动脉自旋标记灌注和扩散加权磁共振成像在非惊厥性部分性癫痫持续状态诊断中的初步应用。
The initial use of arterial spin labeling perfusion and diffusion-weighted magnetic resonance images in the diagnosis of nonconvulsive partial status epileptics.
作者信息
Shimogawa Takafumi, Morioka Takato, Sayama Tetsuro, Haga Sei, Kanazawa Yuka, Murao Kei, Arakawa Shuji, Sakata Ayumi, Iihara Koji
机构信息
Department of Neurosurgery, Kyushu Rosai Hospital, 1-1 Sonekitamachi, Kokura Minami-Ku, Kitakyushu 800-0296, Japan; Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; Department of Neurosurgery, Fukuoka Children's Hospital, 5-1-1 Kashiiteriha, Higashi-ku, Fukuoka 813-0017, Japan.
Department of Neurosurgery, Kyushu Rosai Hospital, 1-1 Sonekitamachi, Kokura Minami-Ku, Kitakyushu 800-0296, Japan; Department of Neurosurgery, Fukuoka Children's Hospital, 5-1-1 Kashiiteriha, Higashi-ku, Fukuoka 813-0017, Japan.
出版信息
Epilepsy Res. 2017 Jan;129:162-173. doi: 10.1016/j.eplepsyres.2016.12.008. Epub 2016 Dec 21.
BACKGROUND
In the diagnosis of nonconvulsive status epilepticus (NCSE), capture of ongoing ictal electroencephalographic (EEG) findings is the gold standard; however, this is practically difficult without continuous EEG monitoring facilities. Magnetic resonance imaging (MRI), including diffusion-weighted imaging (DWI) and perfusion MRI with arterial spin labeling (ASL), have been applied mainly in emergency situations. Recent reports have described that ictal MRI findings, including ictal hyperperfusion on ASL and cortical hyperintensity of cytotoxic edema on DWI, can be obtained from epileptically activated cortex. We demonstrate the characteristics and clinical value of ictal MRI findings.
METHODS
Fifteen patients diagnosed as having NCSE (eight had complex partial status epilepticus (SE) and seven subtle SE) who underwent an initial MRI and subsequent EEG confrmation, participated in this study. Follow-up MRI and repeated routine EEG were performed.
RESULTS
In 11 patients (73%), ictal MRI findings were obtained on both DWI and ASL, while in four (27%) patients, ictal hyperperfusion was found on ASL without any DWI findings being obtained. In all 10 patients with an epileptogenic lesion, there was a tight topographical relationship between the lesion and the localization of ictal MRI findings. In the other five patients, ictal MRI findings were useful to demonstrate the pathophysiological mechanism of NCSE of non-lesional elderly epilepsy, or 'de novo' NCSE of frontal origin as situation-related NCSE. Ictal MRI findings are generally transient; however, in three cases they still persisted, even though ictal EEG findings had completely improved.
CONCLUSION
The present study clearly demonstrates that the initial use of ASL and DWI could help to diagnose partial NCSE and also combined use of the MRI and EEG allows documentation of the pathophysiological mechanism in each patient.
背景
在非惊厥性癫痫持续状态（NCSE）的诊断中，捕捉正在发作的发作期脑电图（EEG）表现是金标准；然而，在没有连续EEG监测设备的情况下，这在实际操作中很困难。磁共振成像（MRI），包括弥散加权成像（DWI）和动脉自旋标记灌注MRI（ASL），主要应用于紧急情况。最近的报告描述了发作期MRI表现，包括ASL上的发作期高灌注和DWI上细胞毒性水肿的皮质高信号，可以从癫痫激活的皮质获得。我们展示了发作期MRI表现的特征和临床价值。
方法
15例被诊断为NCSE的患者（8例为复杂部分性癫痫持续状态（SE），7例为轻微SE）接受了初始MRI检查及随后的EEG确认，参与了本研究。进行了随访MRI和重复的常规EEG检查。
结果
11例患者（73%）在DWI和ASL上均获得了发作期MRI表现，而4例（27%）患者在ASL上发现了发作期高灌注，未获得任何DWI表现。在所有10例有癫痫病灶的患者中，病灶与发作期MRI表现的定位之间存在紧密的地形学关系。在其他5例患者中，发作期MRI表现有助于阐明非病灶性老年癫痫的NCSE或额叶起源的“新发”NCSE作为情境相关NCSE的病理生理机制。发作期MRI表现通常是短暂的；然而，在3例病例中，即使发作期EEG表现已完全改善，它们仍然持续存在。
结论
本研究清楚地表明，最初使用ASL和DWI有助于诊断部分性NCSE，并且MRI和EEG的联合使用能够记录每个患者的病理生理机制。
Zotero 插件