CAJ | 학술논문

目的探讨短时反转恢复(STIR)序列在诊断海马硬化(HS)中的临床应用价值.方法 21例经常规MRI扫描排除了占位性和损伤性病变的内侧颞叶癫痫患者纳入研究.采用STIR技术,进行冠状位、轴位和矢状位成像,依照海马体积的缩小、信号改变、海马内部结构的丧失和侧脑室颞角扩大的海马硬化判断标准,分析比较常规MRI序列和STIR序列的成像结果,并进一步分析6例接受手术切除治疗患者海马的影像-病理相关性.结果常规MRI序列能较好地显示海马的体积改变和信号的改变,但是对于海马内部结构显示不清.经常规MRI诊断14例(66.7％)为一侧HS,4例为一侧可疑HS.而STIR序列能够清晰显示海马内部结构,正常海马可以观察到下托到CA1区并延续到CA2区的线样稍低信号影,呈现“C”字征；而在HS中此信号消失,同时在CA4区,呈现低信号区域.18例(85.7％)经STIR诊断为HS.来自6例手术患者的影像-病理分析显示,“C”字征信号消失与CA1区锥体神经细胞脱失相关,而CA4区低信号则反映了胶质增生.结论 STIR序列的高分辨率可以可靠地显示海马的细微解剖结构,优于常规的MRI序列,在诊断HS中具有重要价值.
목적 탐토단시반전회복(STIR)서렬재진단해마경화(HS)중적림상응용개치.방법 21례경상규MRI소묘배제료점위성화손상성병변적내측섭협전간환자납입연구.채용STIR기술,진행관상위、축위화시상위성상,의조해마체적적축소、신호개변、해마내부결구적상실화측뇌실섭각확대적해마경화판단표준,분석비교상규MRI서렬화STIR서렬적성상결과,병진일보분석6례접수수술절제치료환자해마적영상-병리상관성.결과 상규MRI서렬능교호지현시해마적체적개변화신호적개변,단시대우해마내부결구현시불청.경상규MRI진단14례(66.7％)위일측HS,4례위일측가의HS.이STIR서렬능구청석현시해마내부결구,정상해마가이관찰도하탁도CA1구병연속도CA2구적선양초저신호영,정현“C”자정；이재HS중차신호소실,동시재CA4구,정현저신호구역.18례(85.7％)경STIR진단위HS.래자6례수술환자적영상-병리분석현시,“C”자정신호소실여CA1구추체신경세포탈실상관,이CA4구저신호칙반영료효질증생.결론 STIR서렬적고분변솔가이가고지현시해마적세미해부결구,우우상규적MRI서렬,재진단HS중구유중요개치.
Objective To evaluate the utility of short tau inversion recovery (STIR) sequence in the diagnosis of hippocampal sclerosis ( HS).Methods Twenty-one patients with medial temporal lobe epilepsy without neoplasm lesions or injuries by conventional MRI sequence including T1WI,T2WI and FLAIR were included in this study.STIR imaging in axial,coronal and sagittal sequences was performed on these patients. Diagnosis of HS was based on the findings of hippocampal atrophy,alteration signal,disturbed internal structure and enlargement of the inferior horn. The findings shown on conventional MRI were compared with those on STIR sequence. Furthermore,the correlation of radiologic and histological findings was investigated in 6 patients operated for refractory seizures. Results On conventional MRI sequence,14 patients (66.7％) were confirmed with unilateral HS and 4 patients were suspected with unilateral HS. In contrast,all these 18 patients (85.7％) were confirmed with unilateral HS by STIR.Particularly,STIR sequence delineated the internal structure of hippocampus more clearly than conventional MRI sequences did. "C" shaped contour in subiculum-CA1-CA2 was revealed in normal hippocampus on STIR sequence and disappeared in HS,correlated to the pathology finding of loss of neuron in CA1 in resected tissues in 6 operated patients.The patients with HS also showed areas of hypodensity in CA4 on STIR,in accordance with pathologic findings of gliosis in this area in the 6 operated patients.Conclusion STIR sequence could depict the internal anatomical structure of hippocampus with high resolution superior to conventional MRI sequences,and can be of great value in the diagnosis of HS.