部分性继发全面性发作癫痫患者的弥散张量成像研究
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摘要
目的：运用DTI成像术定量分析部分性继发全面性发作癫痫患者脑白质的完整性,探讨DTI对于常规MRI未发现病灶的部分性继发全面性发作癫痫患者的病灶检出能力,探讨部分性发作患者出现继发全面性发作的发病机制。
方法：对35例成年部分性继发全面性发作癫痫患者和35例性别、年龄及教育程度匹配的正常健康者,使用Siemens3.0T磁共振成像系统,运用平面回波序列在平行于前后联合线平面扫描得到弥散加权成像,采用基于体素的分析方法(VBA)和感兴趣区法(ROI)对癫痫患者和正常对照组的数据进行分析。
结果：35例癫痫患者和35例性别、年龄和教育程度匹配的正常健康者完成磁共振扫描,排除数据质量问题,进入统计分析部分性继发全面性发作癫痫患者30例(12男/18女),对照组30例(14男/16女)；结果发现：①癫痫组双侧梭状回和楔前叶,右侧额内侧回和钩回,左侧扣带回、颞下回、小脑扁桃体和左侧中央前回的脑区FA值较正常对照组降低,差异有显著性；癫痫组与正常对照组比较无FA值低的脑区。②癫痫组双侧海马旁回、颞下回、胼胝体,右侧额内侧回、额下回、扣带回、前扣带回、舌回、梭状回和枕中回,左侧颞中回、钩回和左侧中央前回的脑区ADC值较正常对照组升高,差异具有显著性；左侧直回的脑区ADC值较正常对照组降低,差异具有显著性；③癫痫患者组左侧中央前回λ1,高于正常对照组,差异具有统计学意义；FA值明显低于正常对照组,差异有统计学意义；癫痫患者组λ2、λ3与正常对照组比较无明显变化。
结论：①DTI技术发现常规MRI检查阴性的部分性继发全面性发作癫痫患者存在广泛的脑白质微结构异常；②FA值和ADC值联合分析对于部分性继发全面性发作癫痫的病灶定位更具价值。
Object Using DTI to quantitatively analyze integrity of White matter in partial seizure with secondary generalized epilepsy,in order to assess DTI's ability of detecting seizure foci which can not be seen in conventional MRI in patients of secondary generalized epilepsy and investigate mechanisms of secondary generalized epilepsy in patients of partial seizures.
Methods 35 adult patients of partial seizures with secondary generalized seizures were compaired with 35 sex-age-edcationalstatus matched healthy controls. Using Siemens3.0T MRI system and Echo Planar Imaging(EPI) obtained diffusion weighted imaging of planes parallelling the anterior commissure and posterior commissure (AC-PC)line,then analyzed the datas from patients and controls on basis of voxel-based analysis (VBA) and region of interest method (ROI).
Results After excluding non-quality datas from 35 cases of patients and 35 cases of controls,datas from 30 patients(12 male and 18 female)and 30 controls(14 male and 16 female)finally entered into statistical analysis.Findings were the following:①Fractional anisotropy (FA) of patients was significantly decreased compared with that controls (P<0.001)in region of bilateral fusiform gyrus and precuneus, right medial frontal gyrus and uncus, left cingulate gyrus, inferior temporal gyrus, cerebellar tonsils,and left Precentral Gyrus.Meanwhile, no region with significantly increased FA value in patients was found.②Apparent diffusion coefficient(ADC)of patients was significantly higher than that of controls in region of bilateral parahippocampal gyrus, inferior temporal gyrus, corpus callosum, the right medial frontal gyrus, inferior frontal gyrus, cingulate gyrus, anterior cingulate gyrus, lingual gyrus, fusiform gyrus and occipital gyrus, left middle temporal gyrus, uncus and left Precentral Gyrus. However,ADC in left gyrus rectus was significantly decreased compared with that controls.③Compared with controls,λ1 in patients was significantly higher in the region of left Precentral Gyrus,whileλ2 andλ3 had no changes, and FA was significantly lower.
Conclusions①Extensive white matter microstructure abnormalities was seen in patients of partial seizures with secondary generalized seizures, which cannot be seen on conventional MRI,but sensitive to DTI,②Combination of FA and ADC could provid more valuable information about the lesion localization in patients of partial seizures with secondary generalized seizures.
方法：对35例成年部分性继发全面性发作癫痫患者和35例性别、年龄及教育程度匹配的正常健康者,使用Siemens3.0T磁共振成像系统,运用平面回波序列在平行于前后联合线平面扫描得到弥散加权成像,采用基于体素的分析方法(VBA)和感兴趣区法(ROI)对癫痫患者和正常对照组的数据进行分析。
结果：35例癫痫患者和35例性别、年龄和教育程度匹配的正常健康者完成磁共振扫描,排除数据质量问题,进入统计分析部分性继发全面性发作癫痫患者30例(12男/18女),对照组30例(14男/16女)；结果发现：①癫痫组双侧梭状回和楔前叶,右侧额内侧回和钩回,左侧扣带回、颞下回、小脑扁桃体和左侧中央前回的脑区FA值较正常对照组降低,差异有显著性；癫痫组与正常对照组比较无FA值低的脑区。②癫痫组双侧海马旁回、颞下回、胼胝体,右侧额内侧回、额下回、扣带回、前扣带回、舌回、梭状回和枕中回,左侧颞中回、钩回和左侧中央前回的脑区ADC值较正常对照组升高,差异具有显著性；左侧直回的脑区ADC值较正常对照组降低,差异具有显著性；③癫痫患者组左侧中央前回λ1,高于正常对照组,差异具有统计学意义；FA值明显低于正常对照组,差异有统计学意义；癫痫患者组λ2、λ3与正常对照组比较无明显变化。
结论：①DTI技术发现常规MRI检查阴性的部分性继发全面性发作癫痫患者存在广泛的脑白质微结构异常；②FA值和ADC值联合分析对于部分性继发全面性发作癫痫的病灶定位更具价值。
Object Using DTI to quantitatively analyze integrity of White matter in partial seizure with secondary generalized epilepsy,in order to assess DTI's ability of detecting seizure foci which can not be seen in conventional MRI in patients of secondary generalized epilepsy and investigate mechanisms of secondary generalized epilepsy in patients of partial seizures.
Methods 35 adult patients of partial seizures with secondary generalized seizures were compaired with 35 sex-age-edcationalstatus matched healthy controls. Using Siemens3.0T MRI system and Echo Planar Imaging(EPI) obtained diffusion weighted imaging of planes parallelling the anterior commissure and posterior commissure (AC-PC)line,then analyzed the datas from patients and controls on basis of voxel-based analysis (VBA) and region of interest method (ROI).
Results After excluding non-quality datas from 35 cases of patients and 35 cases of controls,datas from 30 patients(12 male and 18 female)and 30 controls(14 male and 16 female)finally entered into statistical analysis.Findings were the following:①Fractional anisotropy (FA) of patients was significantly decreased compared with that controls (P<0.001)in region of bilateral fusiform gyrus and precuneus, right medial frontal gyrus and uncus, left cingulate gyrus, inferior temporal gyrus, cerebellar tonsils,and left Precentral Gyrus.Meanwhile, no region with significantly increased FA value in patients was found.②Apparent diffusion coefficient(ADC)of patients was significantly higher than that of controls in region of bilateral parahippocampal gyrus, inferior temporal gyrus, corpus callosum, the right medial frontal gyrus, inferior frontal gyrus, cingulate gyrus, anterior cingulate gyrus, lingual gyrus, fusiform gyrus and occipital gyrus, left middle temporal gyrus, uncus and left Precentral Gyrus. However,ADC in left gyrus rectus was significantly decreased compared with that controls.③Compared with controls,λ1 in patients was significantly higher in the region of left Precentral Gyrus,whileλ2 andλ3 had no changes, and FA was significantly lower.
Conclusions①Extensive white matter microstructure abnormalities was seen in patients of partial seizures with secondary generalized seizures, which cannot be seen on conventional MRI,but sensitive to DTI,②Combination of FA and ADC could provid more valuable information about the lesion localization in patients of partial seizures with secondary generalized seizures.
引文
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