颞叶内侧癫痫患者杏仁核体积变化的临床研究

A clinical study of amygdala volume changes in medial temporal lobe epilepsy patients

目的通过应用T1三维磁化强度预备梯度回波(T1 three dimensional magnetization prepared rapid acquisition gradient echo,3D-T1 MPRAGE)序列及FreeSufer软件测量海马及杏仁核体积,研究颞叶内侧癫痫(medial temporal lobe epilepsy,MTLE)患者的杏仁核体积变化。材料与方法前瞻性纳入102例MTLE患者(病例组)和15例健康志愿者(对照组),分别测量双侧海马、杏仁核的体积,以对照组体积的平均值加减2倍标准差作为阈值来判断海马及杏仁核的异常。根据海马体积是否正常,将海马硬化(hippocampal sclerosis,HS)组、海马正常组中杏仁核肥大(amygdala enlargement,AE)患者按致癫侧分为L组、R组,使用配对t检验进行双侧杏仁核体积比较,并使用单因素方差分析将海马正常组-L组、海马正常组-R组及对照组同侧杏仁核进行比较;HS组-L组、HS组-R组及对照组同侧杏仁核进行比较。结果研究发现,海马正常组-L组、海马正常组-R组双侧杏仁核体积差异有统计学意义(P<0.05),HS组-L组、HS组-R组双侧杏仁核体积差异有统计学意义(P<0.05);HS组-L组中右侧杏仁核体积大于HS组-R组及对照组同侧,差异有统计学意义(P<0.05),HS组-R组左侧杏仁核体积大于HS组-L组及对照组同侧,差异有统计学意义(P<0.05);海马正常组-L组中左侧杏仁核体积大于海马正常组-R组及对照组同侧,差异有统计学意义(P<0.05),海马正常组-R组右侧杏仁核体积大于海马正常组-L组及对照组同侧,差异有统计学意义(P<0.05)。结论3D-T1 MPRAGE可以准确测量杏仁核体积,同时MTLE中海马正常患者存在致癫灶同侧的AE,HS患者存在致癫灶对侧AE,表明杏仁核可能参与了MTLE的发生与发展。

Objective:The changes of hippocampus and amygdala volume in patients with medial temporal lobe epilepsy were studied by using T1three dimensional magnetization prepared rapid acquisition gradient echo(3D-T1 MPRAGE)sequence and Free Sufer software to measure the volume of hippocampus and amygdala.Materials and Methods:A total of 102 patients with medial temporal lobe epilepsy(case group)and 15 healthy volunteers(control group)were collected to measure the volume of bilateral hippocampus and amygdala respectively,and the abnormality was judged by taking the mean value of the control group plus or minus 2 times the standard deviation as the normal limit.According to whether the hippocampal volume is normal or not,the patients with amygdala enlargement(AE)in the hippocampal sclerosis(HS)group and the normal hippocampal group were divided into L group and R group according to the epilepsy side.Paired t-test was used to compare bilateral amygdala volumes.One-way ANOVA was used to compare the ipsilateral amygdala of the normal hippocampus-L group,the normal hippocampal-R group and the normal control group;the ipsilateral amygdala of the HS-L group,the HS-R group and the normal control group was compared.Results:The study found that there was a statistically significant difference in the volume of bilateral amygdala between normal hippocampal-L group and normal hippocampal-R group(P<0.05).There was a statistically significant difference in the volume of bilateral amygdala between HS-L group and HS-R group(P<0.05).The volume of the right amygdala in the HS-L group was larger than that of the HS-R group and the same side of the control group(P<0.05).The volume of the left amygdala in the HS-R group was greater than that in the HS-L group and the same side of the control group(P<0.05).The volume of the left amygdala in the normal hippocampus-L group was larger than that in the normal hippocampus-R group and the ipsilateral side of the control group(P<0.05).The volume of the right amygdala in the normal hippocampus-R group was larger than that in the normal hippocampus-L group and control group on the same side(P<0.05).Conclusions:3D-T1 MPRAGE can accurately measure the volume of the amygdala.Meanwhile,patients with normal hippocampus in mesial temporal lobe epilepsy have amygdala enlargement on the same side of the epileptogenic foci,and HS patients have amygdala enlargement on the opposite side of the epileptic foci,indicating that the amygdala may be involved in the occurrence and development of mesial temporal lobe epilepsy.