Department of Radiology, Tuen Mun Hospital, Hong Kong.
Hong Kong Med J. 2010 Aug;16(4):292-8.
To review state-of-the-art neuroimaging modalities in epilepsy and their clinical applications.
PubMed literature searches to March 2010, using the following key words: 'epilepsy', 'positron emission tomography (PET)', 'single photon emission computed tomography (SPECT)', 'MR volumetry', 'diffusion tensor imaging', and 'functional MR imaging'.
All articles including neuroimaging techniques in epilepsy were included in the review.
High-field magnetic resonance imaging is fundamental for high-resolution structural imaging. Functional radionuclide imaging (positron emission tomography/single-photon emission computed tomography) can provide additional information to improve overall accuracy, and show good results with high concordance rates in temporal lobe epilepsy. Magnetic resonance spectroscopy is a useful adjunct consistently demonstrating changing metabolites in the epileptogenic region. Magnetic resonance volumetric imaging shows excellent sensitivity and specificity for temporal lobe epilepsy but thus far it has been inconsistent for extratemporal epilepsy. Diffusion tensor imaging with tractography allows visualisation of specific tracts such as connections with the language and visual cortex to enhance preoperative evaluation. Functional magnetic resonance imaging using blood oxygen level-dependent activation techniques is mainly used in presurgical planning for the high-sensitivity mapping of the eloquent cortex. Both contrast-bolus and arterial spin labelling magnetic resonance perfusion imaging show good correlation with clinical lateralisation of seizure disorder.
Structural imaging is essential in localisation and lateralisation of the seizure focus. Functional radionuclide imaging or advanced magnetic resonance imaging techniques can provide complementary information when an epileptogenic substrate is not identified or in the presence of non-concordant clinical and structural findings.
综述癫痫的最新神经影像学方法及其临床应用。
检索至 2010 年 3 月的 PubMed 文献，使用以下关键词：“癫痫”、“正电子发射断层扫描（PET）”、“单光子发射计算机断层扫描（SPECT）”、“磁共振容积成像”、“弥散张量成像”和“功能磁共振成像”。
纳入所有包含癫痫神经影像学技术的文章进行综述。
高磁场磁共振成像是高分辨率结构成像的基础。功能放射性核素成像（正电子发射断层扫描/单光子发射计算机断层扫描）可提供额外信息，以提高整体准确性，并在颞叶癫痫中显示出良好的结果和高一致性率。磁共振波谱是一种有用的辅助手段，始终能在致痫区显示代谢物的变化。磁共振容积成像对颞叶癫痫具有良好的敏感性和特异性，但迄今为止对颞叶外癫痫的结果并不一致。弥散张量成像和束追踪允许可视化特定束，如与语言和视觉皮层的连接，以增强术前评估。使用血氧水平依赖激活技术的功能磁共振成像主要用于术前规划，以对语言功能区进行高灵敏度定位。对比剂团注和动脉自旋标记磁共振灌注成像均与发作障碍的临床侧化具有良好的相关性。
结构成像对致痫灶的定位和侧化至关重要。当未确定致痫灶或存在临床和结构不一致的情况下，功能性放射性核素成像或先进的磁共振成像技术可提供补充信息。
