Preoperative CT and MR Imaging Evaluation in Complex Partial Seizure Patients

對於來自顳葉病灶的複雜性局部發作癲癇的患者，當內科療法無法得到滿意控制時，外科手術是另一種治療的選擇。此時影像醫學的檢查於癲癇病灶原因和部位的確定，對手術計劃及其預後極具價值。我們研究50位因頑性複雜性局部發作癲癇接受手術患者的術前電腦斷層(CT)和磁振造影(MRI)檢查之影像，和病理結果作對照，以瞭解影像醫學的檢查於癲癇病灶原因和部位的確定之正確性。結果我們發現在19位因腫塊相關性病變患者（包括動靜脈畸型、囊狀病變和顱內腫瘤），CT和MRI檢查在病灶的偵測上均相當敏感，分別為95%和94%。至於在31位非腫塊相關性病變患者，主要為顳葉內側硬化(Mesial temporal sclerosis)，對此類病灶的偵測上MRI顯然優於CT，為93%對48%; CT影像的發現以病灶同側側腦室之顯角擴大（12例）和顯葉腦組織局部低吸收值區域（5例）為主，而MRI影像的發現，除顯角擴大和顯葉萎縮（13例）外，以病灶同側顯葉內或前側於T2為主影像時出現高信號區域（10例）最為常見，此對應部位於病理檢查，常可見到神經細胞的喪失和神經膠增殖的變化。在此研究中，有6例曾接受高解像率的T2為主快速自旋迴訊波序冠切面磁振造影檢查，顯示出更精細的內側顳葉海馬迴結構和影像信號的變化。我們深信，此一新近發展的檢查方法，對顳葉病灶癲癇患者的診斷和外科手術前的評估將會有相當的幫助。

關鍵字

腦，異常；腦，電腦斷層攝影；腦，磁振造影；癲癇

並列摘要

For seizure control in medically refractory cases, imaging studies which provide both accurate localization and cause identification are mandatory for treatment planning and prognosis assessment. In this study, 50 patients who received temporal lobectomy for intractable complex partial seizure were enrolled. Correlation of pre-operative computed tomography (CT) and magnetic resonance imaging (MRI) to the localizing electroencephalography (EEG) foci and the available pathological findings was analyzed. The results showed that, in 19 cases of the mass lesion group which included arteriovenous malformations (AVMs), cystic lesions and neoplasms, both CT and MRI were extremely sensitive (95% vs. 94%) in detecting the lesions; in 31 cases of the non-mass lesion group, the superiority of MRI to CT (93% vs. 48%) in detecting the lesions was revealed. In the latter group, primary CT findings in 31 cases were ipsilateral temporal horn dilatation (12 cases) and a focal low density area in the temporal lobe (5 cases); in MR images of 15 cases, the major findings were temporal lobe atrophy with ipsilateral temporal horn enlargement (13 cases) and abnormal mesial temporal high signal intensity on T2 weighted imaging (10 cases) which corresponded to neuronal loss and gliosis in pathology. In addition high resolution T2-weighted fast spin echo coronal MR imaging was performed in six cases, and found to have advantages in revealing detailed mesial temporal-hippocampal anatomic structures and in detecting subtle signal abnormalities. This suggests that this technique is helpful in making diagnosis and preoperative assessment for hippocampus lesions.

並列關鍵字

brain, abnormalities ； brain, CT ； brain, MR ； epilepsy

國際替代計量

Preoperative CT and MR Imaging Evaluation in Complex Partial Seizure Patients

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