静息态功能磁共振在局灶性皮质发育不良癫痫患者中定位致痫区的价值  

The value of resting-state fMRI local indices in localization of epileptogenic zone for epilepsy patients with focal cortical dysplasia

作　　者：杨博文 赵宝田[1] 莫嘉杰 桑林[2] 胡文瀚[1,3] 张弨 王秀[1] 张建国[1,3] 张凯[1,3] Yang Bowen;Zhao Baotian;Mo Jiajie(Department of Neurosurgery,Capital Medical University Affiliated Beijing Tiantan Hospital)

机构地区：[1]首都医科大学附属北京天坛医院神经外科,北京100070 [2]北京丰台医院神经外科 [3]北京市神经外科研究所功能神经外科研究室

出　　处：《立体定向和功能性神经外科杂志》2021年第3期129-134,共6页Chinese Journal of Stereotactic and Functional Neurosurgery

基　　金：国家重点研发计划资助项目(编号:2018YFC00115401);国家自然科学基金项目(编号:82071457)。

摘　　要：目的基于局部一致性(regional homogeneity,ReHo)、低频振幅(amplitude of low frequency fluctuation,ALFF)和部分性低频振幅(fractional ALFF)三项指标,探究静息态功能磁共振成像(resting-state function MRI,rs-fMRI)在局灶性皮质发育不良继发癫痫患者中定位致痫区(epileptogenic zone,EZ)的能力。方法纳入50例患者和48例健康对照。通过t检验得到患者和对照组之间ReHo、ALFF和fALFF的差异(FDR矫正),将显著脑区作为fMRI定位的致痫区。由两名癫痫专科医师将上述结果与术前评估认定的EZ进行对比,最终得出三种指标定位的敏感度、特异度和准确度,以此评价其定位能力。结果ReHo的定位灵敏度(72%)显著高于ALFF(50%,P=0.019)和fALFF(44%,P=0.004)。ReHo、ALFF和fALFF的定位准确度分别为76.5%,67.3%和63.3%,其中ReHo显著高于fALFF(P=0.043)。ReHo、ALFF和fALFF的定位特异度分别为81.3%,85.4%和83.3%,三者间没有显著差异。此外通过ReHo定位致痫区准确的患者具有更好的手术预后(P<0.001)。结论Rs-fMRI具有辅助定位局灶性皮质发育不良癫痫患者致痫区的能力。未来的术前评估中,该项后处理技术有望成为辅助定位致痫区的有效方法。Objective The aim was to investigate the value of resting-state functional magnetic resonance imaging(rs-fMRI)in detecting epileptogenic zones(EZs)for drug-resistant patients with focal cortical dysplasia,based on the local approaches including regional homogeneity(ReHo),amplitude of low-frequency fluctuations(ALFF),and fractional ALFF(fALFF).Methods The difference of ReHo,ALFF and fALFF between the patient and the control group was calculated,and the significant brain area was defined as the epileptic foci.The focus were then compared with the EZ identified in the pre-operative evaluation.Finally,the sensitivity,specificity and accuracy of the three indices are obtained to evaluate the fMRI localization abilities.Results A total of 50 consecutive patients with focal epilepsy and 48 healthy controls were enrolled.In terms of localizing EZ,RS-fMRI showed significantly higher sensitivity of ReHo(72%)than ALFF(50%,P=0.019)and fALFF(44%,P=0.004).The accuracies of ReHo,ALFF and fALFF were 76.5%,67.3%and 63.3%,respectively,where the ReHo was significantly higher than fALFF(P=0.043).The specificity of ReHo,ALFF,and fALFF were 81.3%,85.4%,and 83.3%,respectively,without significant differences between them.In addition,patients with correct localization of ReHo have a better prognosis(P<0.001).Conclusion RS-fMRI exhibit the ability for detecting EZs in focal epilepsy patients.Furthermore,the method has the potential to assist in EZ delineation in presurgical evaluation.

关 键 词：局灶性皮质发育不良 术前评估 致痫区 功能磁共振 

分 类 号：R742.1[医药卫生—神经病学与精神病学]