Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695011, India.
Neurol India. 2010 May-Jun;58(3):361-70. doi: 10.4103/0028-3886.65569.
Medical management remains unsatisfactory in about a third of patients with epilepsy and some of them are candidates for resective epilepsy surgery. Structural and functional neuroimaging plays an important role in the identification of the precise cortical region responsible for seizures and is very crucial for a good surgical outcome. Furthermore, identification of eloquent cortical areas near the region to be resected is essential to avoid postoperative neurologic deficit. The magnetic resonance imaging (MRI) protocol for epilepsy can be individually tailored depending on the seizure semiology and possibly electroencephalography. New MRI techniques demonstrate the structure of the brain in fine detail, help in understanding the underlying pathology, and demonstrate functional activity of the brain with high spatial and temporal resolution. Metabolic imaging techniques, such as positron emission tomography (PET) and single photon emission tomography (SPECT) visualize metabolic alterations of the brain in the ictal and interictal states. In MR-negative epilepsy patients, these techniques may have localizing value. The proper use and interpretation of the findings provided by these new technologies is crucial. In this review article, we discuss various conventional and advanced MRI techniques, interpretation of various findings, and the role of functional imaging modalities, such as functional MRI, PET, and SPECT in the localization of epileptogenic substrate as well as for understanding the pathophysiology, propagation, and neurochemical correlates of epilepsy.
在大约三分之一的癫痫患者中，医学治疗仍然不尽如人意，其中一些患者是切除性癫痫手术的候选者。结构和功能神经影像学在确定负责癫痫发作的确切皮质区域方面发挥着重要作用，对良好的手术效果至关重要。此外，识别要切除区域附近的语言相关皮质区域对于避免术后神经功能缺陷至关重要。癫痫的磁共振成像 (MRI) 方案可以根据发作的半侧化和可能的脑电图进行个体化定制。新的 MRI 技术可以精细地显示大脑的结构，帮助理解潜在的病理学，并以高空间和时间分辨率显示大脑的功能活动。代谢成像技术，如正电子发射断层扫描 (PET) 和单光子发射断层扫描 (SPECT)，可以可视化发作期和发作间期大脑的代谢改变。在 MR 阴性癫痫患者中，这些技术可能具有定位价值。正确使用和解释这些新技术提供的发现至关重要。在这篇综述文章中，我们讨论了各种常规和先进的 MRI 技术、各种发现的解释，以及功能成像方式（如功能 MRI、PET 和 SPECT）在确定致痫灶以及理解癫痫的病理生理、传播和神经化学相关性方面的作用。
