Wang Yi-He, Wang Zhen-Ming, Wei Peng-Hu, Lu Chao, Fan Xiao-Tong, Ren Lian-Kun, Shan Yong-Zhi, Lu Jie, Zhao Guo-Guang
Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China.
Ann Transl Med. 2021 Feb;9(4):297. doi: 10.21037/atm-20-5719.
Conflicts in regarding the lateralization of the seizure onset for mesial temporal lobe epilepsy (MTLE) are frequently encountered during presurgical evaluation. As a more elaborate, quantified protocol, indices of diffusion spectrum imaging (DSI) might be sensitive to evaluate the seizure involvement. However, the accuracy was less revealed. Herein, we determined the lateralizing value of the DSI indices among MTLE patients.
Eleven MTLE patients were enrolled together with 11 matched health contrasts. All the participants underwent a DSI scan and with reconstruction of the diffusion scalar, including quantitative anisotropy (QA), isotropic (ISO), and track density imaging (TDI) values. Statistics of these indices were applied to identify the differences between the healthy and ipsilateral sides, and those between the patients and the controls, with special attention to areas of the crura of fornix (FORX), the parahippocampal radiation of the cingulum (PHCR), the hippocampus (HP), parahippocampus (PHC), amygdala (AM) and entorhinal cortex (EC).
Regarding lateralization, TDI of the FORX and the PHCR reached an AUC value of 0.95 and 0.93, respectively (P<0.05), and QA, ISO, TDI of the PHCR, as well as TDI of the FORX were statistically significant amongst the laterals of the patients (P<0.05). Also, the QA of the PHCR were statistically different in the patients' ipsilateral side relative to the contrasts (P<0.017). The diffusion level on different grey matter structures were significantly decreased including HP, AM and EC in GQI space (P<0.017).
The quantitative diffusion scalars of the DSI, especially TDI of the FORX and the PHCR, are sensitive indices to define the ipsilateral side for MTLE patients. For preliminary exploration, the use of quantitative DSI scalars may help to improve the seizure outcome by increasing the accuracy of localization and lateralization for MTLE.
在颞叶内侧癫痫（MTLE）的术前评估中，经常会遇到关于癫痫发作起始侧别判断的冲突。作为一种更精细、量化的方案，扩散谱成像（DSI）指标可能对评估癫痫发作累及情况敏感。然而，其准确性尚未充分显现。在此，我们确定了DSI指标在MTLE患者中的侧别判断价值。
纳入11例MTLE患者以及11例匹配的健康对照。所有参与者均接受DSI扫描，并重建扩散标量，包括定量各向异性（QA）、各向同性（ISO）和轨迹密度成像（TDI）值。对这些指标进行统计学分析，以确定健康侧与患侧之间以及患者与对照组之间的差异，特别关注穹窿脚（FORX）、扣带回海马旁辐射（PHCR）、海马（HP）、海马旁回（PHC）、杏仁核（AM）和内嗅皮质（EC）区域。
关于侧别判断，FORX和PHCR的TDI的曲线下面积（AUC）值分别达到0.95和0.93（P<0.05），并且患者两侧之间，PHCR的QA、ISO、TDI以及FORX的TDI具有统计学意义（P<0.05）。此外，患者患侧的PHCR的QA相对于对照组具有统计学差异（P<0.017）。在广义量化指数（GQI）空间中，不同灰质结构的扩散水平显著降低，包括HP、AM和EC（P<0.017）。
DSI的定量扩散标量，尤其是FORX和PHCR的TDI，是确定MTLE患者患侧的敏感指标。对于初步探索，使用定量DSI标量可能有助于通过提高MTLE定位和侧别判断的准确性来改善癫痫发作结果。
