Chu W J, Hetherington H P, Kuzniecky R I, Simor T, Mason G F, Elgavish G A
Center for NMR Research and Development, University of Alabama at Birmingham, 35294-0006, USA.
Neurology. 1998 Aug;51(2):472-9. doi: 10.1212/wnl.51.2.472.
To compare the phosphorous metabolite ratios in the mesial temporal lobe of healthy volunteers (n = 20) with the corresponding ratios in patients with temporal lobe epilepsy (n = 30) using 31P NMR spectroscopic imaging and to lateralize the seizure focus in temporal lobe epilepsy patients using various phosphorous metabolite ratios-phosphocreatine to inorganic phosphate (PCr/Pi), PCr to adenosine triphosphate (PCr/gamma-ATP), and (gamma-ATP/Pi)--and to compare with clinical lateralization results.
All 31P NMR spectroscopic imaging studies were performed on a high-field, 4.1 T, whole-body NMR spectroscopic imaging system using a 31P/1H double-tuned volume coil.
We found an average reduction of 15% in the PCr/Pi and gamma-ATP/Pi ratios compared with the corresponding ratios in healthy volunteers in the entire mesial temporal lobe, and more than a 30% reduction in these two ratios in the anterior region of the epileptogenic mesial temporal lobe. These ratios were also reduced significantly in the ipsilateral lobe when compared with their corresponding values in the contralateral lobe. In patients we lateralized the seizure focus, based on these 31P NMR data, and compared the results with the clinical lateralization. The lateralization based on either the PCr/Pi or the gamma-ATP/Pi ratio yielded a correspondence of 70 to 73% with the final clinical lateralization. In the subgroup of patients (n = 9) that needed intracranial EEG for the presurgical lateralization because of inconclusive results from the noninvasive methods, a 78% correspondence was found with the 31P NMR-based lateralization, whereas MRI provided a correspondence of only 33%, and scalp EEG provided a correspondence of only 56%.
These results suggest the utility of adding the 31P NMR method to the group of noninvasive modalities used for presurgical decision making in temporal lobe epilepsy patients.
使用31P核磁共振波谱成像技术，比较20名健康志愿者颞叶内侧的磷代谢物比率与30名颞叶癫痫患者相应比率，并利用多种磷代谢物比率——磷酸肌酸与无机磷酸盐的比率（PCr/Pi）、磷酸肌酸与三磷酸腺苷的比率（PCr/γ-ATP）以及（γ-ATP/Pi）——对颞叶癫痫患者的癫痫发作灶进行定位，并与临床定位结果进行比较。
所有31P核磁共振波谱成像研究均在一台高场4.1T全身核磁共振波谱成像系统上进行，使用31P/1H双调谐容积线圈。
我们发现，与健康志愿者整个颞叶内侧的相应比率相比，PCr/Pi和γ-ATP/Pi比率平均降低了15%，而在致痫颞叶内侧前部区域，这两个比率降低了30%以上。与对侧叶的相应值相比，同侧叶的这些比率也显著降低。在患者中，我们根据这些31P核磁共振数据对癫痫发作灶进行定位，并将结果与临床定位进行比较。基于PCr/Pi或γ-ATP/Pi比率的定位与最终临床定位的符合率为70%至73%。在因无创方法结果不明确而需要进行颅内脑电图以进行术前定位的患者亚组（n = 9）中，基于31P核磁共振的定位与临床定位的符合率为78%，而磁共振成像（MRI）的符合率仅为33%，头皮脑电图的符合率仅为56%。
这些结果表明，在用于颞叶癫痫患者术前决策的无创检查方法中增加31P核磁共振方法是有用的。
