Li L M, Fish D R, Sisodiya S M, Shorvon S D, Alsanjari N, Stevens J M
Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK.
J Neurol Neurosurg Psychiatry. 1995 Oct;59(4):384-7. doi: 10.1136/jnnp.59.4.384.
In the past the underlying structural abnormalities leading to the development of chronic seizure disorders have usually only been disclosed by histological examination of surgical or postmortem material, due to their often subtle nature that was beyond the resolution of CT or early MRI. The MRI findings in 341 patients with chronic, refractory epilepsy attending The National Hospital for Neurology and Neurosurgery and Chalfont Centre for Epilepsy are reported. Studies were performed on a 1.5 Tesla scanner with a specific volumetric protocol, allowing the reconstruction of 1.5 mm contiguous slices throughout the whole brain. Direct visual inspection of the two dimensional images without the use of additional quantitative measures showed that 254/341 (74%) were abnormal. Twenty four (7%) patients had more than one lesion. The principal MRI diagnoses were hippocampal asymmetry (32%), cortical dysgenesis (12%), tumour (12%), and vascular malformation (8%). Pathological confirmation was available from surgical specimens in 70 patients and showed a very high degree of sensitivity and specificity for the different entities. The advent of more widely available high resolution MRI should make it possible to identify the underlying pathological substrate in most patients with chronic partial epilepsy. This will allow a fundamental reclassification of the epilepsies for both medical and surgical management, with increasing precision as new methods (both of acquisition and postprocessing) are added to the neuroimaging battery used in clinical practice.
过去，导致慢性癫痫疾病发生的潜在结构异常通常只有在对手术或尸检材料进行组织学检查时才能被发现，因为这些异常往往很细微，超出了CT或早期MRI的分辨率。本文报告了在国立神经病学与神经外科医院及查尔方特癫痫中心就诊的341例慢性难治性癫痫患者的MRI检查结果。研究使用1.5特斯拉扫描仪并采用特定的容积扫描方案，能够重建全脑1.5毫米连续切片。在不使用额外定量测量方法的情况下直接观察二维图像发现，254/341（74%）例患者存在异常。24例（7%）患者有不止一处病变。主要的MRI诊断结果为海马不对称（32%）、皮质发育异常（12%）、肿瘤（12%）和血管畸形（8%）。70例患者的手术标本有病理确诊结果，对不同病变的敏感度和特异度都很高。更广泛应用的高分辨率MRI的出现，应能使大多数慢性部分性癫痫患者的潜在病理基础得以识别。这将使癫痫在药物和手术治疗方面的基本分类得以重新进行，随着临床实践中使用的神经影像学手段加入新的方法（采集和后处理方面），分类的精确性也会不断提高。
