原发性脑肿瘤所致癫痫症的结构与功能MRI分析  

Structural and functional MRI study of secondary seizures from brain tumor

作　　者：翟辉[1] 卢光明[1] 

机构地区：[1]南方医科大学南京临床医学院(南京军区南京总医院)医学影像科,南京医学硕士研究生210002

出　　处：《医学研究生学报》2010年第2期157-160,共4页Journal of Medical Postgraduates

基　　金：国家自然科学基金(30470510);南京军区重点医药卫生项目07Z030)

摘　　要：目的从脑肿瘤所致癫痫的结构与功能学角度分析肿瘤与继发癫痫的关系意义重大。文中对比分析不同部位MRI影像学特征的原发性脑肿瘤与继发性癫痫的关系,讨论肿瘤继发癫痫可能的病理生理机制。方法回顾性分析1502例术前行MRI检查且有术后病理诊断的颅内肿瘤患者的癫痫发生情况。对伴有及不伴有继发癫痫的患者肿瘤的起源部位、肿瘤大小及肿瘤与皮层的关系等进行统计分析,以判断这些因素对继发性癫痫形成的影响;并对5例行同步脑电-功能MRI检查的患者癫痫活动相关的血氧水平激活信号进行检测。结果本组患者癫痫发生率为7.7%,肿瘤较大者(最大径线≥4.32 cm)癫痫发生率为9.3%,较小者(最大径线<4.32 cm)发生率为5.5%;脑内型肿瘤继发癫痫的发生率为13.1%,脑外型发生率为2.2%;肿瘤与皮层关系紧密者(肿瘤与皮层距离≤3.0 cm)的癫痫发生率为11.1%,而关系较远者(肿瘤与皮层距离>3.0 cm)发生率为2.2%;以上指标的差异均有统计学意义(P<0.01)。功能MRI结果提示,肿瘤边缘的形态正常脑组织具有较多的癫痫活动相关信号。结论肿瘤的起源部位、大小及与脑皮层的关系均影响脑肿瘤继发癫痫的发生;癫痫活动的起源可能发生于肿瘤周围受影响的神经组织,支持了"皮层癫痫"理论。Objective The structural and functional MRI approach is of great significance to the study of secondary seizures from brain tumor. This study aimed to analyze the correlation between the incidence of seizures and MRI presentations of brain tumors, and look into the neuro-pathophysiological mechanism of secondary seizures from brain tumor. Methods We retrospectively reviewed the MRI presentations, pathological evidence and incidence of secondary seizures of 1 502 brain tumor patients. Chi-square tests were used to look into the correlation between the incidence of seizures and MRI presentations, including the location and size of the tumor and the distance between the tumor and cortex. Simultaneous electroencephalography and functional MRI were performed for 5 of the patients. Results The incidence of seizures was 7.7% in the patients studied, 9.3% in those with larger tumors （ ≥4.32 cm in diameter）, 5.5% in those with smaller tumors （ 〈 4.32 cm in diameter）, 13.1% in those with intra-cerebra tumors, 2.2% in those with extra-cerebra tumors, 11.1% in those with a shorter distance （ ≤3.0 cm） between the tumor and cortex, and 2.2% in those with a longer distance （ 〉3.0 cm） between the tumor and cortex, all with statistically significant differences （P 〈 0.01 ）. Functional MRI also showed epileptic activation-related BOLD signals in the peri-tumor areas of the brain. Conclusion The incidence of seizures is correlated with the location and size of the tumor and the spatial relationship between the tumor and cortex. The epileptic activity may arise from the peritumor brain tissue, which supports the ＂cortical epilepsy theory＂, and provides imaging evidence for understanding the neuro-pathophysiological mechanism of secondary seizures from brain tumor.

关 键 词：脑肿瘤 癫痫 MRI 

分 类 号：R445.2[医药卫生—影像医学与核医学]