7T 磁共振成像在局灶性皮质发育不良 IIa 型和癫痫患者中的临床应用。
Clinical Application of 7T Magnetic Resonance Imaging in Patients with Focal Cortical Dysplasia IIa and Epilepsy.
机构信息
Functional Neurosurgery Department, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China.
State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China.
出版信息
Stereotact Funct Neurosurg. 2021;99(3):212-220. doi: 10.1159/000511152. Epub 2020 Dec 11.
BACKGROUND
Focal cortical dysplasia (FCD) is one of the most important pathogenic findings in patients with extratemporal lobe epilepsy. Magnetic resonance imaging (MRI)-negative is the most important negative factor to predict postoperative seizure freedom; however, FCD-I and part of FCD-IIa are MRI-negative on routine MRI.
OBJECTIVES
To explore the diagnostic values of 7T MRI and its new scan sequences in epilepsy patients with FCD-IIa.
METHODS
To include patients with focal seizure and suspicious focal abnormal imaging on 3T MRI during preoperative evaluation and perform a 7T MRI scan with white matter-suppressed (WMS) and gray-white matter tissue border enhancement (GWBE) sequences, resective epilepsy surgery, and postoperative pathological finding of FCD-IIa. The preoperative qualitative and localization significance of 7T MRI and 3T MRI in lesions with FCD-IIa was compared, and then, the imaging characteristics of lesions with FCD-IIa on 7T MRI were analyzed.
RESULTS
Ten cases were enrolled in this study. Seven tesla MRI presented high spatial resolutions and a high signal-to-noise ratio. WMS and GWBE could selectively suppress the signal of special tissue and improved the possibility of FCD findings. FCD-IIa showed abnormal thickness of gray matter and a blurring border and was hypointense on 7T MRI compared with 3T MRI. Seven patients showed improvement in the qualitative diagnosis strength grade of FCD, and 6 subjects showed improvement in the localization strength grade of the lesion border after careful reading of the 7T MR images. Significant differences were found in the qualitative diagnosis of FCD (p < 0.05) and localization of the lesion border (p < 0.05) between the neuroimaging diagnoses based on 3T MRI and the findings based on 7T MRI.
CONCLUSION
7T MRI with WMS and GWBE sequences shows application value in the preoperative imaging diagnosis of lesions with FCD-IIa in epilepsy patients.
背景
局灶性皮质发育不良（FCD）是颞叶外癫痫患者最重要的致病发现之一。磁共振成像（MRI）阴性是预测术后无癫痫发作最重要的负因素；然而，常规 MRI 上 FCD-I 和部分 FCD-IIa 为 MRI 阴性。
目的
探讨 7T MRI 及其新扫描序列在 FCD-IIa 癫痫患者中的诊断价值。
方法
纳入术前评估中 3T MRI 显示局灶性发作和可疑局灶性异常影像的局灶性癫痫患者，并进行 7T MRI 扫描，采用白质抑制（WMS）和灰质-白质组织边界增强（GWBE）序列，行切除性癫痫手术，术后病理发现 FCD-IIa。比较 FCD-IIa 病变 7T MRI 与 3T MRI 的术前定性和定位意义，分析 FCD-IIa 病变的影像学特征。
结果
本研究纳入 10 例患者。7T MRI 具有较高的空间分辨率和较高的信噪比。WMS 和 GWBE 可以选择性地抑制特殊组织的信号，提高 FCD 发现的可能性。FCD-IIa 在 7T MRI 上显示灰质厚度异常、边界模糊，与 3T MRI 相比呈低信号。7 例患者 FCD 的定性诊断强度分级提高，6 例患者仔细阅读 7T MRI 图像后病变边界定位强度分级提高。3T MRI 神经影像学诊断与 7T MRI 检查结果在 FCD 的定性诊断（p<0.05）和病变边界的定位（p<0.05）方面差异有统计学意义。
结论
WMS 和 GWBE 序列的 7T MRI 在癫痫患者 FCD-IIa 病变的术前影像诊断中具有应用价值。
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