沿血管周围间隙扩散张量成像指标分析内侧颞叶癫痫类淋巴系统的功能异常  

Analyzing the dysfunction of the mesial temporal lobe epilepsy glymphatic system based on diffusion tensor imaging analysis along the perivascular space index

作　　者：王昭杰 许强 李玉卓 李建瑞 陈译文 杨昉 沈晨曦 纪祥军 杨刚 卢光明 张志强 Wang Zhaojie;Xu Qiang;Li Yuzhuo;Li Jianrui;Chen Yiwen;Yang Fang;Shen Chenxi;Ji Xiangjun;Yang Gang;Lu Guangming;Zhang Zhiqiang(Department of Diagnostic Radiology,Jinling Hospital,Affiliated Hospital of Medical School,Nanjing University,Nanjing 210002,China;Department of Neurology,Jinling Hospital,Affiliated Hospital of Medical School,Nanjing University,Nanjing 210002,China;Department of Neurosurgery,Jinling Hospital,Affiliated Hospital of Medical School,Nanjing University,Nanjing 210002,China)

机构地区：[1]南京大学医学院附属金陵医院放射诊断科,南京210002 [2]南京大学医学院附属金陵医院神经内科,南京210002 [3]南京大学医学院附属金陵医院神经外科,南京210002

出　　处：《中华放射学杂志》2025年第2期168-176,共9页Chinese Journal of Radiology

基　　金：国家自然科学基金(82371951);国家科技创新2030—“脑科学与类脑研究”(2022ZD0211800);国家重点研发计划(2018YFA0701703)。

摘　　要：目的:采用沿血管周围间隙扩散张量成像分析(DTI-ALPS)探讨内侧颞叶癫痫伴海马硬化(mTLE-HS)患者与健康人间、不同发作类型间的脑内类淋巴系统(GS)功能差异,并分析患者GS功能与病程的相关性及预测手术疗效的效能。方法:该研究为横断面研究。回顾性连续纳入2009年7月至2021年7月于南京大学医学院附属金陵医院就诊的171例mTLE-HS患者(mTLE-HS组)及75名健康志愿者(对照组)。分析所有受试者的一般资料,如发作类型(部分性发作、继发全面性发作)、预后等,并采集三维磁化准备快速梯度回波序列T_(1)WI及DTI图像。使用VBM分析方法对脑脊液进行分割并进行体积计算,使用基于Atlas的DTI-ALPS方法进行双侧大脑ALPS指数计算。采用独立样本t检验或配对t检验比较mTLE-HS组与对照组、不同发作类型患者间ALPS指数的差异,采用Pearson相关分析mTLE-HS组双侧ALPS指数与病程的相关性;采用受试者操作特征曲线和曲线下面积评估ALPS指数对手术疗效的预测价值。结果:171例mTLE-HS患者中mTLE伴左侧HS 98例,mTLE伴右侧HS 73例;37例接受手术治疗,其中预后好27例、预后差10例。mTLE伴左侧HS、mTLE伴右侧HS的左侧ALPS指数较对照组左侧ALPS指数降低(P<0.05);mTLE伴右侧HS的右侧ALPS指数较对照组的右侧ALPS指数降低(P<0.001),mTLE伴左侧HS与对照组的右侧ALPS指数差异无统计学意义(P=0.080)。继发全面性发作患者患侧ALPS指数均显著低于部分性发作患者患侧ALPS指数(P<0.05),而继发全面性发作患者与部分性发作患者的健侧ALPS指数差异均无统计学意义(P>0.05)。mTLE伴左侧HS的左侧ALPS指数、右侧ALPS指数与病程均呈负相关(r=-0.272,P=0.007;r=-0.307,P=0.002),但mTLE伴右侧HS的左侧ALPS指数、右侧ALPS指数与病程无相关性(P>0.05)。mTLE-HS患侧DTI-ALPS指数对手术疗效具有较好的分类诊断效能,曲线下面积为0.778。结论:mTLE-HS患者存在脑内GS功能障�Objective To investigate the differences of the glymphatic system(GS)function between patients with mesial temporal lobe epilepsy with hippocampal sclerosis(mTLE-HS)and healthy controls and between different seizure types by using diffusion tensor imaging along perivascular space(DTI-ALPS),and to analyze the correlation between GS function and the course of disease,as well as the efficacy of predicting the surgical outcome.Methods This study was a cross-sectional study.A total of 171 patients with mTLE-HS(mTLE-HS group)and 75 healthy volunteers(HC group)were retrospectively enrolled from July 2009 to July 2021 at Jinling Hospital,Affiliated Hospital of Medical School,Nanjing University.The general information of all subjects,such as seizure type(partial seizure,secondary generalized seizure),surgical outcome,etc.,was analyzed.The 3D magnetization prepared rapid gradient echo T_(1)WI and DTI sequence images were collected.The VBM analysis method was used to segment cerebrospinal fluid and calculate the volume.The ALPS index of the bilateral brain was calculated using the Atlas-based DTI-ALPS method.Independent sample t-test or paired t test were used to compare the ALPS index between the mTLE-HS group and HC group,and between patients with different seizure types.Pearson correlation analysis was used to analyze the correlation between bilateral ALPS index and disease duration in mTLE-HS group.The predictive value of the ALPS index for surgical outcomes was evaluated by receiver operating characteristics curve and area under the curve.Results Among the 171 mTLE-HS patients,98 patients were mTLE with left-side HS(mTLE-LHS)and 73 patients were mTLE with right-side HS(mTLE-RHS);37 patients underwent surgical treatment,including 27 with good prognosis and 10 with poor prognosis.Compared with the HC group,the left-side ALPS index of mTLE-LHS and mTLE-RHS were both decreased(P<0.05).The right-side ALPS index in mTLE-RHS was lower than that in the HC group(P<0.001).There was no significant difference in the right-side ALP

关 键 词：颞叶 癫痫 类淋巴系统 沿血管周围间隙扩散张量成像分析 海马硬化 

分 类 号：R74[医药卫生—神经病学与精神病学]