[磁共振成像诊断内侧颞叶硬化]

Sánchez-Alvarez J C, Pastor-Pons E, García-Gómez T, Escamilla F, Galdón A, Busquier H, Castañeda M, Serrano P J, Aguilar D, Altuzarra A

Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Granada, España.

Rev Neurol. 2000;31(8):701-11.

INTRODUCTION

Mesial temporal sclerosis (MTS) is a progressive drug-resistant epileptic syndrome which requires rapid, effective diagnosis and treatment. Histologically there is atrophy and gliosis of the hippocampus.

OBJECTIVE

To establish magnetic resonance (MR) imaging guidelines for correct diagnosis.

PATIENTS AND METHODS

We made a prospective study of 78 patients with drug-resistant temporal lobe epilepsy (44 women and 34 men; age 6-66 years, mean 31 years). Using a magnet of 1.5 Teslas paracoronal sections were made of the hippocampus with T1 volumetric with inversion-recovery, FLAIR (fluid-attenuated inversion-recovery) and T2 relaxometry. A control group of 30 healthy volunteers was established. The reduction in volume and hippocampal T2 hyperintensity were considered to be MTS diagnosed on MR.

RESULTS

No hippocampal differences were observed among the healthy volunteers. The confidence intervals (mean +/- 1.96 SD) were: right volume: 4.169-5.911 mm3; left volume: 4.097-5.940 mm3; time of T2 relaxation: 98-113 ms. MTS was observed in 42 patients (54%): 24 left, 14 right and four asymmetrical bilateral. The results of the diagnostic validity (sensitivity/specificity) were: T1 volumetric 91/92%, FLAIR 93.5/98% and T2 relaxometry 91/92%. There was atrophy of other extrahippocampal structures in five cases of MTS; 10 patients with MTS (23.5%) had another extrahippocampal lesion associated (dual pathology), particularly migration disorders; 21 patients (27%) had lesions without MTS (tumors, alterations of migration, nonspecific gliosis) and in 15 cases (19%) there were no abnormal findings. A total of 27 patients were operated on: 22 with MTS (21 had diagnostic MR, one case had no abnormal findings), four cases had tumors and one had cortical dysplasia.

CONCLUSION

The combination of quantitative techniques (T1 volumetric with inversion-recovery and T2 relaxometry) and FLAIR optimize MTS diagnosis using MR.

引言

内侧颞叶硬化（MTS）是一种进行性耐药性癫痫综合征，需要快速、有效的诊断和治疗。组织学上表现为海马萎缩和胶质增生。

目的

建立正确诊断的磁共振（MR）成像指南。

患者与方法

我们对78例耐药性颞叶癫痫患者进行了前瞻性研究（44例女性和34例男性；年龄6 - 66岁，平均31岁）。使用1.5特斯拉的磁体对海马进行冠状位扫描，采用T1容积反转恢复序列、液体衰减反转恢复序列（FLAIR）和T2弛豫测量法。建立了一个由30名健康志愿者组成的对照组。海马体积减小和T2高信号被认为是MR诊断的MTS。

结果

健康志愿者之间未观察到海马差异。置信区间（均值±1.96标准差）为：右侧体积：4.169 - 5.911立方毫米；左侧体积：4.097 - 5.940立方毫米；T2弛豫时间：98 - 113毫秒。42例患者（54%）观察到MTS：左侧24例，右侧14例，双侧不对称4例。诊断有效性（敏感性/特异性）结果为：T1容积反转恢复序列91/92%，FLAIR 93.5/98%，T2弛豫测量法91/92%。5例MTS患者存在其他海马外结构萎缩；10例MTS患者（23.5%）伴有另一种海马外病变（双重病理），尤其是迁移障碍；21例患者（27%）有不伴有MTS的病变（肿瘤、迁移改变、非特异性胶质增生），15例（19%）无异常发现。共有27例患者接受手术：22例为MTS（21例有诊断性MR，1例无异常发现），4例有肿瘤，1例有皮质发育异常。