Heinz E R, Crain B J, Radtke R A, Burger P C, Friedman A H, Djang W T, Wilkinson W E
Department of Radiology, Duke University Medical Center, Durham, NC 27710.
AJR Am J Roentgenol. 1990 Sep;155(3):581-6. doi: 10.2214/ajr.155.3.2117360.
Thirty-nine consecutive patients with medically intractable complex partial seizures were studied with electroencephalography and MR imaging to localize an epileptogenic focus for temporal lobectomy. The patients were divided into three groups on the basis of pathologic findings after lobectomy: Group 1 comprised 13 patients with neoplasms, hamartomas, or cysts; group 2 comprised 13 patients with moderate and severe mesial temporal sclerosis (one patient was included in both groups 1 and 2); and group 3 comprised 14 patients who underwent aspiration lobectomy, which yielded limited tissue for pathologic study so no pathologic diagnosis was made. The majority of the patients in group 3 were assumed to have mesial temporal sclerosis. Abnormal MR signal in the temporal lobe on T2-weighted images was graded as minimal increase (1+), intermediate or moderate increase (2+), and very significant increase (3+). An abnormal signal was demonstrated in 26 (67%) of the 39 patients. In group 1, the tumor/cyst subgroup, an abnormal signal was seen in all 13 patients. Most had 3+ signal. There was increased signal in eight (62%) of 13 patients in group 2 and in six (43%) of 14 patients in group 3. This study suggests that MR can detect almost all tumors and a significant number of mesial temporal sclerosis lesions in individuals with complex partial seizures. On the basis of this small series, individuals who exhibit significant signal (3+) can be expected to have neoplasms, hamartomas, or cysts, and patients who exhibit minimal signal (1+) will usually have mesial temporal sclerosis.
对39例药物治疗难以控制的复杂部分性癫痫患者进行了脑电图和磁共振成像检查，以定位颞叶切除术的致痫灶。根据叶切除术后的病理结果，将患者分为三组：第1组包括13例患有肿瘤、错构瘤或囊肿的患者；第2组包括13例中度和重度内侧颞叶硬化患者（1例同时纳入第1组和第2组）；第3组包括14例行抽吸性叶切除术的患者，其病理研究组织有限，因此未做出病理诊断。第3组中的大多数患者被认为患有内侧颞叶硬化。T2加权图像上颞叶的异常磁共振信号被分为轻度增加（1+）、中度增加（2+）和显著增加（3+）。39例患者中有26例（67%）显示异常信号。在第1组（肿瘤/囊肿亚组）中，所有13例患者均可见异常信号。大多数为3+信号。第2组13例患者中有8例（62%）信号增强，第3组14例患者中有6例（43%）信号增强。本研究表明，磁共振成像可以检测出几乎所有患有复杂部分性癫痫患者的肿瘤和大量内侧颞叶硬化病变。基于这个小样本系列，显示显著信号（3+）的个体可能患有肿瘤、错构瘤或囊肿，而显示最小信号（1+）的患者通常患有内侧颞叶硬化。
