EEG-fMRI在局灶性癫痫致痫灶定位中的诊断价值

Diagnostic value of EEG-fMRI in localization of epileptogenic foci in focal epilepsy

目的探讨脑电图-功能磁共振成像(EEG-fMRI)在局灶性癫痫致痫灶定位诊断中的应用价值。方法选取2017年10月至2018年12月于本院接受治疗的头MRl结构影像阴性的局灶性癫痫患者90例为研究对象,所有患者均行头部静息态功能磁共振(RS-fMRI)及3.0T EEG-fMRI检查,3.0T EEG-fMRI检查以电脑图中癫痫样放电为事件,经过分析得出与放电相关的血氧水平依赖信号反应区。对所有患者血氧水平依赖信号激活反应区与电-临床症状定位的关系进行分析,以电-临床症状定位为指标,判断吻合程度。结果EEG-fMRI诊断颞叶癫痫51例,额叶癫痫24例,额颞叶癫痫15例,且所有患者血氧水平依赖信号均改变;RS-fMRI诊断显示56例患者血氧水平依赖信号改变,基本吻合电-临床症状学定位;EEG-fMRI诊断显示69例基本吻合电-临床症状学定位,21例为主要部分吻合;EEG-fMRI诊断符合率(100%)及血氧水平依赖信号检出率(100.00%)均高于RS-fMRI(71.11%、62.22%),差异具有统计学意义(P<0.05)。结论EEG-fMRI及血氧水平依赖信号反应区可为局灶性癫痫致痫区的非侵入性定位提供有利帮助,且能在癫痫灶术前评估时提供有利的额外信息,定位价值较高。

Objective To investigate the value of electroencephalography-functional magnetic resonance imaging(EEG-fMRI)in the diagnosis of focal epileptic foci.Methods 90 patients with focal epilepsy with negative head MRL structural images treated in our hospital from October 2017 to December 2018 were selected as the study subjects.All patients underwent head resting-state functional magnetic resonance imaging(RS-fMRI)and 3.0 T EEG-fMRI was performed with epilepsy-like discharge in the computer map as an event.After analysis,the blood oxygen level dependent signal response region associated with the discharge was obtained.For all patients,the relationship between the oxygen level-dependent signal activation response area and the electro-clinical symptom localization was analyzed,and the electrical-clinical symptom localization was used as the index to judge the degree of anastomosis respectively.Results The diagnosis of EEG-fMRI included 51 cases of temporal lobe epilepsy,24 cases of frontal lobe epilepsy,15 cases of frontotemporal lobeepilepsy,and all patients had changes in blood oxygen level-dependent signal.RS-fMRI showed 56 cases had changes in blood oxygen level-dependent signal,with basic anastomosis-clinical symptomatic localization.EEG-fMRI showed 69 cases of basic anastomosis-clinical symptomatic localization,21 cases were the main part of the anastomosis.The coincidence rate of EEG-fMRI(100%)and the detection rate of blood oxygen level(100.00%)were higher than that of RS-fMRI(71.11%,62.22%),the difference was statistically significant(P<0.05).Conclusion The EEG-fMRI and the blood oxygen level dependent signal reaction zone can be helpful to the non-invasive location of the focal epilepsy area,and can provide favorable additional information in the pre-operation assessment of the epileptic focus,which the location value is high.