癫痫后小脑萎缩模式的磁共振影像学表现  

Magnetic resonance imaging features of cerebellar atrophy pattern after epilepsy

作　　者：冯细梅 王倩 金虹 杨帅 邢妩[1] FENG Ximei;WANG Qian;JIN Hong;YANG Shuai;XING Wu(Department of Radiology,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院放射科,长沙410008

出　　处：《中南大学学报（医学版）》2023年第5期691-697,共7页Journal of Central South University ：Medical Science

基　　金：湖南省自然科学基金(2023JJ30954)。

摘　　要：目的:临床上部分癫痫患者伴有与症状不相符的小脑萎缩,但是癫痫后小脑萎缩的模式及小脑萎缩在癫痫发生机制中的作用尚未阐明。本研究通过分析癫痫后小脑萎缩患者的磁共振图像来探究癫痫后小脑萎缩的特殊模式。方法:选取2017年1月至2022年1月于中南大学湘雅医院就诊并接受颅脑MRI检查的41例癫痫患者作为病例组,所有患者的颅脑MRI检查结果均提示小脑萎缩;另选同期体检者41例作为对照组。收集2组研究对象的一般临床资料及颅脑MRI检查结果。比较2组的齿状核最大面积及信号、桥臂最大宽度、脑桥最大前后径、第四脑室最大横断位面积。将存在差异的指标进一步纳入logistic回归分析以明确癫痫后小脑萎缩患者的特征性影像学改变。结果:与对照组比较,病例组的桥臂最大宽度、脑桥最大前后径明显减小,第四脑室最大横断位面积明显增加(均P<0.05);2组间低、等、高3类齿状核信号分布的差异有统计学意义(χ^(2)=43.114,P<0.001),但齿状核最大面积差异无统计学意义(P>0.05)。桥臂最大宽度[比值比(odds ratio,OR)=3.327,95%CI 1.454~7.615,P=0.004]、第四脑室最大横断位面积(OR=0.987,95%CI 0.979~0.995,P=0.002)为区分癫痫后小脑萎缩与正常对照的独立因素,而脑桥最大前后径不属于区分二者的独立因素(OR=1.456,95%CI 0.906~2.339,P>0.05)。结论:癫痫后小脑萎缩模式在磁共振影像学上表现为桥臂的明显萎缩、第四脑室的明显扩大、齿状核信号的增高而齿状核萎缩不明显。这种特殊的模式可能与癫痫发作及加重的病理过程有关。Objective:Clinically,it has been found that some patients with epilepsy are accompanied by cerebellar atrophy that is inconsistent with symptoms,but the pattern of cerebellar atrophy after epilepsy and the role of cerebellar atrophy in the mechanism of epilepsy have not been elucidated.This study aims to explore the specific pattern of cerebellar atrophy after epilepsy via analyzing magnetic resonance images in patients with postepileptic cerebellar atrophy.Methods:A total of 41 patients with epilepsy,who received the treatment in Xiangya Hospital of Central South University from January 2017 to January 2022 and underwent cranial MRI examination,were selected as the case group.The results of cranial MRI examination of all patients showed cerebellar atrophy.In the same period,41 cases of physical examination were selected as the control group.General clinical data and cranial MRI results of the 2 groups were collected.The maximum area and signal of dentate nucleus,the maximum width of the brachium pontis,the maximum anterior-posterior diameter of the pontine,and the maximum transverse area of the fourth ventricle were compared between the 2 groups.The indexes with difference were further subjected to logistic regression analysis to clarify the characteristic imaging changes in patients with cerebellar atrophy after epilepsy.Results:Compared with the control group,the maximum width of the brachium pontis and the maximum anterior-posterior diameter of the pontine were decreased significantly,the maximum transverse area of the fourth ventricle was increased significantly in the case group(all P<0.05).The difference in distribution of the low,equal,and high signal in dentate nucleus between the 2 groups was statistically significant(χ^(2)=43.114,P<0.001),and the difference in the maximum area of dentate nucleus between the 2 groups was not significant(P>0.05).The maximum width of the brachium pontis[odds ratio(OR)=3.327,95%CI 1.454 to 7.615,P=0.004]and the maximum transverse area of the fourth ventricle(OR=0.987,95%C

关 键 词：癫痫 小脑萎缩 齿状核 桥臂 第四脑室 

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