Aydin Hasan, Oktay Nilay Aydin, Kizilgoz Volkan, Altin Elif, Tatar Idil Gunes, Hekimoglu Baki
MRI Department, S.B. Ankara Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey.
Iran J Radiol. 2012 Mar;9(1):1-11. doi: 10.5812/iranjradiol.6686. Epub 2012 Mar 25.
Epilepsy, a well-known mostly idiopathic neurologic disorder, has to be correctly diagnosed and properly treated. Up to now, several diagnostic approaches have been processed to determine the epileptic focus.
The aim of this study was to discover whether proton-MR-spectroscopic imaging (MRSI) aids in the diagnosis of temporal lobe epilepsy in conjunction with classical electroencephalography (EEG) findings.
Totally, 70 mesial temporal zones consisting of 39 right hippocampi and 31 left hippocampi of 46 patients (25 male, 21 female) were analyzed by proton MRSI. All patients underwent a clinical neurologic examination, scalp EEG recording and prolonged video EEG monitoring. Partial seizures on the right, left or both sides were recorded in all patients. All patients were under medical treatment and none of the patients underwent amygdalohippocampectomy and similar surgical procedures.
The normal average lactate (Lac), phosphocreatine, N-acetyl aspartate (NAA), creatine (Cr), choline (Cho), myo-inositol, glutamate and glutamine (Glx) peaks and Nacetyl aspartate/Cr, NAA/ Cho + Cr, Cho/Cr ratios were measured from the healthy opposite hippocampi or from the control subjects. The Lac, glutamate and glutamine (Glx), myo-inositol, phosphocreatine and NAA metabolites plus Cho/Cr ratio showed statistical difference between the normal and the epileptic hippocampi. Cho, Cr metabolites plus NAA/Cr, NAA/ Cho + Cr ratios were almost the same between the groups. The sensitivity of Proton-MR-Spectroscopy for lateralization of the epileptic foci in all patients was 96% and the specificity was 50%.
Proton-MRSI can easily be considered as an alternative modality of choice in the diagnosis of temporal lobe epilepsy and in the future; Proton-MR-Spectroscopy may become the most important technique used in epilepsy centers.
癫痫是一种广为人知的多为特发性的神经系统疾病，必须得到正确诊断和恰当治疗。到目前为止，已经采用了几种诊断方法来确定癫痫病灶。
本研究的目的是探究质子磁共振波谱成像（MRSI）结合经典脑电图（EEG）结果是否有助于颞叶癫痫的诊断。
对46例患者（25例男性，21例女性）的70个内侧颞叶区域进行分析，其中包括39个右侧海马体和31个左侧海马体，采用质子MRSI。所有患者均接受了临床神经学检查、头皮脑电图记录和长时间视频脑电图监测。所有患者均记录了右侧、左侧或双侧的部分性发作。所有患者均接受药物治疗，且无一例患者接受杏仁核海马切除术及类似手术。
从健康的对侧海马体或对照组受试者中测量了正常的平均乳酸（Lac）、磷酸肌酸、N-乙酰天门冬氨酸（NAA）、肌酸（Cr）、胆碱（Cho）、肌醇、谷氨酸和谷氨酰胺（Glx）峰值以及N-乙酰天门冬氨酸/肌酸、NAA/胆碱+肌酸、胆碱/肌酸比值。Lac、谷氨酸和谷氨酰胺（Glx）、肌醇、磷酸肌酸和NAA代谢物以及胆碱/肌酸比值在正常海马体和癫痫海马体之间存在统计学差异。胆碱、肌酸代谢物以及NAA/肌酸、NAA/胆碱+肌酸比值在各组之间几乎相同。质子磁共振波谱对所有患者癫痫病灶定位的敏感性为96%，特异性为50%。
质子MRSI很容易被视为颞叶癫痫诊断的一种替代选择方式，并且在未来，质子磁共振波谱可能会成为癫痫中心使用的最重要技术。
