海马硬化型颞叶癫痫患者的脑白质微结构损害与临床相关性的弥散张量成像研究  

Correlation between white matter microstructural lesions by diffusion tensor imaging and clinical profiles in patients with temporal lobe epilepsy and hippocampal sclerosis

作　　者：吴聪[1] 郑金瓯[1] 黄东红[1] 陈子蓉[1] 

机构地区：[1]广西医科大学第一附属医院神经内科,广西南宁530021

出　　处：《实用放射学杂志》2014年第5期725-729,共5页Journal of Practical Radiology

基　　金：国家自然科学基金项目（81360202）;广西自然科学基金项目（2011GXNSFA018263）.

摘　　要：目的：采用磁共振弥散张量成像（diffusion tensor imaging,DTI）方法,研究伴有海马硬化（hippocampal sclerosis,HS）的颞叶癫痫（temporal lobe epilepsy,TLE）患者全脑白质微结构损害的特点,并探索其与患者发病年龄、病程的关系。方法对30例伴有 HS 的 TLE 患者（其中13例为左侧 HS 和17例为右侧 HS）以及23例年龄和性别匹配的正常被试者进行全脑 DTI 扫描,通过基于纤维束的空间统计（track-based spatial statistics,TBSS）方法寻找组间各向异性（fractional anisotropy,FA）值有显著性差异的脑白质区域,并将其作为感兴趣区域（region of interest,ROI）,研究患者发病年龄及病程与 ROI 的 FA 值的相关性。结果与健康对照组相比,左侧 HS 组 FA 值降低的区域主要为双侧放射冠,左侧胼胝体膝部,右侧胼胝体体、胼胝体压部、后丘脑辐射、外囊及上纵束；右侧 HS 组 FA 值降低的区域主要为双侧胼胝体、放射冠、丘脑后辐射、扣带、上纵束,右侧内囊前肢、内囊的晶状体后部、外囊。左侧 HS 组左侧的胼胝体膝部的 FA 值与病程呈负相关,右侧放射冠前部的 FA 值与发病年龄正相关,右侧 HS 组双侧放射冠上部的 FA 值均与病程正相关。结论 DTI 结果提示伴有 HS 的 TLE 患者存在较广泛白质的损害,且不局限于颞叶；左侧 HS 的TLE 患者的发病年龄对放射冠前部的改变存在影响,而脑白质纤维受损的程度与患者的病程没有必然关系。Objective Diffusion tensor imaging（DTI）was used to explore the characteristics of white matter （WM）microstruc-ture lesion in patients with temporal lobe epilepsy（TLE）and hippocampal sclerosis（HS）.Then we investigated the influence of the age of epilepsy onset and the course on WM changes.Methods DTI data were obtained in 30 TLE patients with HS and 23 age and sex-matched healthy controls.Thirteen patients had left HS （LHS）and seventeen had right HS （RHS）.Between-group compari-sons of fractional anisotropy （FA）were carried out by using track-based spatial statistics （TBSS）.In addition,FA in regions of in-terest （ROI）where white matter lesions had statistically significant difference was correlated with the age of onset and the course. Results Subjects in the LHS group,as compared to healthy controls,demonstrated these clusters of reduced FA：bilateral corona radiata,the left genu of corpus callosum,the right body and splenium of corpus callosum,the right posterior thalamic radiation,ex-ternal capsule and superior longitudinal fasciculus.White the subjects in the RHS group,the clusters of reduced FA are involving bi-lateral corpus callosum,corona radiata,posterior thalamic radiation,cingulum,superior longitudinal fasciculus,and the right ante-rior limb of internal capsule,the right retrolenticular part of internal capsule and external capsule.In LHS group,the FA of the left genu of corpus callosum was negatively correlated with the course,and the FA of the right anterior corona radiata was positively cor-related with the age of onset.In RHS group,the FA of the bilateral superior corona radiata was positively correlated with the course.Conclusion DTI detects extensive changes in TLE with HS that are not confined to temporal lobe.The age of epilepsy onset in LHS was correlated with the changes of anterior corona radiata,while the course and the WM change were not definitely linked to each other.

关 键 词：海马硬化 颞叶癫痫 弥散张量成像 基于纤维束的空间统计 

分 类 号：R742[医药卫生—神经病学与精神病学] R749.17[医药卫生—临床医学]