磁共振彌散張量成像在右側顳葉癲癇手術患者中的應用_《華西醫學》

作者：

余曉鳳 ¹ , 陳芹 ¹ , 周波 ² , 唐穎瑩 ¹ , 羅春燕 ¹ , 肖風來 ¹ , 曾鈺欽 ³ , 王昱清 ⁴ , 唐鶴菡 ⁵ , 雷町 ⁶ , 龔啟勇 ⁴ ,  周東 ¹

1四川大學華西醫院神經內科（成都，610041）;2四川省醫學科學院·四川省人民醫院精神科;3 中南大學湘雅醫院;4四川大學華西醫院磁共振研究中心;5四川大學華西醫院放射科;6四川大學華西醫院神經外科;

關鍵詞：

顳葉癲癇磁共振彌散成像技術各向異性分數手術

DOI：

10.7507/1002-0179.20130495

視頻：

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目的　利用磁共振彌散張量成像技術（DTI）對右側難治性顳葉癲癇（TLE）患者術前及術后腦白質各向異性分數（FA）進行縱向隨訪研究，并對其與病程等臨床癥狀之間的相關性進行分析，探討右側TLE患者的腦白質FA變化模式。方法　2008年7月－2009年8月納入10例右側難治性TLE患者。對每個受試者采用GE 3.0 T磁共振及8通道頭線圈掃描，所有DTI圖像通過單次回波平面成像序列采集。采用基于體素分析的SPM8軟件對受試患者術前術后FA圖進行配對t檢驗，觀察難治性TLE患者腦白質變化模式。采用Pearson相關計算FA變化幅度與病程等臨床癥狀之間的相關性，經比較校正后P值＜0.05的區域為有統計學意義的區域。結果　右側TLE患者FA值降低的區域包括左側顳下回、雙側額中回及左側殼核、右側楔葉。FA升高的區域包括左側海馬旁回、左側顳葉、右側額下回和左側中央旁小葉。相關分析發現，右側TLE患者右側額下回FA變化值與發病年齡呈負相關，左側顳下回FA變化值與術后隨訪間隔時間呈負相關。結論　右側難治性TLE患者手術治療后大腦白質變化不僅局限于顳葉，還涉及顳葉外結構。

引用本文： 余曉鳳,陳芹,周波,唐穎瑩,羅春燕,肖風來,曾鈺欽,王昱清,唐鶴菡,雷町,龔啟勇,周東. 磁共振彌散張量成像在右側顳葉癲癇手術患者中的應用. 華西醫學, 2013, 28(10): 1569-1574. doi: 10.7507/1002-0179.20130495 復制

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8.	Kim JH, Lee JM, Kang E, et al. Functional reorganization associated with semantic language processing in temporal lobe epilepsy patients after anterior temporal lobectomy: a longitudinal functional magnetic resonance image study[J]. J Korean Neurosurg Soc, 2010, 47(1): 17-25.
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14.	Thivard L, Lehéricy S, Krainik A, et al. Diffusion tensor imaging in medial temporal lobe epilepsy with hippocampal sclerosis[J]. Neuroimage, 2005, 28(3): 682-690.
15.	Gross DW, Concha L, Beaulieu C. Extratemporal white matter abnormalities in mesial temporal lobe epilepsy demonstrated with diffusion tensor imaging[J]. Epilepsia, 2006, 47(8): 1360-1363.
16.	Focke NK, Yogarajah M, Bonelli SB, et al. Voxel-based diffusion tensor imaging in patients with mesial temporal lobe epilepsy and hippocampal sclerosis[J]. Neuroimage, 2008, 40(2): 728-737.
17.	Lin JJ, Riley JD, Juranek J, et al. Vulnerability of the frontal-temporal connections in temporal lobe epilepsy[J]. Epilepsy Res, 2008, 82(2-3): 162-170.
18.	Nilsson D, Go C, Rutka JT, et al. Bilateral diffusion tensor abnormalities of temporal lobe and cingulate gyrus white matter in children with temporal lobe epilepsy[J]. Epilepsy Res, 2008, 81(2-3): 128-135.
19.	Govindan RM, Makki MI, Sundaram SK, et al. Diffusion tensor analysis of temporal and extra-temporal lobe tracts in temporal lobe epilepsy[J]. Epilepsy Res, 2008, 80(1): 30-41.
20.	Concha L, Gross DW, Wheatley BM, et al. Diffusion tensor imaging of time-dependent axonal and myelin degradation after corpus callosotomy in epilepsy patients[J]. Neuroimage, 2006, 32(3): 1090-1099.
21.	Ahmadi ME, Hagler DJ, McDonald CR, et al. Side matters: diffusion tensor imaging tractography in left and right temporal lobe epilepsy[J]. AJNR Am J Neuroradiol, 2009, 30(9): 1740-1747.
22.	Concha L, Livy DJ, Beaulieu C, et al. In vivo diffusion tensor imaging and histopathology of the fimbria-fornix in temporal lobe epilepsy[J]. J Neurosci, 2010, 30(3): 996-1002.
23.	Nguyen D, Vargas MI, Khaw N, et al. Diffusion tensor imaging analysis with tract-based spatial statistics of the white matter abnormalities after epilepsy surgery[J]. Epilepsy Res, 2011, 94(3): 189-197.
24.	Riley JD, Franklin DL, Choi V, et al. Altered white matter integrity in temporal lobe epilepsy: association with cognitive and clinical profiles[J]. Epilepsia, 2010, 51(4): 536-545.
25.	Schoene-Bake JC, Faber J, Elger CE, et al. White matter changes in post-surgical temporal lobe epilepsy[J]. Neurophysiol Clin, 2009, 120(1): e59-e60.
26.	Concha L, Beaulieu C, Wheatley BM, et al. Bilateral white matter diffusion changes persist after epilepsy surgery[J]. Epilepsia, 2007, 48(5): 931-940.
27.	Yogarajah M, Focke NK, Bonelli SB, et al. The structural plasticity of white matter networks following anterior temporal lobe resection[J]. Brain, 2010, 133(Pt 8): 2348-2364.
28.	Backes WH, Deblaere K, Vonck K, et al. Language activation distributions revealed by fMRI in post-operative epilepsy patients: differences between left- and right-sided resections[J]. Epilepsy Res, 2005, 66(1-3): 1-12.
29.	Hugg JW, Kuzniecky RI, Gilliam FG, et al. Normalization of contralateral metabolic function following temporal lobectomy demonstrated by 1H magnetic resonance spectroscopic imaging[J]. Ann Neurol, 1996, 40(2): 236-239.
30.	Spanaki MV, Kopylev L, DeCarli C, et al. Postoperative changes in cerebral metabolism in temporal lobe epilepsy[J]. Arch Neurol, 2000, 57(10): 1447-1452.
31.	Jansen JF, Aldenkamp AP, Marian Majoie HJ, et al. Functional MRI reveals declined prefrontal cortex activation in patients with epilepsy on topiramate therapy[J]. Epilepsy Behav, 2006, 9(1): 181-185.

1. 　Wiebe S, Blume WT, Girvin JP, et al. A randomized, controlled trial of surgery for temporal-lobe epilepsy[J]. N Engl J Med, 2001, 345(5): 311-318.
2. 　Binder JR, Bellgowan PS, Hammeke TA, et al. A comparison of two FMRI protocols for eliciting hippocampal activation[J]. Epilepsia, 2005, 46(7): 1061-1070.
3. 　Brázdil M, Chlebus P, Mikl M, et al. Reorganization of language-related neuronal networks in patients with left temporal lobe epilepsy: an fMRI study [J]. Eur J Neurol, 2005, 12(4): 268-275.
4. 　Téllez-Zenteno JF, Dhar R, Wiebe S. Long-term seizure outcomes following epilepsy surgery: a systematic review and meta-analysis[J]. Brain, 2005, 128(5): 1188-1198.
5. 　Concha L, Beaulieu C, Collins DL, et al. White-matter diffusion abnormalities in temporal-lobe epilepsy with and without mesial temporal sclerosis[J]. J Neurol Neurosurg Psychiatry, 2009, 80(3): 312-319.
6. 　Gotman J. Epileptic networks studied with EEG-MRI[J]. Epilepsia, 2008, 49(Suppl 3): 42-51.
7. 　Henry TR, Mazziotta JC, Engel J, et al. Quantifying interictal metabolic activity in human temporal lobe epilepsy[J]. J Cereb Blood Flow Metab, 1990, 10(5): 748-757.
8. 　Kim JH, Lee JM, Kang E, et al. Functional reorganization associated with semantic language processing in temporal lobe epilepsy patients after anterior temporal lobectomy: a longitudinal functional magnetic resonance image study[J]. J Korean Neurosurg Soc, 2010, 47(1): 17-25.
9. 　Labate A, Cerasa A, Gambardella A, et al. Hippocampal and thalamic atrophy in mild temporal lobe epilepsy: a VBM study[J]. Neurology, 2008, 71(14): 1094-1101.
10. 　Shon YM, Kim YI, Koo BB, et al. Group-specific regional white matter abnormality revealed in diffusion tensor imaging of medial temporal lobe epilepsy without hippocampal sclerosis[J]. Epilepsia, 2010, 51(4): 529-535.
11. 　Beaulieu C. The basis of anisotropic water diffusion in the nervous system - a technical review[J]. NMR Biomed, 2002, 15(7-8): 435-455.
12. 　Arfanakis K, Hermann BP, Rogers BP, et al. Diffusion tensor MRI in temporal lobe epilepsy[J]. Magn Reson Imaging, 2002, 20(7): 511-519.
13. 　Concha L, Beaulieu C, Gross DW. Bilateral limbic diffusion abnormalities in unilateral temporal lobe epilepsy[J]. Ann Neurol, 2005, 57(2): 188-196.
14. 　Thivard L, Lehéricy S, Krainik A, et al. Diffusion tensor imaging in medial temporal lobe epilepsy with hippocampal sclerosis[J]. Neuroimage, 2005, 28(3): 682-690.
15. 　Gross DW, Concha L, Beaulieu C. Extratemporal white matter abnormalities in mesial temporal lobe epilepsy demonstrated with diffusion tensor imaging[J]. Epilepsia, 2006, 47(8): 1360-1363.
16. 　Focke NK, Yogarajah M, Bonelli SB, et al. Voxel-based diffusion tensor imaging in patients with mesial temporal lobe epilepsy and hippocampal sclerosis[J]. Neuroimage, 2008, 40(2): 728-737.
17. 　Lin JJ, Riley JD, Juranek J, et al. Vulnerability of the frontal-temporal connections in temporal lobe epilepsy[J]. Epilepsy Res, 2008, 82(2-3): 162-170.
18. 　Nilsson D, Go C, Rutka JT, et al. Bilateral diffusion tensor abnormalities of temporal lobe and cingulate gyrus white matter in children with temporal lobe epilepsy[J]. Epilepsy Res, 2008, 81(2-3): 128-135.
19. 　Govindan RM, Makki MI, Sundaram SK, et al. Diffusion tensor analysis of temporal and extra-temporal lobe tracts in temporal lobe epilepsy[J]. Epilepsy Res, 2008, 80(1): 30-41.
20. 　Concha L, Gross DW, Wheatley BM, et al. Diffusion tensor imaging of time-dependent axonal and myelin degradation after corpus callosotomy in epilepsy patients[J]. Neuroimage, 2006, 32(3): 1090-1099.
21. 　Ahmadi ME, Hagler DJ, McDonald CR, et al. Side matters: diffusion tensor imaging tractography in left and right temporal lobe epilepsy[J]. AJNR Am J Neuroradiol, 2009, 30(9): 1740-1747.
22. 　Concha L, Livy DJ, Beaulieu C, et al. In vivo diffusion tensor imaging and histopathology of the fimbria-fornix in temporal lobe epilepsy[J]. J Neurosci, 2010, 30(3): 996-1002.
23. 　Nguyen D, Vargas MI, Khaw N, et al. Diffusion tensor imaging analysis with tract-based spatial statistics of the white matter abnormalities after epilepsy surgery[J]. Epilepsy Res, 2011, 94(3): 189-197.
24. 　Riley JD, Franklin DL, Choi V, et al. Altered white matter integrity in temporal lobe epilepsy: association with cognitive and clinical profiles[J]. Epilepsia, 2010, 51(4): 536-545.
25. 　Schoene-Bake JC, Faber J, Elger CE, et al. White matter changes in post-surgical temporal lobe epilepsy[J]. Neurophysiol Clin, 2009, 120(1): e59-e60.
26. 　Concha L, Beaulieu C, Wheatley BM, et al. Bilateral white matter diffusion changes persist after epilepsy surgery[J]. Epilepsia, 2007, 48(5): 931-940.
27. 　Yogarajah M, Focke NK, Bonelli SB, et al. The structural plasticity of white matter networks following anterior temporal lobe resection[J]. Brain, 2010, 133(Pt 8): 2348-2364.
28. 　Backes WH, Deblaere K, Vonck K, et al. Language activation distributions revealed by fMRI in post-operative epilepsy patients: differences between left- and right-sided resections[J]. Epilepsy Res, 2005, 66(1-3): 1-12.
29. 　Hugg JW, Kuzniecky RI, Gilliam FG, et al. Normalization of contralateral metabolic function following temporal lobectomy demonstrated by 1H magnetic resonance spectroscopic imaging[J]. Ann Neurol, 1996, 40(2): 236-239.
30. 　Spanaki MV, Kopylev L, DeCarli C, et al. Postoperative changes in cerebral metabolism in temporal lobe epilepsy[J]. Arch Neurol, 2000, 57(10): 1447-1452.
31. 　Jansen JF, Aldenkamp AP, Marian Majoie HJ, et al. Functional MRI reveals declined prefrontal cortex activation in patients with epilepsy on topiramate therapy[J]. Epilepsy Behav, 2006, 9(1): 181-185.

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《華西醫學》

磁共振彌散張量成像在右側顳葉癲癇手術患者中的應用

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