Eltze Christin M, Chong Wui K, Bhate Sanjay, Harding Brian, Neville Brian G R, Cross J Helen
Institute of Child Health, University College London, United Kingdom.
Epilepsia. 2005 Dec;46(12):1988-92. doi: 10.1111/j.1528-1167.2005.00339.x.
Identification of focal cortical dysplasia (FCD) on magnetic resonance (MR) images of young children with refractory focal epilepsy is important, as surgical resection may offer improvement of seizure control and subsequent developmental progress. However, the MR appearances of malformations of cortical development may change during brain maturation. We report 4 children with refractory focal epilepsy, whose MR images in infancy showed localized cortical and subcortical signal abnormalities (hypointense on T(2)-weighted and hyperintense on T(1)-weighted images), suggestive of abnormal cortical development. The visibility of these lesions was significantly reduced on later MR images. Subtle blurring of the gray-white matter junction in these areas was the only indicator of cortical abnormality in 3 patients, which was recognized only after comparison with earlier images. Taylor-type FCD was subsequently confirmed in all patients, following surgical cortical resection of the lesions. MR images performed early within the first year of life in children with epilepsy are important to identify areas of FCD. The appearances of FCD on later scans can be very subtle escaping recognition, and conclusions may be misleading with respect to diagnosis and appropriateness of surgical treatment.
在患有难治性局灶性癫痫的幼儿磁共振（MR）图像上识别局灶性皮质发育异常（FCD）很重要，因为手术切除可能会改善癫痫控制并促进后续发育进程。然而，皮质发育畸形的MR表现可能会在脑成熟过程中发生变化。我们报告了4例难治性局灶性癫痫患儿，其婴儿期的MR图像显示局部皮质和皮质下信号异常（T2加权像上低信号，T1加权像上高信号），提示皮质发育异常。这些病变在后来的MR图像上的可见度显著降低。在3例患者中，这些区域灰白质交界的细微模糊是皮质异常的唯一指标，仅在与早期图像比较后才被识别。在对病变进行手术皮质切除后，所有患者均随后确诊为泰勒型FCD。对于癫痫患儿，在生命的第一年内尽早进行MR成像对于识别FCD区域很重要。FCD在后期扫描中的表现可能非常细微，难以识别，关于诊断和手术治疗的适宜性的结论可能会产生误导。
