高分辨率MRI对常规MR阴性内侧颞叶癫痫患者致痫灶定位的价值研究

Value Study of High-resolution MRI in Localization of Epileptic Foci in Patients with Routine MR Negative Temporal Lobe Epilepsy

目的探讨高分辨率磁共振斜冠状位T2加权成像在常规MR阴性内侧颞叶癫痫(Temporal Lobe Epilepsy,TLE)患者致痫灶定位中的临床价值。方法选取自2017年2月至2020年7月就诊于本院癫痫中心且经病理证实的常规MR阴性内侧TLE患者8例和内侧TLE伴海马硬化(Hippocampal Sclerosis,HS)患者12例,以及25例正常人作为对照组。采用Siemens 3.0 T Skyra MR对所有被试者分别行常规MRI及高分辨率斜冠状位T2WI检查,比较两种检查技术对癫痫致痫灶检出的敏感性、特异性及准确性。结果12例内侧TLE伴HS患者常规MRI和HR-MRI检查均能发现海马内部结构(Hippocampal Internal Architecture,HIA)改变,常规MRI及高分辨率斜冠状位T2WI具有相同诊断效能,ROC得出敏感性、特异性、准确性及AUC值均分别为100%、96.0%、97.3%、0.980;而8例常规MR阴性内侧TLE患者中的轻度HS仅可在HR-MRI检查中发现HIA变化,常规MRI检查敏感性、特异性、准确性及AUC值分别为0、96%、72.7%、0.480;HR-MRI检查敏感性、特异性、准确性及AUC值分别为87.5%、96%、93.9%、0.918。结论对于存在轻度HS的MR阴性内侧TLE患者而言,HR-MRI斜冠状位T2加权成像能发现在常规MRI检查中无法显示的HIA的变化,可以对定位术前致痫灶提供参考依据,具有一定临床价值。

Objective To investigate the clinical value of high-resolution oblique coronal MRI T2WI in the localization of epileptic foci in patients with routine MR negative temporal lobe epilepsy(TLE).Methods A total of 12 patients with mesial TLE with hippocampus sclerosis(MTLE+HS),8 patients with conventional MR negative TLE and 25 normal persons were enrolled in the study from February 2017 to July 2020.Siemens 3.0 T Skyra MR was used to examine all subjects with conventional MRI and high-resolution oblique coronal T2WI,respectively.The sensitivity,specificity and accuracy of conventional MRI and high-resolution oblique coronal T2WI in detecting epileptic foci were calculated to evaluate the value for localizing epileptic foci of TLE.Results In 12 MTLE+HS patients,both routine MRI and HR-MRI examination could detect the changes in hippocampal internal architecture,and both had the same diagnostic efficacy.The sensitivity,specificity,accuracy and AUC of ROC values were 100%,96.0%,97.3%,and 0.980,respectively.In 8 patients with MR negative mesial TLE,HR-MRI T2WI could detect changes in the internal structure of the hippocampus.The sensitivity,specificity,accuracy and AUC values of conventional MRI were 0,96%,72.7%and 0.480,respectively.The sensitivity,specificity,accuracy and AUC of HR-MRI T2WI were 87.5%,96%,93.9%and 0.918,respectively.Conclusion HR-MRI oblique coronal T2WI can detect the changes in the internal structure of the hippocampus in patients with MR-negative mesial TLE,that cannot be shown in conventional MRI examination,and it is useful for localizing epileptogenic zone of MR-negative mesial TLE and has certain clinical value.