CAJ | 학술논문

目的：采用磁共振弥散张量成像(diffusion tensor imaging,DTI)方法,研究伴有海马硬化(hippocampal sclerosis,HS)的颞叶癫痫(temporal lobe epilepsy,TLE)患者全脑白质微结构损害的特点,并探索其与患者发病年龄、病程的关系。方法对30例伴有 HS 的 TLE 患者(其中13例为左侧 HS 和17例为右侧 HS)以及23例年龄和性别匹配的正常被试者进行全脑 DTI 扫描,通过基于纤维束的空间统计(track-based spatial statistics,TBSS)方法寻找组间各向异性(fractional anisotropy,FA)值有显著性差异的脑白质区域,并将其作为感兴趣区域(region of interest,ROI),研究患者发病年龄及病程与 ROI 的 FA 值的相关性。结果与健康对照组相比,左侧 HS 组 FA 值降低的区域主要为双侧放射冠,左侧胼胝体膝部,右侧胼胝体体、胼胝体压部、后丘脑辐射、外囊及上纵束；右侧 HS 组 FA 值降低的区域主要为双侧胼胝体、放射冠、丘脑后辐射、扣带、上纵束,右侧内囊前肢、内囊的晶状体后部、外囊。左侧 HS 组左侧的胼胝体膝部的 FA 值与病程呈负相关,右侧放射冠前部的 FA 值与发病年龄正相关,右侧 HS 组双侧放射冠上部的 FA 值均与病程正相关。结论 DTI 结果提示伴有 HS 的 TLE 患者存在较广泛白质的损害,且不局限于颞叶；左侧 HS 的TLE 患者的发病年龄对放射冠前部的改变存在影响,而脑白质纤维受损的程度与患者的病程没有必然关系。
목적：채용자공진미산장량성상(diffusion tensor imaging,DTI)방법,연구반유해마경화(hippocampal sclerosis,HS)적섭협전간(temporal lobe epilepsy,TLE)환자전뇌백질미결구손해적특점,병탐색기여환자발병년령、병정적관계。방법대30례반유 HS 적 TLE 환자(기중13례위좌측 HS 화17례위우측 HS)이급23례년령화성별필배적정상피시자진행전뇌 DTI 소묘,통과기우섬유속적공간통계(track-based spatial statistics,TBSS)방법심조조간각향이성(fractional anisotropy,FA)치유현저성차이적뇌백질구역,병장기작위감흥취구역(region of interest,ROI),연구환자발병년령급병정여 ROI 적 FA 치적상관성。결과여건강대조조상비,좌측 HS 조 FA 치강저적구역주요위쌍측방사관,좌측변지체슬부,우측변지체체、변지체압부、후구뇌복사、외낭급상종속；우측 HS 조 FA 치강저적구역주요위쌍측변지체、방사관、구뇌후복사、구대、상종속,우측내낭전지、내낭적정상체후부、외낭。좌측 HS 조좌측적변지체슬부적 FA 치여병정정부상관,우측방사관전부적 FA 치여발병년령정상관,우측 HS 조쌍측방사관상부적 FA 치균여병정정상관。결론 DTI 결과제시반유 HS 적 TLE 환자존재교엄범백질적손해,차불국한우섭협；좌측 HS 적TLE 환자적발병년령대방사관전부적개변존재영향,이뇌백질섬유수손적정도여환자적병정몰유필연관계。
Objective Diffusion tensor imaging(DTI)was used to explore the characteristics of white matter (WM)microstruc-ture lesion in patients with temporal lobe epilepsy(TLE)and hippocampal sclerosis(HS).Then we investigated the influence of the age of epilepsy onset and the course on WM changes.Methods DTI data were obtained in 30 TLE patients with HS and 23 age and sex-matched healthy controls.Thirteen patients had left HS (LHS)and seventeen had right HS (RHS).Between-group compari-sons of fractional anisotropy (FA)were carried out by using track-based spatial statistics (TBSS).In addition,FA in regions of in-terest (ROI)where white matter lesions had statistically significant difference was correlated with the age of onset and the course. Results Subjects in the LHS group,as compared to healthy controls,demonstrated these clusters of reduced FA:bilateral corona radiata,the left genu of corpus callosum,the right body and splenium of corpus callosum,the right posterior thalamic radiation,ex-ternal capsule and superior longitudinal fasciculus.White the subjects in the RHS group,the clusters of reduced FA are involving bi-lateral corpus callosum,corona radiata,posterior thalamic radiation,cingulum,superior longitudinal fasciculus,and the right ante-rior limb of internal capsule,the right retrolenticular part of internal capsule and external capsule.In LHS group,the FA of the left genu of corpus callosum was negatively correlated with the course,and the FA of the right anterior corona radiata was positively cor-related with the age of onset.In RHS group,the FA of the bilateral superior corona radiata was positively correlated with the course.Conclusion DTI detects extensive changes in TLE with HS that are not confined to temporal lobe.The age of epilepsy onset in LHS was correlated with the changes of anterior corona radiata,while the course and the WM change were not definitely linked to each other.