质子磁共振波谱与脑电图在无病灶颞叶癫痫定侧诊断中的价值对照研究  

Comparison of the localization diagnosis between 1H-magnetic resonance spectroscopy and electroencephalogram in temporal lobe epilepsy without lesion

作　　者：宋双双[1] 李伟 张丕宁[1] 牛蕾[1] 马敏阁[1] 隋庆兰[1] Song Shuangshuang;Li Wei;Zhang Pining;Niu Lei;Ma Minge;Sui Qinglan(Department of Radiology, the Affiliated Hospital of Oingdao University, Qingdao 266555, Chin)

机构地区：[1]山东省青岛大学附属医院放射科,266555 [2] 山东省莱阳市中心医院放射科

出　　处：《中华神经科杂志》2017年第12期912-916,共5页Chinese Journal of Neurology

摘　　要：目的 以脑电图定侧诊断结果为参考,探讨质子磁共振波谱（1H-MRS）在无病灶颞叶癫痫定侧诊断中的作用和价值.方法 收集2015年6月至2016年10月就诊于青岛大学附属医院的临床诊断为颞叶癫痫且常规MRI检查阴性的33例患者作为癫痫组、33名健康人作为对照组,进行海马区域1 H-MRS扫描和测量,并以头皮/视频脑电图的定侧结果为标准,评价N-乙酰天冬氨酸（NAA）/肌酸、NAA/（肌酸＋胆碱）在颞叶癫痫定侧诊断中的作用.结果 健康对照组双侧海马区1 H-MRS显示NAA肌酸、胆碱/肌酸及NAA/（肌酸＋胆碱）的差异均无统计学意义,取双侧海马区各检测指标的平均值为正常值.33例癫痫患者1H-MRS显示病侧海马区NAA/肌酸和NAA/（肌酸＋胆碱）值明显降低,对侧海马区NAA/肌酸和NAA/（肌酸＋胆碱）值亦降低.以脑电图定侧为标准,分别以NAA/肌酸和NAA/（肌酸＋胆碱）作为指标进行定侧,发现谱线异常分别为28例和29例,异常率分别为85％和88％;定侧与脑电图一致分别为17例和18例,符合率为52％和55％;定侧相反分别为4例和6例,错误率为12％和18％;无法定侧分别为12例和9例,无法定侧率为36％和27％.二者的定侧结果之间差异无统计学意义.结论 1H-MRS可以为无病灶颢叶癫痫诊断提供更方便、客观的诊断依据,与其他检查联合有利于颞叶癫痫的定侧诊断.NAA/肌酸和NAA/（肌酸＋胆碱）对无病灶颞叶癫痫的定侧诊断效果没有明显差别,均可作为定侧标准.Objective To evaluate the value of localization diagnosis of 1H-magnetic resonance spectroscopy （MRS） in the patients with structural MRI-negative temporal lobe epilepsy （TLE） based on the results of localization diagnosis of electroencephalogram （EEG） in patients with TLE without lesion.Methods Thirty-three patients with MRI-negative TLE and 33 age-and sex-matched healthy control subjects underwent MRS and took the side localized by scalp/video EEG as standard,to evaluate the value of N-acetyl-L-aspartic acid （NAA）/creatine （Cr）,NAA/（Cr ＋ choline （Cho）） in the localization diagnosis of TLE.Results There was no significant difference in NAA/Cr,Cho/Cr and NAA/（Cr ＋ Cho） in bilateral hippocampi of 33 healthy controls,and the mean values of them in bilateral hippocampi were regarded as normal values.The NAA/Cr and NAA/（Cr ＋ Cho） ratios were significantly decreased in both sides of the hippocampi ipsilateral and contralateral to the seizure side.Taking NAA/Cr and NAA/（Cr ＋Cho） as an index to localize respectively and comparing with the localization diagnosis of EEG,spectral anomalies were found in 28 cases and 29 cases respectively,and the abnormal rate reached 85% and 88%.The localization diagnosis of 17 and 18 cases was consistent with the EEG,the rate being 52% and 55% respectively,but 12% （4/33） and 18% （6/33） were opposite.There were 36% （12/33） and 27% （9/33） cases who could not be localized.The localization diagnosis results by NAA/Cr and NAA/（Cr ＋Cho） were not significantly different.Conclusions The existence of mirror-image foci may be the main reason of the failure of localization diagnosis.1H-MRS has higher value for localization of TLE foci,and combining 1H-MRS with other techniques can further improve the accuracy and reliability of localizing the epileptic foci in patients with TLE.Compared with EEG in the diagnosis of TLE,there are no significant differences in the localization diagnosis of TLE by NAA/Cr and NAA/（Cr ＋ Cho）,whic

关 键 词：磁共振波谱学 癫痫 颞叶 脑电图 诊断 

分 类 号：R445.2[医药卫生—影像医学与核医学] R741.044[医药卫生—诊断学] R742.1[医药卫生—临床医学]