Woermann F G, McLean M A, Bartlett P A, Parker G J, Barker G J, Duncan J S
MRI Unit, National Society of Epilepsy, University Department of Clinical Neurology, Institute of Neurology, London, UK.
Ann Neurol. 1999 Mar;45(3):369-76. doi: 10.1002/1531-8249(199903)45:3<369::aid-ana13>3.0.co;2-q.
Single-voxel proton magnetic resonance spectroscopy (1H MRS) has shown abnormalities in patients with temporal lobe epilepsy (TLE) and hippocampal sclerosis (HS). Many TLE patients, however, do not have HS or other lesions on quantitative magnetic resonance imaging (MRI) (MRI-negative). Fifteen control subjects, 15 patients with unilateral HS, and 15 MRI-negative TLE patients underwent 1H MRS at an echo time of 30 msec on a 1.5-T GE Signa scanner. Voxels were tailored to the individual hippocampi. N-Acetylaspartate (NAA), creatine, choline, total glutamate plus glutamine (Glx), and myo-inositol (Ins) were quantitated by using an external standard and LCModel, a user-independent quantitation method. Normal ranges were defined as the control mean +/- 2.5 SD. In HS patients, 12 of 15 had abnormally low NAA in sclerotic hippocampi; 3 of these 12 also had abnormally low NAA contralaterally. Abnormally low NAA/Ins ratios lateralized the side affected by HS in 7 of 15 patients, without any bilateral abnormalities. In 15 MRI-negative TLE patients, 4 had abnormally low hippocampal NAA ipsilateral to seizure onset, 1 of whom had abnormally low NAA bilaterally. Analysis of groups of subjects showed a bilateral decrease in NAA, most marked in patients with HS and on the side of seizure onset. The mean NAA/Ins ratio was lower in patients with HS than in control subjects and in MRI-negative patients. The concentration of Glx was higher ipsilateral to seizure onset in MRI-negative patients than in HS patients. Quantitative short echo time 1H MRS identified abnormalities in 87% of patients with HS and 27% of MRI-negative TLE patients in concordance with other lateralizing data. In individual and group comparisons, 1H MRS described a metabolite profile in the hippocampi of MRI-negative TLE patients that was different from patients with HS, with an increase in Glx and a less marked decrease in NAA than was seen in HS.
单体素质子磁共振波谱（1H MRS）已显示颞叶癫痫（TLE）和海马硬化（HS）患者存在异常。然而，许多TLE患者在定量磁共振成像（MRI）上没有HS或其他病变（MRI阴性）。15名对照受试者、15名单侧HS患者和15名MRI阴性的TLE患者在1.5-T GE Signa扫描仪上于回波时间30毫秒时接受了1H MRS检查。体素根据个体海马进行定制。使用外标和LCModel（一种独立于用户的定量方法）对N-乙酰天门冬氨酸（NAA）、肌酸、胆碱、总谷氨酸加谷氨酰胺（Glx）和肌醇（Ins）进行定量。正常范围定义为对照平均值±2.5标准差。在HS患者中，15例中有12例硬化海马中的NAA异常降低；这12例中的3例对侧NAA也异常降低。异常低的NAA/Ins比值使15例患者中的7例受HS影响的一侧定位，没有任何双侧异常。在15例MRI阴性的TLE患者中，4例发作起始侧海马的NAA异常降低，其中1例双侧NAA异常降低。对受试者组的分析显示NAA双侧降低，在HS患者中最为明显，且在发作起始侧。HS患者的平均NAA/Ins比值低于对照受试者和MRI阴性患者。MRI阴性患者发作起始侧同侧的Glx浓度高于HS患者。定量短回波时间1H MRS在87%的HS患者和27%的MRI阴性TLE患者中发现了与其他定位数据一致的异常。在个体和组间比较中，1H MRS描述了MRI阴性TLE患者海马中的代谢物谱，该谱与HS患者不同，Glx增加，NAA降低程度不如HS患者明显。
