Kuzniecky R, Hugg J, Hetherington H, Martin R, Faught E, Morawetz R, Gilliam F
Department of Neurology, UAB Epilepsy Center, University of Alabama at Birmingham, USA.
Neurology. 1999 Sep 11;53(4):694-8. doi: 10.1212/wnl.53.4.694.
To investigate the predictive value of 1H MRSI for outcome in patients with mesial temporal lobe epilepsy (MTLE).
1H MRSI has been shown to be highly sensitive in the lateralization of temporal lob epilepsy.
The authors analyzed the relationship between the 1H MRSI findings and surgical outcome in 40 consecutive patients who underwent temporal lobe surgery for MTLE. Outcome at a mean of 24 months (range 18 to 40 months) was classified as seizure free or not seizure free.
At follow-up, 78% of patients were seizure free. Correlations showed no predictive value for the creatine/N-acetylated compound (Cr/NA) ratio of the operated temporal lobe and outcome. However, a relationship was found between surgical failure and the Cr/NA ratio of the nonoperated temporal lobe and with a Cr/NA ratio in the nonoperated lobe above 1.21 in patients with bilateral abnormalities (p < 0.01).
Preoperative elevations in the Cr/NA ratio in the nonoperated temporal lobe or the presence of higher metabolic ratios contralateral to the proposed surgery are associated with surgical failure. The predictive value of 1H MRSI absolute metabolite concentrations for outcome in MTLE requires further investigation.
探讨氢质子磁共振波谱成像（1H MRSI）对内侧颞叶癫痫（MTLE）患者预后的预测价值。
1H MRSI已被证明在颞叶癫痫的定侧方面高度敏感。
作者分析了40例因MTLE接受颞叶手术的连续患者的1H MRSI结果与手术预后之间的关系。平均24个月（范围18至40个月）的预后分为无癫痫发作或有癫痫发作。
随访时，78%的患者无癫痫发作。相关性分析显示，手术侧颞叶的肌酸/N-乙酰化化合物（Cr/NA）比值对预后无预测价值。然而，发现手术失败与未手术侧颞叶的Cr/NA比值以及双侧异常患者未手术侧叶的Cr/NA比值高于1.21有关（p < 0.01）。
术前未手术侧颞叶的Cr/NA比值升高或拟手术对侧存在较高代谢比值与手术失败相关。1H MRSI绝对代谢物浓度对MTLE预后的预测价值需要进一步研究。
