弥散成像技术对氨己烯酸相关头颅MRI异常检测的优势

The advantage of diffusion weighted imagin technique in the toxicity detection of vigabatrin

目的 探讨不同核磁序列对氨己烯酸引起相关头颅MRI异常(Vigabatrin-associated brain abnormalities on MRI,VABAM)的检出差异,从而进一步指导临床对VABAM的认识,完善适宜影像检查序列。方法 回顾性纳入2020年1月—2023年1月在清华大学玉泉医院癫痫中心门诊或住院诊治的婴儿痉挛及癫痫性痉挛患者353例。其中行头颅MRI检查,包括3D薄扫T1、T2、T2-液体衰减反转恢复序列(FLAIR)像,以及DWI、ADC序列患儿131例,其中服用氨己烯酸患者65例。评估不同影像序列检查对氨己烯酸继发核磁异常的检出情况。结果 在这65例患者中,检出VABAM23例,检出率为35.4%。平均应用氨己烯酸剂量(100.73±35.54)mg/(kg·d)。VABAM阳性检出率为:DWI序列95.7%,ADC序列26.1%,FLAIR序列21.3%,T2序列4.3%,T1序列0。DWI组检出率同其他序列均存在显著性差异,ADC序列同DWI序列及T1序列的检出率存在显著差异,同T2序列、FLAIR序列不存在差异。结论 DWI序列对于VABAM的检出率具有不可替代的优势,因此我们对于服用氨己烯酸的婴儿痉挛及癫痫性痉挛发作的患者,尽量完善DWI序列核磁扫描,提高VABAM阳性检出率,避免出现临床症状及进一步脑损伤。

Objective To explore the differences in the detection of vigabatrin-associated brain abnormalities on MRI by different MRI sequences,so as to further guide the clinical understanding of VABAM and improve the appropriate imaging sequences.Methods A total of 353 patients with infantile spasm or epileptic spasm who were admitted to the Epilepsy Center of Yuquan Hospital of Tsinghua University from January 2020 to January 2023 were retrospectively included.MRI was performed in 131 cases,including 3D T1,T2,T1-fluid-attenuated inversion recovery sequence(FLAIR)images,DWI and ADC sequences,of which 65 cases taking VGB.We aim to evaluate the detection of vigabatrin-associated brain abnormalities on MRI by different MRI sequences in these children.Results Among the 65 patients,VABAM was detected in 23 cases,the detection rate was 35.4%.The average dosage of vigabatrin was 100.73±35.54 mg/(kg·d).The positive detection rates of VABAM were 95.7%in DWI sequence,26.1%in ADC sequence,21.3%in FLAIR sequence,4.3%in T2 sequence and 0 in T1 sequence.The detection rate of ADC sequence was significantly different from DWI sequence and T1 sequence,but not from T2 sequence and FLAIR group.Conclusion DWI sequence has irreplaceable advantages in the detection rate of VABAM.Therefore,for patients with infantile spasm and epileptic spasm who take vigabatrin,we should try our best to add DWI sequence scanning to improve the positive detection rate and avoid clinical symptoms,so as to avoid further brain damage.