Cendes F, Leproux F, Melanson D, Ethier R, Evans A, Peters T, Andermann F
Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada.
J Comput Assist Tomogr. 1993 Mar-Apr;17(2):206-10. doi: 10.1097/00004728-199303000-00008.
In this study we compared the results of qualitative visual analysis of MRI with volumetric studies of the amygdala (AM) and hippocampal formation (HF) in a group of 31 patients. Twenty-six patients with temporal lobe epilepsy (TLE) and six with non-TLE had MRI studies using a 1.5 T Gyroscan following a specific protocol for scan acquisition. The MR images were interpreted by two blinded radiologists and by a third if discrepancy arose. Volumetric studies were carried out by one or two raters. The volumetric measurements of AM and HF were accurate in lateralizing the epileptogenic area in patients with TLE, concordant with the EEG in 92%; there was no false lateralization. In those patients who underwent surgery, there was a correlation between the degree of mesial temporal sclerosis demonstrated by histopathology, the amount of volume reduction, and the asymmetry. In patients with non-TLE, there was no volume asymmetry of AM or HF. The MR qualitative assessment yielded positive lateralization in patients with TLE in 56%, conflicting lateralization in 20%, and lateralization contralateral to the focus in 12%. A hyperintense signal in mesial structures was found ipsilateral to the focus in 40% and contralateral in 12% of patients with TLE. Volumetric study improves the diagnostic yield of MRI evaluation in patients with TLE not related to gross structural lesions. The interrater variability is low and the data are accurate and reproducible. Because they are quantitative, volumetric studies permit better comparison of results in different subgroups of patients with TLE.
在本研究中，我们比较了31例患者的MRI定性视觉分析结果与杏仁核（AM）和海马结构（HF）的体积研究结果。26例颞叶癫痫（TLE）患者和6例非TLE患者按照特定的扫描采集方案，使用1.5T Gyroscan进行了MRI检查。MR图像由两名不知情的放射科医生解读，如有分歧则由第三名医生解读。体积研究由一两名评估者进行。AM和HF的体积测量在定位TLE患者的致痫区域方面是准确的，与脑电图的一致性为92%；没有假定位。在接受手术的患者中，组织病理学显示的内侧颞叶硬化程度、体积缩小量和不对称性之间存在相关性。在非TLE患者中，AM或HF没有体积不对称。MR定性评估在TLE患者中产生阳性定位的比例为56%，冲突定位的比例为20%，与病灶对侧定位的比例为12%。在40%的TLE患者中，在内侧结构中发现了与病灶同侧的高强度信号，在12%的患者中发现了与病灶对侧的高强度信号。体积研究提高了与明显结构病变无关的TLE患者MRI评估的诊断率。评估者间的变异性较低，数据准确且可重复。由于它们是定量的，体积研究允许更好地比较不同TLE患者亚组的结果。
