Duncan John S, Winston Gavin P, Koepp Matthias J, Ourselin Sebastien
Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University College London, London, UK; National Hospital for Neurology and Neurosurgery, London, UK; Chalfont Centre for Epilepsy, Chalfont St Peter, Gerrards Cross, UK.
Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, University College London, London, UK; National Hospital for Neurology and Neurosurgery, London, UK; Chalfont Centre for Epilepsy, Chalfont St Peter, Gerrards Cross, UK.
Lancet Neurol. 2016 Apr;15(4):420-33. doi: 10.1016/S1474-4422(15)00383-X. Epub 2016 Feb 24.
Brain imaging has a crucial role in the presurgical assessment of patients with epilepsy. Structural imaging reveals most cerebral lesions underlying focal epilepsy. Advances in MRI acquisitions including diffusion-weighted imaging, post-acquisition image processing techniques, and quantification of imaging data are increasing the accuracy of lesion detection. Functional MRI can be used to identify areas of the cortex that are essential for language, motor function, and memory, and tractography can reveal white matter tracts that are vital for these functions, thus reducing the risk of epilepsy surgery causing new morbidities. PET, SPECT, simultaneous EEG and functional MRI, and electrical and magnetic source imaging can be used to infer the localisation of epileptic foci and assist in the design of intracranial EEG recording strategies. Progress in semi-automated methods to register imaging data into a common space is enabling the creation of multimodal three-dimensional patient-specific datasets. These techniques show promise for the demonstration of the complex relations between normal and abnormal structural and functional data and could be used to direct precise intracranial navigation and surgery for individual patients.
脑成像在癫痫患者的术前评估中起着至关重要的作用。结构成像可揭示大多数局灶性癫痫潜在的脑部病变。包括扩散加权成像、采集后图像处理技术以及成像数据量化在内的磁共振成像（MRI）采集技术的进步，正在提高病变检测的准确性。功能MRI可用于识别对语言、运动功能和记忆至关重要的皮质区域，而纤维束成像可揭示对这些功能至关重要的白质束，从而降低癫痫手术导致新发病变的风险。正电子发射断层扫描（PET）、单光子发射计算机断层扫描（SPECT）、同步脑电图和功能MRI以及电和磁源成像可用于推断癫痫灶的定位，并协助设计颅内脑电图记录策略。将成像数据配准到共同空间的半自动方法的进展，使得能够创建多模态三维患者特异性数据集。这些技术有望展示正常与异常结构和功能数据之间的复杂关系，并可用于指导针对个体患者的精确颅内导航和手术。
