Martin Pascal, Bender Benjamin, Focke Niels K
1 Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, 2 Department of Diagnostic and Interventional Neuroradiology, University of Tübingen, 72076 Tübingen, Germany.
Quant Imaging Med Surg. 2015 Apr;5(2):188-203. doi: 10.3978/j.issn.2223-4292.2015.01.10.
Currently, a relevant proportion of all histopathologically proven focal cortical dysplasia (FCD) escape visual detection; this shows the need for additional improvements in analyzing MRI data. A positive MRI is still the strongest prognostic factor for postoperative freedom of seizures. Among several post-processing methods voxel-based morphometry (VBM) of T1- and T2-weighted sequences and T2 relaxometry are routinely applied in pre-surgical diagnostics of cryptogenic epilepsy in epilepsy centers. VBM is superior to conventional visual analysis with 9-15% more identified epileptogenic foci, while T2 relaxometry has its main application in (mesial) temporal lobe epilepsy. Further methods such as surface-based morphometry (SBM) or diffusion tensor imaging are promising but there is a lack of current studies comparing their individual diagnostic value. Post-processing methods represent an important addition to conventional visual analysis but need to be interpreted with expertise and experience so that they should be apprehended as a complementary tool within the context of the multi-modal evaluation of epilepsy patients. This review will give an overview of existing post-processing methods of structural MRI and outline their clinical relevance in detection of epileptogenic structural changes.
目前，在所有经组织病理学证实的局灶性皮质发育不良（FCD）中，有相当一部分无法通过肉眼检测出来；这表明在分析MRI数据方面还需要进一步改进。MRI呈阳性仍然是术后无癫痫发作的最强预后因素。在几种后处理方法中，基于体素的形态学测量（VBM）的T1加权和T2加权序列以及T2弛豫测量法在癫痫中心的隐源性癫痫术前诊断中经常应用。VBM优于传统的视觉分析，可多识别出9%至15%的致痫灶，而T2弛豫测量法主要应用于（内侧）颞叶癫痫。诸如基于表面的形态学测量（SBM）或扩散张量成像等进一步的方法很有前景，但目前缺乏比较它们各自诊断价值的研究。后处理方法是对传统视觉分析的重要补充，但需要专业知识和经验来解读，因此在癫痫患者的多模态评估中应将其视为一种辅助工具。本综述将概述现有的结构MRI后处理方法，并概述它们在检测致痫性结构变化方面的临床相关性。
