Atsina Kofi-Buaku, Sharan Ashwini D, Wu Chengyuan, Evans James J, Sperling Michael R, Skidmore Christopher T, Gorniak Richard J
1 Department of Radiology, Thomas Jefferson University, 132 S 10th St, Main Bldg, Ste 780A, Philadelphia, PA 19107.
2 Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA.
AJR Am J Roentgenol. 2017 Jan;208(1):48-56. doi: 10.2214/AJR.16.16144. Epub 2016 Sep 22.
Laser interstitial thermal therapy (LITT), a method for ablating brain tissue under real-time MR thermometry, has been used more frequently in recent years to treat nonmalignant lesions. The purpose of this study is to longitudinally characterize MRI features after LITT in patients with drug-resistant epilepsy, primarily in the setting of mesial temporal sclerosis.
MR images from 23 consecutive patients who underwent LITT were retrospectively reviewed. All patients had images obtained immediately after the ablation. Multiple patients had follow-up imaging at various time points after treatment, from postoperative days 7 through 1539. A total of 54 MRI studies were reviewed.
Immediately after LITT, MR images showed a ring-enhancing lesion at the ablation site with minimal surrounding edema. Seven images showed increased enhancement of the ipsilateral choroid plexus. Images in the subacute phase showed a mild increase in edema with similar enhancement. Images in the transitional phase showed a decrease in edema with variable enhancement. Images in the chronic phase showed minimal gliosis with or without cavity formation or cavity formation alone, with either decreased or no enhancement.
This report describes the time course of the imaging findings after LITT for drug-resistant epilepsy. The typical stages include rim-enhancing lesion with minimal edema, followed by an increase in edema, to eventual gliosis and nonenhancing cavity formation. Radiologists need to be familiar with the postablation findings to minimize misdiagnosis and prevent unnecessary workup.
激光间质热疗（LITT）是一种在实时磁共振测温下消融脑组织的方法，近年来在治疗非恶性病变方面应用更为频繁。本研究的目的是纵向描述耐药性癫痫患者接受LITT治疗后的MRI特征，主要是在颞叶内侧硬化的情况下。
回顾性分析23例连续接受LITT治疗患者的MR图像。所有患者在消融后立即进行了图像采集。多名患者在治疗后的不同时间点进行了随访成像，从术后第7天至1539天。共回顾了54项MRI研究。
LITT术后即刻，MR图像显示消融部位有环形强化病变，周围水肿轻微。7幅图像显示同侧脉络丛强化增加。亚急性期图像显示水肿轻度增加，强化相似。过渡期图像显示水肿减轻，强化不一。慢性期图像显示轻度胶质增生，有或无空洞形成或仅有空洞形成，强化减少或无强化。
本报告描述了耐药性癫痫患者接受LITT治疗后影像学表现的时间进程。典型阶段包括边缘强化病变伴轻微水肿，随后水肿增加，最终出现胶质增生和无强化的空洞形成。放射科医生需要熟悉消融后的表现，以尽量减少误诊并避免不必要的检查。
