Kim J H, Tien R D, Felsberg G J, Osumi A K, Lee N, Friedman A H
Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA.
AJNR Am J Neuroradiol. 1995 Apr;16(4):627-36.
To identify the extent of hippocampal sclerosis in temporal lobe epilepsy with fast spin-echo MR and correlate it with histopathologic findings and surgical outcome.
MR images of 30 patients with temporal lobe epilepsy and pathologically proved hippocampal sclerosis and 30 control subjects were obtained using a fast spin-echo technique with 4000/100/4 (repetition time/echo time/excitations), 16 echo train, 2- to 3-mm section thickness with interleave, 256 x 256 matrix, and 18-cm field of view. Criteria for MR diagnosis of hippocampal sclerosis included hippocampal atrophy diagnosed with MR volumetry and/or T2-weighted signal change. Hippocampal sectional areas were plotted, and T2 signal changes were topographically evaluated to identify the extent of hippocampal sclerosis, which was subsequently correlated with histopathologic findings and surgical outcome.
Hippocampal sclerosis was diffuse, involving both hippocampal head and body, in 96.7% of patients (29 of 30 patients). One patient had normal MR findings. Focal hippocampal sclerosis was not seen. Histopathologic findings of hippocampal sclerosis were present in all 29 patients who had abnormal MR findings. Eighty-six percent of patients (18 of 21 patients), who were followed for at least 1 year after temporal lobectomy, were seizure free (81%, 17 of 21 patients) or significantly improved (5%, 1 of 21 patients).
Fast spin-echo MR enables accurate definition of the extent of hippocampal sclerosis in patients with temporal lobe epilepsy. All cases of hippocampal sclerosis identified in this study involved the hippocampus diffusely. However, leaving the posterior portion of the hippocampus during surgery does not seem to be a major factor influencing surgical outcome.
利用快速自旋回波磁共振成像（MR）确定颞叶癫痫中海马硬化的程度，并将其与组织病理学结果及手术效果相关联。
对30例经病理证实为海马硬化的颞叶癫痫患者及30例对照者，采用快速自旋回波技术进行MR成像，参数为4000/100/4（重复时间/回波时间/激励次数）、16个回波链、2至3毫米层厚且层间隔采集、256×256矩阵以及18厘米视野。MR诊断海马硬化的标准包括通过MR容积测量法诊断的海马萎缩和/或T2加权信号改变。绘制海马各层面面积图，并对T2信号改变进行拓扑学评估以确定海马硬化的程度，随后将其与组织病理学结果及手术效果相关联。
96.7%（30例中的29例）的患者海马硬化呈弥漫性，累及海马头部和体部。1例患者MR表现正常，未见局灶性海马硬化。29例MR表现异常的患者均有海马硬化的组织病理学表现。21例颞叶切除术后至少随访1年的患者中，86%（21例中的18例）无癫痫发作（81%，21例中的17例）或有显著改善（5%，21例中的1例）。
快速自旋回波MR能够准确界定颞叶癫痫患者海马硬化的程度。本研究中所有确诊的海马硬化病例均为海马弥漫性受累。然而，手术中保留海马后部似乎并非影响手术效果的主要因素。
