CAJ | 학술논문

目的探讨在头MRI结构影像阴性的局灶性癫痫患者中,同步脑电图-功能磁共振成像(EEG-fMRI)技术在致痫灶定位诊断中的应用价值.方法选取自2013年4月至2014年7月天津医科大学总医院功能神经外科病房及癫痫专科门诊的头MRI结构影像阴性的局灶性癫痫患者,再进行3.0T EEG-fMRI及头部静息态功能磁共振(RS-fMRI)检查,前者以脑电图中癫痫样放电为事件,经过离线分析得出与放电相关的血氧水平依赖信号(BOLD)反应区.分析每例患者的BOLD激活反应区与电-临床症状定位的关系,以电-临床症状定位作为主要指标分别评判吻合程度.结果共纳入15例患者,其中颞叶癫痫7例;额叶癫痫5例;额颞叶癫痫3例.EEG-fMRI均有与癫痫样放电相关的BOLD信号改变,与电-临床症状定位相比,12例(12/15)基本吻合,3例(3/15)主要部分吻合;15例中3例患者的RS-fMRI有BOLD信号改变,且与电-临床症状学定位基本吻合.EEG-fMRI对BOLD信号的检出率高于RS-fMRI.结论 EEG-fMRI检测的与癫痫样放电相关的BOLD反应区可以帮助局灶性癫痫进行非侵入性致痫区定位,为癫痫灶术前评估提供额外的有效信息.
목적 탐토재두MRI결구영상음성적국조성전간환자중,동보뇌전도-공능자공진성상(EEG-fMRI)기술재치간조정위진단중적응용개치.방법 선취자2013년4월지2014년7월천진의과대학총의원공능신경외과병방급전간전과문진적두MRI결구영상음성적국조성전간환자,재진행3.0T EEG-fMRI급두부정식태공능자공진(RS-fMRI)검사,전자이뇌전도중전간양방전위사건,경과리선분석득출여방전상관적혈양수평의뢰신호(BOLD)반응구.분석매례환자적BOLD격활반응구여전-림상증상정위적관계,이전-림상증상정위작위주요지표분별평판문합정도.결과 공납입15례환자,기중섭협전간7례;액협전간5례;액섭협전간3례.EEG-fMRI균유여전간양방전상관적BOLD신호개변,여전-림상증상정위상비,12례(12/15)기본문합,3례(3/15)주요부분문합;15례중3례환자적RS-fMRI유BOLD신호개변,차여전-림상증상학정위기본문합.EEG-fMRI대BOLD신호적검출솔고우RS-fMRI.결론 EEG-fMRI검측적여전간양방전상관적BOLD반응구가이방조국조성전간진행비침입성치간구정위,위전간조술전평고제공액외적유효신식.
Objective To explore the diagnostic value of simultaneous electroencephalography/ functional magnetic resonance imaging (EEG-fMRI) for epileptic foci in focal epilepsy of normal brain structure.Methods The normal structural images of EEG-fMRI and resting state-fMRI (RS-fMRI) with 3.0T high-field MR system were performed for 15 focal epileptic patients from April 2013 to July 2014.On EEG-fMRI,epileptiform discharges were regarded as nerve stimulation.And off-line analysis yielded the blood oxygen level-dependent (BOLD) responses related to epileptiform discharges.The relationship was analyzed between BOLD activation reaction and electroencephalography-clinical symptomatology position.And the electroencephalography-clinical symptomatology position was selected as a major indicator of judging the degree of concordance.Results The involved lobes were temporal (n =7),frontal (n =5) and frontotemporal (n =3).On EEG-fMRI,all patients demonstrated BOLD responses related to epileptiform discharges.Compared with electroencephalography-clinical symptomatology position,12 cases (12/15) were fully concordant and 3 cases (3/15) partially concordant.Three patients had BOLD responses in accordance with electroencephalography-clinical symptomatology position on RS-fMRI.And the detection rate of BOLD responses was higher for EEG-fMRI than that for RS-fMRI.Conclusion The BOLD responses related to epileptiform discharges may help locate noninvasively the epileptogenic region of focal epilepsy and provide additional useful information for preoperative evaluations of epilepsy.