Chan S, Chin S S, Nordli D R, Goodman R R, DeLaPaz R L, Pedley T A
Department of Radiology, Columbia-Presbyterian Medical Center, New York, NY 10032, USA.
Ann Neurol. 1998 Nov;44(5):749-57. doi: 10.1002/ana.410440508.
The purpose of this study was to determine the role of high-resolution T2-weighted fast multiplanar inversion-recovery (FMPIR) magnetic resonance (MR) imaging in detecting and delineating microscopic focal cortical dysplasia (FCD). We performed MR scans with FMPIR on 42 patients with suspected neocortical epilepsy. Ten MR studies were read prospectively as showing FCD; these case histories, electroencephalographic studies, and neuroimaging data were reviewed. Eight of these patients subsequently underwent focal cortical resection guided by intraoperative electrocorticography. The MR findings were correlated with pathological findings in these 8 patients. For purposes of radiological-pathological correlation, the FCD lesions were divided into two classes. Radiological classification was based on the absence (type A) or presence (type B) of T2 prolongation of the subcortical white matter. Pathological grading as type I or type II was based on a previously described pathological grading system. Specific MR findings associated with FCD included focal blurring of the gray-white matter interface (n = 9), thickening of the cortical ribbon (n = 7), and T2 prolongation of the subcortical white matter (n = 4). In 3 patients, the only MR finding that suggested FCD was localized blurring of the gray-white matter junction. In 2 of these 3 patients, the MR diagnosis of FCD could be made only by FMPIR. FCD was confirmed histologically in 7 of 8 patients, with insufficient tissue for complete histopathological evaluation in 1 case. Radiological classification of FCD agreed with pathological classification in 5 of 7 cases. Correlation of MR findings with intraoperative electrocorticography results indicated that the MR study localized the epileptogenic lesion correctly in 8 of 8 cases. Scalp ictal electroencephalographic studies localized the epileptogenic lesion in 5 of 8 cases; positron emission tomographic scans were focally abnormal in 3 of 3 cases. FMPIR MR imaging permitted accurate diagnosis and localization of FCD in all patients with pathologically proved FCD. MR identification of FCD aided presurgical planning and intraoperative management of these patients.
本研究的目的是确定高分辨率T2加权快速多平面反转恢复（FMPIR）磁共振（MR）成像在检测和描绘微小局灶性皮质发育异常（FCD）中的作用。我们对42例疑似新皮质癫痫患者进行了FMPIR MR扫描。前瞻性地阅读了10份MR研究报告，显示为FCD；对这些病例的病史、脑电图研究和神经影像学数据进行了回顾。其中8例患者随后在术中皮质脑电图引导下进行了局灶性皮质切除术。将这8例患者的MR表现与病理结果进行了对比。为了进行放射学-病理学对比，将FCD病变分为两类。放射学分类基于皮质下白质T2延长的有无（A型）或存在（B型）。病理分级为I型或II型是基于先前描述的病理分级系统。与FCD相关的特定MR表现包括灰白质界面局灶性模糊（n = 9）、皮质带增厚（n = 7）以及皮质下白质T2延长（n = 4）。在3例患者中，提示FCD的唯一MR表现是灰白质交界处局限性模糊。在这3例患者中的2例中，仅通过FMPIR才能做出FCD的MR诊断。8例患者中有7例经组织学证实为FCD，1例因组织不足无法进行完整的组织病理学评估。7例中的5例FCD的放射学分类与病理分类一致。MR表现与术中皮质脑电图结果的对比表明，MR研究在8例中的8例中正确定位了致痫病变。头皮发作期脑电图研究在8例中的5例中定位了致痫病变；正电子发射断层扫描在3例中的3例中显示局部异常。FMPIR MR成像能够对所有经病理证实为FCD的患者进行准确的诊断和定位。MR对FCD的识别有助于这些患者的术前规划和术中管理。
