| PART Ⅰ The value of high-resolution MRI in the diagnosis of brain structural etiology of epilepsyObjective To explore the distribution of brain structural etiology in epilepsy patients of all ages,and to analyze the value of high resolution magnetic resonance imaging(MRI)in the diagnosis of brain structural etiology of epilepsy.Materials and methods The clinical data of 247 cases of hospital patients with epilepsy were collected retrospectively,and among them 116 cases of epilepsy with brain structural etiology,identified by clinical and auxiliary examination data were analysed-All 116 patients were scanned with a 3.0T Siemens Magnetom Prisma scanner using a 32-channel phased array head coil.The age,gender and distribution of specific structural etiology of 116 patients were collected and analyzed.To analyze and summarize the features of different structural causes in high resolution magnetic resonance imaging(MRI).Results Among the 116 patients with epilepsy caused by brain structural causes,54 patients(46.5%)were aged from 0 to 18 years old,including 29 males and 25 females.There were 25 cases(21.6%)aged from 19 to 40 years old,including 13 males and 12 females.There were 18 cases(15.5%)aged from 41 to 60 years old,including 11 males and 7 females.There were 19 cases(16.4%)of>aged 60 years,including 11 males and 8 females.In this study,patients under the age of 18(infants and adolescents)were at high risk of epilepsy,accounting for 46.5%of the total study population.At the same time,the prevalence rate of male patients in all ages was slightly higher than that of female patients,but in general,there was no significant difference in the incidence probability of epilepsy between men and women(P>0.05).Cortical dysplasia was the most common disease in patients aged 0-18 years,followed by brain trauma,brain tumor,hippocampal sclerosis,amygdala enlargement,etc.Cortical dysplasia was the most common disease in patients aged 19-40 years,followed by brain trauma,amygdala enlargement,hippocampal sclerosis,brain tumor,cerebrovascular disease,etc.Brain tumor was the most common disease in patients aged 41 to 60 years,followed by hippocampal sclerosis,amygdala enlargement,brain trauma,cerebrovascular disease,etc.Cerebrovascular disease was the most common disease in patients aged 60 years,followed by brain tumor,hippocampal sclerosis,brain trauma,amygdala enlargement,etc.High resolution magnetic resonance ’imaging has advantages in showing microscopic structural lesions in the brain.The high resolution MRI findings for each structural cause are summarized as follows:(1)Cortical dysplasia ① Focal Cortical Dysplasia:a.focal gray matter blurring b.focal cortical thickening c.focal cortical thickening with abnormal T2-weighted images adjacent to the white matter d.abnormal signal in gray matter e.Abnormal signal in white matter f.Periodical or lobe atrophy;②heterotopic gray matter:strips,bands,quasi-circular,gyri like T1 and T2 gray matter signals in white matter areas;③Split encephaly:a transverse fissure across the cerebral hemispheres with isoTl and T2 gray matter signals at the edge.(2)Cerebral trauma:① old bleeding lesions in the brain②encephalomalacia foci③iencephalomalacia foci with gliosis④ Intracerebral ischemia;(3)Cerebrovascular disease:①cerebral infarction② cerebral hemorrhage③The encephalomalacia foci after cerebral infarction;(4)Brain tumors;(5)Hippocampal sclerosis:①Hippocampal volume decreased ② The signal of T2-weighted and T2-FLAIR images is increased;(6)amygdala enlargement:amygdala volume increased,visible on the left,right or bilateral,bilateral rare.Conclusion Cortical dysplasia,brain trauma,cerebrovascular disease,brain tumor,hippocampal sclerosis,amygdala enlargement are the main structural causes of epilepsy in all ages,and the distribution of etiology is also different in patients of different ages.High resolution magnetic resonance imaging(HMRI)has advantages in showing microscopic structural lesions in the brain.PART Ⅱ The application of advanced diffusion imaging in the localization of epileptic foci in temporal lobe epilepsy with amygdala enlargementObjective Advanced diffusion imaging is helpful in locating epileptic foci in the brain in patients with conventionally MRI-negative epilepsy.The study is aiming to use Diffusion tensor imaging(DTI)and neurite orientation dispersion and density imaging(NODDI)to detect epileptic foci in patients with temporal lobe epilepsy with amygdala enlargement.Materials and methods Totally 15 patients with temporal lobe epilepsy showing amygdala enlargement in conventional MRI images and 14 age and gender matched normal volunteers were recruited in the study.All of them underwent DTI and NODDI sequence scans through a 3.0T Siemens Magnetom Prisma scanner.The mean diffusivity(MD),partial anisotropy(FA),neurite densitv index(NDI)and orientation dispersion index(ODI)of amygdala and hippocampus in patients with epilepsy were analyzed quantitatically.Receiver operating characteristic(ROC)and corresponding AUC values of each parameter were obtained to analyze and determine the independent predictors of epileptic foci.Results The FA and NDI values in the amygdala of the affected side were significantly lower than those of the healthy side,while the MD and ODI values were significantly higher than those of the healthy side(P<0.05).The NDI value of the hippocampus of the affected side was significantly lower than that of the healthy side(P<0.05),and there were no statistically significant differences in FA value,MD value and ODI value.The NDI value of the affected side of the epileptic patients was significantly lower than that of the control group(P<0.05),and there were no significant statistical differences in FA value,MD value and ODI value.There was no significant statistical difference in hippocampal FA,MD,NDI and ODI values between the epileptic patients and the control group.The ROC curves of the amygdala parameters of the affected and healthy sides of the patients were obtained.The areas under the ROC curves of FA,MD,NDI and ODI were 0.19(95%CI,0.03-0.35),0.78(95%CI,0.61-0.95),0.22(95%CI,0.05-0.38)and 0.84(95%CI,0.68-0.99),respectively.ODI value had the highest diagnostic accuracy.Conclusion DTI and NODDI can help in the diagnosis and evaluation of epileptogenic foci in patients with temporal lobe epilepsy with amygdala enlargement,and NODDI has a higher diagnostic accuracy. |
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