摘要
目的探讨常规磁共振成像阴性的额叶局灶性皮质发育不良（FCD）的诊断和定位方法,为手术治疗提供依据。方法选择2008年3月—2009年6月河北省人民医院收治的常规磁共振成像表现阴性的额叶癫痫并经手术治疗后病理诊断为FCD的患者28例,术前联合应用脑磁图（MEG）、弥散张量成像（DTI）检查诊断、定位。结果 MEG显示发作间期棘波分布于右侧额叶13例,左侧额叶10例,额顶叶3例,双侧额叶2例。棘波灶与中央前回运动区相隔15例,相邻11例,部分相融2例。DTI检查结果显示,感兴趣区（ROI）的表观弥散系数值（ADC）较对侧升高〔（1.55±0.14）mm^2/s与（0.87±0.05）mm^2/s,t=2.734,P〈0.05〕,部分各向异性（FA）值较对侧降低〔（0.21±0.03）与（0.30±0.10）,t=2.384,P〈0.05〕。28例癫痫患者行手术治疗,病理回报FCDⅠA型6例、ⅠB型9例、ⅠC型8例、ⅡA型5例。患者术后随访12-26个月,平均17.3个月,Engel＇sⅠa级7例、Ⅰb级10例、Ⅱ级8例、Ⅲ级3例。结论联合应用MEG和DTI技术可以准确诊断、定位常规磁共振成像阴性的额叶FCD,为精确切除致痫灶、提高额叶癫痫控制率提供保障。
Objective To investigate the diagnosis and localization method for MRI- negative frontal focal cortical dysplasia（ FCD）,and to provide the basis for the surgical treatment. Methods 28 patients who had frontal lobe epilepsy were treated in Hebei Provincial People＇s Hospital from March 2008 to July 2009,were selected as study subjects,their MRI results were negative,and they were diagnosed with FCD by post- operative pathology,magnetoencephalography（ MEG） and diffusion tensor imaging（ DTI） were used to diagnose and locate lesions. Results The distribution of interictal spike waves detected by MEG： 13 cases in right frontal lobe,10 in left frontal lobe,3 in frontal and parietal lobes,2 in bilateral frontal lobe. The spike waves region and precentral motor area of 15 cases were separated at a distance,the spike waves region was adjacent to precentral motor area among 11 cases,the spike waves region partially integrated into precentral motor area among 2 cases. DTI examination results showed that,apparent diffusion coefficient（ ADC） in region of interest（ ROI） was significantly higher than that in contralateral region 〔（ 1. 55 ± 0. 14） mm^2/ s vs.（ 0. 87 ± 0. 05） mm^2/ s,t = 2. 734,P〈 0. 05 〕,fractional anisotropy（ FA）value in ROI was significantly lower than that in opposite region 〔（ 0. 21 ± 0. 03） vs.（ 0. 30 ± 0. 10）,t = 2. 384,P〈 0. 05〕.28 patients received surgical treatment,pathological reports showed 6 cases of FCD type ⅠA,9 cases of type ⅠB,8 cases of type ⅠC,5 cases of FCD type ⅡA. All patients were followed up for 12 to 26 months,the average follow- up time was 17. 3months. 7 case of Engel ＇s grade Ⅰa,10 cases of grade B,8 cases of grade Ⅱ,3 cases of grade Ⅲ. Conclusion Combined application of MEG and DTI technology can accurately diagnose and locate MRI- negative frontal FCD, which can guide the precise excision of epileptogenic focus and improve the control rate of frontal lobe epilepsy.
出处
《中国全科医学》
CAS
CSCD
北大核心
2015年第6期729-732,共4页
Chinese General Practice
关键词
脑磁图描记术
弥散张量成像
磁共振成像
皮质发育畸形
癫痫
诊断
Magnetoencephalography
Diffusion tensor imaging
Magnetic resonance imaging
Malformations of cortical development
Epilepsy
Diagnosis
