基于杏仁核和海马体积测定的颞叶内侧癫痫亚组分析  

Subgroup analysis of medial temporal lobe epilepsy based on amygdala and hippocampus volume measurement

作　　者：刘琦[1] 张一玮 郭金竹[1] 郭毅[1] 窦万臣[1] 金丽日[3] 周祥琴[3] 冯逢[2] Liu Qi;Zhang Yiwei;Guo Jinzhu;Guo Yi;Dou Wanchen;Jin Liri;Zhou Xiangqin;Feng Fen(Department of Neurosurgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Radiology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Neurology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医院神经外科,北京100730 [2]中国医学科学院北京协和医院放射科,北京100730 [3]中国医学科学院北京协和医院神经内科,北京100730

出　　处：《中华神经外科杂志》2023年第2期156-161,共6页Chinese Journal of Neurosurgery

基　　金：中国医学科学院医学与健康科技创新工程项目(2020-I2M-C&T-B-018)。

摘　　要：目的基于影像自动分割技术测定的杏仁核和海马体积分组,探讨单纯杏仁核增大的颞叶内侧癫痫(mTLE)亚组患者的临床特点及疗效。方法收集2015年1月至2019年12月中国医学科学院北京协和医院神经外科诊治的定侧明确的107例难治性mTLE患者的资料,以及同期进行体格检查的195名健康志愿者的资料,进行回顾性分析。使用AccuBrain®精准脑影像定量分析系统自动测量头颅MRI图像上双侧杏仁核和海马的体积及其在颅腔内的占比,以杏仁核体积在颅腔中的占比大于健康人同侧占比的均值+2倍标准差作为杏仁核增大的标准。将杏仁核增大而不伴海马萎缩的患者定义为单纯杏仁核增大组,其他患者作为对照组。比较两组患者的临床特征及疗效。采用国际抗癫痫联盟(ILAE)分级评估手术疗效。结果195名健康成人的左、右侧杏仁核体积的颅腔占比分别为(0.12±0.01)%、(0.13±0.01)%。107例mTLE患者的致痫侧、非致痫侧杏仁核体积的颅腔占比均为(0.13±0.02)%。9例患者单纯杏仁核增大,均为致痫侧;发作过程均伴有意识障碍。107例难治性mTLE患者的中位随访时间为26个月(12~84个月)。至末次随访,ILAE 1级70例(65.4%),2级6例(5.6%),3级8例(7.5%),4级17例(15.9%),5级6例(5.6%);其中,单纯杏仁核增大组ILAE 1级8例,4级1例。单纯杏仁核增大组与对照组比较,患者的年龄、性别、既往热惊厥病史、外伤史、异常出生史、术前病程、临床表现、手术方式、随访时间、末次随访时ILAE分级的差异均无统计学意义(均P>0.05)。结论初步观察发现,药物难治性mTLE患者中,存在单纯杏仁核增大的患者,发作均伴有意识障碍,手术治疗效果良好;但尚未观察到与其他mTLE患者临床特征和疗效的差异。Objective To investigate the clinical characteristics and treatment efficacy of medial temporal lobe epilepsy(mTLE)subgroup patients with simple amygdala enlargement.The grouping method is based on the volume of amygdala and hippocampus measured by automatic image segmentation technique.Methods The data of 107 patients with refractory mTLE diagnosed and treated at the Neurosurgery Department of Peking Union Medical College Hospital,Chinese Academy of Medical Sciences from January 2015 to December 2019 were collected,and the data of 195 healthy volunteers who underwent physical examination during the same time period were also collected.A retrospective statistical analysis was performed on those data.Using AccuBrain®the cloud software the volumes of bilateral amygdala and hippocampus and their proportion in the cranial cavity on the head MRI image were automatically measured.The cranial cavity proportion of the amygdala volume greater than the mean value+2 times the standard deviation of the ipsilateral proportion of normal people was determined as the standard of amygdala enlargement.The patients with amygdala enlargement without hippocampal atrophy were defined as simple amygdala enlargement group,otherwise they were in control group.The clinical characteristics and therapeutic effects of the two groups were compared.Evaluation of surgical effect was based on the International League Against Epilepsy(ILAE)system.Results The proportions of left and right amygdala volumes in the cranial cavities of 195 healthy adults were(0.12±0.01)%and(0.13±0.01)%respectively.The proportion of cranial cavity volume of amygdala in epileptic side and non-epileptic side of 107 patients with mTLE were both(0.13±0.02)%.The amygdala of 9 patients showed simple enlargement,which was on the epileptic side.The seizure process was accompanied by disturbance of consciousness.The median follow-up time of 107 patients with refractory mTLE was 26 months(12-84 months).At the end of follow-up,there were 70 cases(65.4%)of ILAE grade 1,6 cases

关 键 词：癫痫 颞叶 杏仁核 磁共振成像 自动分割 

分 类 号：R742.1[医药卫生—神经病学与精神病学]