Lee D H, Gao F Q, Rogers J M, Gulka I, Mackenzie I R, Parrent A G, Kubu C S, Munoz D G, McLachlan R S, Blume W T, Girvin J P
Department of Diagnostic Radiology, London Health Sciences Center, University of Western Ontario, Canada.
AJNR Am J Neuroradiol. 1998 Jan;19(1):19-27.
We evaluated the MR findings in patients with temporal lobe epilepsy to determine the predictive value of MR imaging in assessing patient outcome.
MR studies from 186 of 274 consecutive patients who underwent temporal lobectomy for intractable epilepsy were reviewed retrospectively. Images were interpreted by an experienced neuroradiologist, who was blinded to the side of seizure activity and to pathologic findings.
MR imaging exhibited 93% sensitivity and 83% specificity in detecting hippocampal/amygdalar abnormalities (n = 121), and 97% sensitivity and 97% specificity in detecting abnormalities in the rest of the temporal lobe (n = 60). Abnormal high signal of the hippocampus on T2-weighted images had a sensitivity of 93% and specificity of 74% in predicting mesial temporal sclerosis (n = 115). The presence of hippocampal atrophy on MR correlated with the duration of seizures. Sensitivity and specificity of MR imaging in detecting temporal lobe tumors (n = 42) were 83% and 97%, respectively, based on abnormal signal and mass effect. After surgery, 63% of patients were seizure free and 28% had a significant reduction of seizure frequency at an average of 24 months (range, 12 to 78 months) after surgery. Patients with a single lesion in the anterior temporal lobe or hippocampus/amygdala had a better outcome than patients with multiple lesions (n = 22). Interrater agreement varied from 0.4 to 0.93, with best agreement for tumors or abnormal hippocampal signal on T2-weighted images.
MR imaging is highly sensitive in detecting and locating abnormalities in the temporal lobe and the hippocampus/amygdala in patients with temporal lobe epilepsy. Hippocampal atrophy appears to correspond to the duration of seizure disorder.
我们评估了颞叶癫痫患者的磁共振成像（MR）表现，以确定MR成像在评估患者预后方面的预测价值。
回顾性分析了274例因难治性癫痫接受颞叶切除术的连续患者中186例的MR研究。图像由一位经验丰富的神经放射科医生解读，该医生对癫痫发作部位和病理结果不知情。
MR成像在检测海马体/杏仁核异常（n = 121）方面表现出93%的敏感性和83%的特异性，在检测颞叶其他部位异常（n = 60）方面表现出97%的敏感性和97%的特异性。T2加权图像上海马体的异常高信号在预测内侧颞叶硬化（n = 115）方面的敏感性为93%，特异性为74%。MR上海马体萎缩的存在与癫痫发作持续时间相关。基于异常信号和占位效应，MR成像在检测颞叶肿瘤（n = 42）方面的敏感性和特异性分别为83%和97%。术后，63%的患者无癫痫发作，28%的患者癫痫发作频率显著降低，平均在术后24个月（范围为12至78个月）。颞叶前部或海马体/杏仁核有单个病变的患者比有多个病变的患者（n = 22）预后更好。观察者间一致性在0.4至0.93之间，T2加权图像上肿瘤或海马体异常信号的一致性最佳。
MR成像在检测和定位颞叶癫痫患者颞叶及海马体/杏仁核的异常方面高度敏感。海马体萎缩似乎与癫痫发作障碍的持续时间相关。
