磁共振形态学测量分析方法在局灶性皮质发育不良中的应用
Morphological analysis of brain MRI and its application in focal cortical dysplasia
目的 探讨MRI形态学测量分析方法(MAP)在局灶性皮质发育不良(FCD)所致难治性癫痫术前定位诊断中的应用价值.方法 回顾性纳入2014年1月至2016年1月清华大学玉泉医院癫痫中心行致痫灶切除术后病理证实为局灶性FCD Ⅰ型和Ⅱ型的53例患者.应用MAP对术前高分辨率MRI进行后处理,得到灰白质交界成像的阳性结果(MAP+区域),对MAP+区域和手术切除部位的一致性与手术预后进行统计学分析.结果 53例患者中,MAP+区域被切除的患者术后癫痫无发作率(67.9%,36/53)高于MAP+区域未被切除的患者(7.5%,4/53) (P =0.002).MRI病灶阴性组中,MAP+区域被切除患者的术后癫痫无发作率(62.5%,20/32)高于MAP+区域未被切除的患者(9.4%,3/32)(P=0.006).在MRI病灶阳性组中未发现MAP+区域切除与预后相关(P =0.352).结论MAP的灰白质交界成像结果能提高FCD病灶的检出率,对于致痫灶的术前定位诊断、指导手术切除和立体定向脑电图的方案设计具有临床意义.
更多Objective To investigate the clinical value of MRI morphological analysis in identification of focal cortical dysplasia (FCD) in presurgical evaluation of epileptogenic zone (EZ).Methods We retrospectively analyzed the clinical data of 53 patients who were admitted to Epilepsy Center,Tsinghua University Yuquan Hospital and underwent surgical removal of epileptic foci and were pathologically confirmed as FCD Ⅰ or FCD Ⅱ.Morphometric analysis programme was used to post-process presurgical high-resolution MRI to obtain the gray-white matter junction imaging (MAP+ region) and statistical analysis was used to determine the consistency of the MAP + region and surgical site and postoperative epilepsy control.Results In this series,the probability of postoperative seizure-free (67.9%,36/53) was higher in patients whose MAP* regions were resected than that (7.5%,4/53) in patients whose MAP+ regions were not resected (P=0.002).In the MRl-negative group,the probability of postoperative seizure-free (62.5%,20/32) was higher in patients whose MAP+ regions were resected than that (9.4%,3/32) in patients whose MAP+ regions were not resected (P =0.006).In the MRI positive group,MAP+ regional resection was not associated with the clinical outcome (P =0.352).Conclusions The gray-white matter junction imaging could improve the detection rate of FCD lesions,which might have clinical value in localization of EZ and resection of EZ and making electrode plan of stereotactic electroencephalogram (SEEG).
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