磁共振阴性癫痫患者皮层厚度改变的对比研究

A Comparative Study of Cortical Thickness Changes in Patients with Magnetic Resonance-Negative Epilepsy

摘要: 目的：探讨使用自动化分割工具进行皮层厚度测量在磁共振阴性癫痫患者术前诊断中的应用价值。方法：回顾性收集脑电图表现为左侧颞叶放电，并经术中脑电图确诊为颞叶内侧型癫痫的患者术前磁共振图像(T1-MPRAGE)，并收集年龄性别匹配的健康对照组图像，使用Freesurfer软件的recon-all功能对两组皮层厚度进行测量，使用t检验对比两组全脑各脑区皮层厚度差异。结果：共收集376名对照组和279名患者图像，两组平均年龄和性别构成差异无统计学意义(P > 0.05)，对比两组脑区皮层厚度后发现，颞叶内侧型癫痫患者全脑平均皮层厚度较健康对照组均较大，除右侧尾中额叶、双侧岛叶、双侧颞极外，差异均有统计学意义(P < 0.05)。结论：使用Freesurfer工具能够快速便捷地实现皮层厚度测量，并适用于大规模人群的研究，颞叶内侧型癫痫存在广泛分布于全脑的皮层厚度减小，提示癫痫的长期放电对于患者全脑灰质功能可能都存在影响，并在异常放电活跃侧脑区影响可能更大，未来还需要进一步研究探索皮层神经元的改变与对功能的影响。

Abstract: Objective: To investigate the value of cortical thickness measurements using automated segmenta-tion tools in the preoperative diagnosis of patients with magnetic resonance-negative epilepsy. Methods: Preoperative magnetic resonance images (T1-MPRAGE) were retrospectively collected from patients with electroencephalograms showing left temporal lobe discharges and diagnosed with medial temporal lobe epilepsy by intraoperative electroencephalograms, and images from age-sex-matched healthy controls were collected, and cortical thicknesses of the two groups were measured by using the recon-all function of the Freesurfer software, and t-tests were used to com-pare the differences of cortical thicknesses of the whole-brain regions between the two groups. Dif-ferences in cortical thickness between the two groups were compared using the t-test. Results: A total of 376 control and 279 patient images were collected, and the differences in mean age and gender composition between the two groups were not statistically significant (P > 0.05). Comparison of the cortical thickness of the brain regions between the two groups revealed that the mean corti-cal thickness of the whole brain was greater in patients with medial temporal lobe epilepsy com-pared with that of healthy controls in both groups, except for the right caudal medial frontal lobe, bilateral insula, and bilateral temporal poles, and the differences were statistically significant (P < 0.05). Conclusion: Cortical thickness measurements can be achieved quickly and easily using the Freesurfer tool and are suitable for large-scale population studies. The presence of widely distrib-uted cortical thickness reductions throughout the brain in medial temporal lobe epilepsy suggests that prolonged epileptic discharges may have an effect on gray matter function throughout the pa-tient’s brain and may be greater in brain regions on the side of the brain where the abnormal dis-charges are active, and that further research is needed to explore the cortex in the future. Further studies are needed to explore the alteration of cortical neurons and the effect on function.