Departments of Neurology, West China Hospital, Sichuan University, Chengdu, China.
Departments of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital, Sichuan University, Chengdu, China.
Eur J Neurol. 2017 Dec;24(12):1471-1478. doi: 10.1111/ene.13441. Epub 2017 Oct 6.
This study aimed to assess the evolution of perinodular and contralateral white matter abnormalities in patients with periventricular nodular heterotopia (PNH) and epilepsy.
Diffusion tensor imaging (DTI) (64 directions) and 3 T structural magnetic resonance imaging were performed in 29 PNH patients (mean age 27.3 years), and 16 patients underwent a second scan (average time between the two scans 1.1 years). Fractional anisotropy and mean diffusivity were measured within the perilesional and contralateral white matter.
Longitudinal analysis showed that white matter located 10 mm from the focal nodule displayed characteristics intermediate to tissue 5 mm away, and normal-appearing white matter (NAWM) also established evolution profiles of perinodular white matter in different cortical lobes. Compared to 29 age- and sex-matched healthy controls, significant decreased fractional anisotropy and elevated mean diffusivity values were observed in regions 5 and 10 mm from nodules (P < 0.01), whilst DTI metrics of the remaining NAWM did not differ significantly from controls. Additionally, normal DTI metrics were shown in the contralateral region in patients with unilateral PNH.
Periventricular nodular heterotopia is associated with microstructural abnormalities within the perilesional white matter and the extent decreases with increasing distance from the nodule. In the homologous contralateral region, white matter diffusion metrics were unchanged in unilateral PNH. These findings have clinical implications with respect to the medical and surgical interventions of PNH-related epilepsy.
本研究旨在评估脑室周围结节性异位（PNH）伴癫痫患者的结节周和对侧白质异常演变。
对 29 例 PNH 患者（平均年龄 27.3 岁）进行了扩散张量成像（DTI）（64 个方向）和 3T 结构磁共振成像检查，其中 16 例患者进行了第二次扫描（两次扫描之间的平均时间为 1.1 年）。在病灶周围和对侧白质内测量各向异性分数和平均弥散系数。
纵向分析显示，距病灶 10mm 的白质表现出介于 5mm 远处组织和正常外观白质（NAWM）之间的特征，不同皮质脑回的 NAWM 也建立了结节周白质的演变特征。与 29 名年龄和性别匹配的健康对照者相比，距结节 5mm 和 10mm 处的各向异性分数显著降低，平均弥散系数显著升高（P<0.01），而其余 NAWM 的 DTI 指标与对照组无显著差异。此外，单侧 PNH 患者对侧区域的 DTI 指标正常。
脑室周围结节性异位与病灶周围白质的微观结构异常有关，且随着与结节距离的增加，异常程度逐渐减轻。在单侧 PNH 的同源对侧区域，白质弥散指标无变化。这些发现对 PNH 相关癫痫的医学和手术干预具有临床意义。
