MR FLAIR与1H-MRS对颞叶癫痫致痫灶定侧的价值

Value of MR FLAIR and 1H-MRS for the Localization of Epileptogenic Foci in Temporal Lobe Epilepsy

目的采用MR FLAIR序列及1H-MRS对颞叶癫痫(Temporal Lobe Epilepsy,TLE)患者的致痫灶进行定侧,探讨两种方法在TLE致痫灶定侧中的应用价值。方法采用西门子Trio 3.0T MRI对20例单侧颞叶癫痫患者及19例正常人进行MR平扫及1H-MRS扫描,扫描结束后分析斜轴与斜冠状位FLAIR扫描所得到的双侧海马,并进行致痫灶定侧。对1H-MRS数据处理后测量Glu/Cr比值,并对致痫灶进行定侧定位。将两种方法的诊断结果与术后病理对照,评价其定侧定位诊断的价值。结果20例TLE患者术后病理显示均为海马硬化,FLAIR序列定侧诊断的灵敏度、特异度、准确度分别为85%、94.7%、89.7%。当Glu/Cr临界值为2.12时,其定侧诊断的灵敏度、特异度、准确度分别为75%、94.7%、84.6%。两者联合的定侧诊断的灵敏度、特异度、准确度分别为95%、94.7%、94.87%。ROC曲线下面积分别为0.899、0.871及0.949。结论FLAIR序列与1H-MRS对TLE患者致痫灶定侧中有较高诊断价值,两者联合应用可进一步提高其定侧诊断效能。

Objective To investigate the application value of FLAIR and 1H-MRS for localizing epileptogenic zone of temporal lobe epilepsy.Methods A total of 20 patients with temporal lobe epilepsy and 19 normal controls were scanned by Siemens Trio 3.0 T MRI.After the scanning,the bilateral hippocampus oblique axial and oblique coronal FLAIR images were analyzed in order to localize epileptogenic zone of temporal lobe epilepsy,the ratio of Glu/Cr in 1H-MRS was measured to localize epileptogenic zone of temporal lobe epilepsy.The diagnostic results of the two methods were compared with postoperative pathology to evaluate the value for localizing epileptogenic zone of temporal lobe epilepsy.Results The pathological findings of 20 patients with temporal lobe epilepsy were hippocampal sclerosis.The sensitivity,specificity and accuracy of FLAIR were 85%,94.7%and 89.7%respectively.When the critical value of Glu/Cr was 2.12,the sensitivity,specificity and accuracy were 75%,94.7%and 84.6%respectively.The sensitivity,specificity and accuracy of combined FLAIR and MRS were 95%,94.7%and 94.87%respectively.The area under ROC curve was 0.899,0.871 and 0.949 respectively.Conclusion FLAIR and MRS were of good diagnostic value for localizing epileptogenic zone of temporal lobe epilepsy,and combined the FLAIR and MRS can improve the diagnostic efficiency.