Department of Radiology, Peking University First Hospital, Beijing, China.
Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Brain Behav. 2023 Apr;13(4):e2919. doi: 10.1002/brb3.2919. Epub 2023 Mar 7.
To compare the white matter (WM) asymmetry in left and right medial temporal lobe epilepsy (mTLE) with and without hippocampal sclerosis (HS+, HS-) and assess the correlation of preoperative asymmetry and the dynamics of WM fibers with surgical outcomes.
Preoperative MRI scans were collected from 58 mTLE patients (40 HS+, 18 HS-); 15 (11 HS+, 4 HS-) then underwent postoperative MRI scans. DTI parameters, including the fractional anisotropy (FA), mean diffusion coefficient (MD), axial diffusion coefficient (AD), and radial diffusion coefficient (RD), were extracted from 20 paired WM tracts by PANDA based on the JHU WM tractography atlas. The bilateral cerebral parameters and the pre- to postoperative changes in the DTI parameters of specific fiber tracts were compared. The asymmetry indexes (AIs) of paired fibers were also analyzed.
There were fewer asymmetrical WM fibers in HS- patients than in HS+ patients. The pattern of WM asymmetry differed between left and right mTLE patients. Differences in the FA AI of the inferior fronto-occipital fasciculus and inferior longitudinal fasciculus (ILF) were found in left HS+ patients with different surgical outcomes. All mTLE patients exhibited decreases in FA and increases in MD and RD in specific ipsilateral WM fibers. In International League Against Epilepsy (ILAE) grade 1 patients, the MD values in the ipsilateral CGH increased over time, whereas the RD values in the ipsilateral ILF and the AD values in the ipsilateral ILF and UNC decreased. In ILAE grade 2-5 patients, the FA values in the ipsilateral cingulate gyrus part of the cingulum (CGC) increased over time.
The WM tract asymmetry was more extensive in HS+ patients than in HS- patients. The preoperative WM fiber AIs in left HS+ patients may be useful for surgical prognosis. Additionally, pre- to postoperative changes in WM fibers may help predict surgical outcomes.
比较伴有和不伴有海马硬化（HS+、HS-）的左、右内侧颞叶癫痫（mTLE）患者的白质（WM）不对称性，并评估术前不对称性和 WM 纤维动态与手术结果的相关性。
从 58 例 mTLE 患者（40 例 HS+，18 例 HS-）中收集术前 MRI 扫描；其中 15 例（11 例 HS+，4 例 HS-）随后进行了术后 MRI 扫描。基于 JHU WM 束追踪图谱，使用 PANDA 从 20 对 WM 束中提取弥散张量成像（DTI）参数，包括各向异性分数（FA）、平均扩散系数（MD）、轴向扩散系数（AD）和径向扩散系数（RD）。比较双侧脑参数和特定纤维束 DTI 参数的术前至术后变化。还分析了配对纤维的不对称指数（AI）。
HS-患者的 WM 纤维不对称性较少。左、右 mTLE 患者的 WM 不对称模式不同。不同手术结果的左 HS+患者的下额枕束和下纵束（ILF）FA AI 存在差异。所有 mTLE 患者在特定同侧 WM 纤维中均表现出 FA 降低和 MD 和 RD 增加。在国际抗癫痫联盟（ILAE）1 级患者中，同侧 CGH 的 MD 值随时间增加，而同侧 ILF 的 RD 值和同侧 ILF 和 UNC 的 AD 值随时间减少。在 ILAE 2-5 级患者中，同侧扣带束扣带前回（CGC）的 FA 值随时间增加。
HS+患者的 WM 束不对称性较 HS-患者更广泛。左 HS+患者术前 WM 纤维 AI 可能有助于手术预后。此外，WM 纤维的术前至术后变化可能有助于预测手术结果。
