter DKI parameters were correlated with QOLIE-31 score,suggesting that the damage of white matter microstructure had a certain influence on the quality of life of IGE patients.