Xu Shang-Wen, Xi Ji-Hui, Lin Chen, Wang Xiao-Yang, Fu Li-Yuan, Kralik Stephen Francis, Chen Zi-Qian
Department of Medical Imaging, Fuzhou General Hospital, Xi'erhuan Beilu, Fuzhou, Fujian, PR China DABR Department of Radiology Mayo Clinic Department of Radiology and Imaging Science, Indiana University School of Medicine, Indianapolis, IN.
Medicine (Baltimore). 2018 Aug;97(33):e11803. doi: 10.1097/MD.0000000000011803.
Noninvasive imaging plays a pivotal role in assessing the brain structural and functional changes in presurgical mesial temporal lobe epilepsy (MTLE) patients. Our goal was to study the relationship between the changes of cerebral white matter (WM) and cognitive functions in MTLE patients.Voxel-based morphometry (VBM) and tract-based spatial statistics (TBSS) MRI were performed on 24 right-handed MTLE patients (12 with left MTLE and 12 with right MTLE) and 12 matching healthy controls. Gray matter (GM), WM, and whole brain (WB) volumes were measured with VBM while fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were measured with TBSS. All patients and controls also underwent Montreal Cognitive Assessment (MoCA) before MRI.WM volume and the ratio of WM volume versus WB volume were significantly lower in MTLE patients compared with controls. WM volume in MTLE patients had a positive correlation with MoCA score (r = 0.71, P < .001) and a negative correlation with the duration of epilepsy (r = -0.693, P < .001). Volumetric differences were mainly located in the corpus callosum, uncinate fasciculus, inferior longitudinal fasciculus, and superior longitudinal fasciculus. FA of both left MTLE and right MTLE groups was significantly decreased, while MD, AD, and RD were significantly increased. Most left MTLE patients showed bilateral WM fiber tract changes versus ipsilateral changes for right MTLE patients.Changes in DTI parameters and WM volume were found in MTLE patients and more ipsilateral changes were seen with right-sided MTLE. Cognitive changes of MTLE patients were found to be correlated with the changes in WM structure. These findings not only provide useful information for lateralization of the seizure focus but can also be used to explain functional connectivity disorders which may be an important physiological basis for cognitive changes in patients with MTLE.
无创成像在评估内侧颞叶癫痫（MTLE）患者术前脑结构和功能变化中起着关键作用。我们的目标是研究MTLE患者脑白质（WM）变化与认知功能之间的关系。对24名右利手MTLE患者（12例左侧MTLE和12例右侧MTLE）和12名匹配的健康对照者进行了基于体素的形态学测量（VBM）和基于纤维束的空间统计学（TBSS）磁共振成像（MRI）。用VBM测量灰质（GM）、WM和全脑（WB）体积，同时用TBSS测量各向异性分数（FA）、平均扩散率（MD）、轴向扩散率（AD）和径向扩散率（RD）。所有患者和对照者在MRI检查前均接受了蒙特利尔认知评估（MoCA）。与对照组相比，MTLE患者的WM体积以及WM体积与WB体积之比显著降低。MTLE患者的WM体积与MoCA评分呈正相关（r = 0.71，P < 0.001），与癫痫发作持续时间呈负相关（r = -0.693，P < 0.001）。体积差异主要位于胼胝体、钩束、下纵束和上纵束。左侧MTLE组和右侧MTLE组的FA均显著降低，而MD、AD和RD均显著升高。大多数左侧MTLE患者表现为双侧WM纤维束改变，而右侧MTLE患者表现为同侧改变。MTLE患者出现了DTI参数和WM体积的变化，右侧MTLE患者出现了更多同侧改变。发现MTLE患者的认知变化与WM结构变化相关。这些发现不仅为癫痫灶的定位提供了有用信息，还可用于解释功能连接障碍，这可能是MTLE患者认知变化的重要生理基础。
