Hsu Y Y, Chang C N, Chu N S, Chang C, Hsu J C
Department of Radiology, Chang Gung Medical College, Taipei, Taiwan ROC.
J Formos Med Assoc. 1997 Aug;96(8):593-8.
We prospectively studied eight patients with complex partial seizures, using single-voxel proton magnetic resonance spectroscopy (MRS). Control data from 12 healthy volunteers were obtained with the same MRS protocol. The ratios between the peak areas of N-acetylaspartate, creatine and phosphocreatine (Cr), and choline-containing compounds (Cho) were analyzed. The results showed statistically significant lower N-acetylaspartate:Cr, N-acetylaspartate:Cho, and N-acetylaspartate: Cho + Cr ratios, and a higher Cho:Cr ratio in the mesial temporal lobes of the patient group than in healthy controls. Because N-acetylaspartate is located in the neurons and Cho and Cr in the glial cells, these observations represent the underlying neuronal loss and reactive astrocytosis in the epileptogenic foci. MRS can detect abnormal metabolic changes in most complex partial seizure patients with normal electroencephalography and magnetic resonance images. MRS can also identify bitemporal abnormalities which are a common feature in patients with complex partial seizures. Proton MRS could not confirm the specific location of seizure foci. Further investigation with quantitative spectral analysis and correlation with surgical outcome is needed to improve the contribution of MRS to the diagnosis and localization of seizure foci.
我们采用单体素质子磁共振波谱（MRS）对8例复杂部分性发作患者进行了前瞻性研究。使用相同的MRS方案获取了12名健康志愿者的对照数据。分析了N-乙酰天门冬氨酸、肌酸和磷酸肌酸（Cr）以及含胆碱化合物（Cho）的峰面积之间的比率。结果显示，与健康对照组相比，患者组内侧颞叶的N-乙酰天门冬氨酸:Cr、N-乙酰天门冬氨酸:Cho以及N-乙酰天门冬氨酸:Cho + Cr比率在统计学上显著降低，而Cho:Cr比率更高。由于N-乙酰天门冬氨酸位于神经元中，而Cho和Cr位于神经胶质细胞中，这些观察结果代表了致痫灶中潜在的神经元丢失和反应性星形细胞增生。MRS能够在大多数脑电图和磁共振图像正常的复杂部分性发作患者中检测到异常代谢变化。MRS还能够识别双侧颞叶异常，这是复杂部分性发作患者的一个常见特征。质子MRS无法确定癫痫灶的具体位置。需要通过定量光谱分析以及与手术结果的相关性进行进一步研究，以提高MRS对癫痫灶诊断和定位的贡献。
