CAJ | 학술논문

目的评价基于动脉自旋标记(ASL)的MRI技术在内侧颞叶癫痫(mTLE)定侧方面的应用价值,探讨mTLE癫痫网络脑区的脑灌注改变及其临床相关情况.方法选取25例左侧mTLE、23例右侧mTLE患者及30名正常志愿者,通过脉冲式ASL序列技术进行MR扫描,并采集脑血流量(CBF)数据.采用基于体素的方差分析技术,寻找mTLE患者相比正常对照组脑CBF改变的脑区,并分析其与临床病程的相关性.采用基于感兴趣区分析的技术,计算mTLE患者双侧颞叶灌注的偏侧化指数,初步评价其在颞叶癫痫定侧方面的应用价值.结果与正常对照组相比,mTLE患者表现为双侧颞叶内侧和外侧区域、双侧额顶叶,以及与脑默认模式网络有关的脑区CBF降低,且以患侧为著；患侧颞叶的CBF值与癫痫病程呈负相关(r=-0.51,P＜0.01).通过对两组患者CBF值偏侧化指数计算,发现当偏侧化指数值为-0.01时,依据CBF进行mTLE定侧的敏感度为76.0％(19/25)、特异度为78.3％(18/23).结论基于ASL的MR成像技术揭示mTLE颞叶及颞叶外脑灌注的降低,反映了内侧颞叶癫痫网络功能受损的性质；此技术具有较好的癫痫临床定侧价值.
목적 평개기우동맥자선표기(ASL)적MRI기술재내측섭협전간(mTLE)정측방면적응용개치,탐토mTLE전간망락뇌구적뇌관주개변급기림상상관정황.방법 선취25례좌측mTLE、23례우측mTLE환자급30명정상지원자,통과맥충식ASL서렬기술진행MR소묘,병채집뇌혈류량(CBF)수거.채용기우체소적방차분석기술,심조mTLE환자상비정상대조조뇌CBF개변적뇌구,병분석기여림상병정적상관성.채용기우감흥취구분석적기술,계산mTLE환자쌍측섭협관주적편측화지수,초보평개기재섭협전간정측방면적응용개치.결과 여정상대조조상비,mTLE환자표현위쌍측섭협내측화외측구역、쌍측액정협,이급여뇌묵인모식망락유관적뇌구CBF강저,차이환측위저；환측섭협적CBF치여전간병정정부상관(r=-0.51,P＜0.01).통과대량조환자CBF치편측화지수계산,발현당편측화지수치위-0.01시,의거CBF진행mTLE정측적민감도위76.0％(19/25)、특이도위78.3％(18/23).결론 기우ASL적MR성상기술게시mTLE섭협급섭협외뇌관주적강저,반영료내측섭협전간망락공능수손적성질；차기술구유교호적전간림상정측개치.
Objective To evaluate the feasibility of the lateralization of unilateral medial temporal lobe epilepsy(mTLE)by using arterial-spin-labeling(ASL)based perfusion MR imaging and investigate the changes of perfusion in the regions related to mTLE network and the relationship between the perfusion and the clinical status.Methods Twenty-five patients with left-sided and 23 with right-sided mTLE were enroiled,and 30 healthy volunteers were recruited.The cerebral blood flow(CBF)of related region was measured based on pulsed-ASL sequence on Siemens 3 T scanner.The CBF of the mTLE group were compared with that in the controls by using ANOVA analysis.The asymmetric indices of CBF in the medial temporal lobe were calculated as the lesion side compared with the normal side in matched region in mTLE group.Results Compared with the volunteers,the patients with mTLE showed the decrease of CBF in the bilateral medial and lateral temporal,the frontal and parietal regions relating to the default-mode network and more serious in lesion side.The CBF values of the medial temporal lobe were negatively correlated with the epilepsy duration(r =-0.51,P ＜0.01).The asymmetric index of CBF as-0.01 has a 76.0％(19/25)sensitivity and a 78.3％(18/23)specificity to distinguish the lesion side.Conclusions The decrease of CBF in the temporal and extra-temporal region by ASL-based MRI suggests the functional abnormalities in the network involved by mTLE.The ASL technique is a useful tool for lateralizing the unilateral mTLE.