基于表面形态学分析和基于体素形态学分析在“MRI阴性”儿童及青少年额叶癫痫中的应用

Application of surface-based morphometry and voxel-based morphometry in"MRI negative"frontal lobe epilepsy of children and adolescents

目的应用基于表面形态学分析(surface-based morphometry,SBM)和基于体素形态学分析(voxel-based morphometry,VBM)两种方法对MRI阴性的儿童及青少年额叶癫痫全脑区形态学进行测量,探讨儿童及青少年额叶癫痫患者脑微结构改变的形态学特征,分析脑微结构改变的脑区与病程、智商(intelligence quotient,IQ)之间的相关性。材料与方法纳入在我院神经内科及儿科就诊的儿童及青少年癫痫患者,癫痫患儿的诊断需要满足2017年国际抗癫痫联盟(International League Against Epilepsy,ILAE)制定的诊断标准,根据患儿的病史、脑电图分析及临床症状等挑选出额叶癫痫患者作为病例组。同期招募健康患儿作为对照组。须详细记录研究组和对照组的临床信息。分别对两组被试行MRI检查,获取高分辨率3D-T1WI结构像数据、T2液体衰减反转恢复(T2 fluid attenuated inversion recovery,T2-FLAIR)序列扫描数据等。病例组被试于检查3天内采用中国-韦氏儿童智力量表行智力测试。SBM、VBM分别采用FreeSurfer软件和VBM软件对所有被试进行脑形态学分析,采用SPSS 23.0分析MRI阴性额叶癫痫患儿形态学改变的脑区与病程、IQ之间的相关性,比较FreeSurfer、VBM两种分析软件所得异常脑区的异同。结果两组被试的性别、年龄、受教育年限差异无统计学意义(P>0.05);与对照组相比,SBM分析结果显示病例组存在异常脑区:左侧大脑皮层的额极、额上回、中央后回和右侧大脑皮层梭状回、额中回、额下回以及双侧颞上回表面面积缩小(P<0.05),左侧大脑皮层中央前回、右侧大脑皮层的楔前叶和额叶上、中、下回皮层楔前叶以及双侧颞上回体积减小(P<0.05);VBM分析结果显示病例组的左侧颞下回和右侧屏状核、额中回以及双侧中央后回灰质体积减小(P<0.05),异常脑区与病程、IQ无显著相关性(P<0.05)。结论SBM、VBM分析方法均能发现儿童及青少年额叶癫痫患者脑形态异常的脑区,且SBM较VBM分析提取的异常脑区更多;两种分析方法均有额中回、中央后回的形态学改变;儿童及青少年额叶癫痫患者脑区异常的改变主要累及额叶及周围脑区。

Objective:Surface-based morphometry(SBM)and voxel-based morphometry(VBM)were used to measure the whole brain morphology of frontal lobe epilepsy in children and adolescents with negative MRI.The morphological characteristics of brain microstructure changes in children and adolescents with epilepsy were discussed.The correlation between the brain regions with the change of brain microstructure and the course of disease and intelligence quotient(IQ)was analyzed.Materials and Methods:Children and adolescents with epilepsy were collected from the Department of Neurology and Pediatrics of our hospital.The diagnosis of children with epilepsy should meet the diagnostic criteria established by the International League Against Epilepsy(ILAE)in 2017.Patients with frontal lobe epilepsy were selected as case group according to the medical history,electroencephalogram analysis and clinical symptoms of the children.Healthy children were recruited as control group.Clinical information of the case group and control group should be recorded in detail.Two groups were tested with MRI to obtain high-resolution 3D-T1WI structural image data and T2-fluid attenuated inversion recovery(T2-FLAIR)data.The case group underwent an intelligence test using the China-Wechsler Intelligence Scale for Children within 3 days of examination.SBM and VBM used FreeSurfer software and VBM software.SPSS 23.0 was used to analyze the correlation between brain areas and disease duration and IQ in children with MRI negative frontal lobe epilepsy,and compare the similarities and differences of abnormal brain areas obtained by SBM and VBM.Results:There was no significant difference in gender,age and education between the two groups(P>0.05),compared with the control group,the results of SBM showed abnormal brain areas in the case group:the frontal pole,superior frontal gyrus,posterior central gyrus,middle frontal gyrus,inferior frontal gyrus and bilateral superior temporal gyrus in the left cerebral cortex decreased(P<0.05),the precuneus and precuneus and bilateral superior temporal gyrus in the superior,middle and inferior gyrus of the left and right cerebral cortex decreased reduced(P<0.05);the results of VBM analysis showed reduced gray matter volume in the left inferior temporal gyrus,right screen nucleus and middle frontal gyrus and bilateral posterior central gyrus in children and adolescents with epilepsy(P<0.05),there was no significant correlation between abnormal brain areas and disease course and IQ(P<0.05).Conclusions:SBM and VBM analysis methods can both detect brain regions with abnormal brain morphology in children and adolescents with frontal lobe epilepsy,and SBM can extract more abnormal brain regions than VBM analysis;morphological changes of middle frontal gyrus and posterior central gyrus were observed in both analysis methods;the abnormal changes in the brain regions of children and adolescents with frontal lobe epilepsy mainly involve the frontal lobe and peripheral brain regions.