Quantitative Study Of Amygdala Brain Microstructure、Substance Metabolism And Blood Perfusion Changes In Cryptogenic Medial Temporal Lobe Epilepsy

Objective:Using diffusion kurtosis imaging(DKI),~1H-MRS,and 3D pseudo-continuous arterial spin labeling(3D-p CASL);explore the microstructure,metabolism and flow perfusion in medial temporal lobe epilepsy(MTLE),and explore the correlation of amygdala changes in TLE patients.Methods:In this study,28 patients diagnosed with medial temporal lobe epilepsy were collected as the observation group,And selected 22 healthy volunteers who were examined at the same time as the control group,DKI,MRS and ASL imaging were performed in both the observation and control groups,Measure the DKI(FA,MK,MD),~1H-MRS(NAA/Cho+Cr,NAA/Cho,Cho/Cr)and 3D-p CASL(CBF)parameter values of the bilateral amygdala,And automatically measure the amygdala volume results according to the Free Surfer software,Case group were amygdala atrophy,normal amygdala,and amygdala hypertrophy;One-way ANOVA was used to compare the differences in nucleus parameter values between healthy controls and TLE patients;Comparison of the left and left amygdala was performed by paired t-test;To compare the diagnostic value and detection rate of the three examination methods for epilepsy in the temporal lobe;Correlation of volume,structure and functional changes of amygdala in the case group.Results:The CBF,MK,FA,NAA/Cr,NAA/Cho,NAA/Cho+Cr values of the amygdala were decreased in the contralateral and the affected side in the affected group,The decrease in the affected side is more significantly;The MD,Cho/Cr values of the amygdala were elevated in the contralateral and affected side of the affected group,The increase of the affected side was more obvious P<0.05);MRS parameter values with a high sensitivity,DKI parameters have high specificity,NAA/Cho+Cr,MD have high sensitivity,Cho/Cr,MD with a relatively high specificity,By combining NAA/Cho+Cr,CBF and MD parameters,Can improve the diagnostic efficacy for the localization diagnosis of temporal lobe epilepsy,Sensitivity of 87.5%,Specificity was 97.7%;Positive correlation between amygdala volume and CBF and NAA/Cho values in the affected group(r=0.791,0.555,P<0.01),Amygdala volume showed a low correlation with MD,NAA/Cho+Cr(r=-0.414,0.393,P<0.01),Amygdala volume was weakly negatively associated with FA values(r=-0.283,P<0.05).Conclusion:Combined amygdala ~1H-MRS,3D-p CASL and DKI examination can significantly improve the diagnostic efficacy of MRI negative medial temporal epilepsy;MTLE volume,substance metabolism,blood perfusion,and microstructural changes,suggesting that amygdala flow perfusion changes earlier than amygdala.These three examination techniques help determine the pathological changes in amygdala and evaluate disease progression.