Abstract：Objective: To analyze the application of multimodal cranial magnetic resonance imaging in refractory epilepsy. Methods: A total of 78 patients with refractory epilepsy diagnosed by postoperative pathological results in our hospital from March 2021 to May 2023 were selected as the observation objects of this study. All patients underwent head MRI and multimodal MRI examination. The detection rate of epileptogenic zone, the consistency with postoperative pathological results, the relationship with neurological deficits, the total effective rate of postoperative prognosis and the contribution weight of different sequences to epileptogenic zone were compared. Results: Using postoperative pathological findings as the gold standard, 34 cases of medial temporal lobe sclerosis, 20 cases of focal cortical dysplasia, and 24 cases of other aetiologies were detected. Multimodal MRI detected 32, 18, and 21 cases of these types respectively, 71 cases in sum, with a detection rate of 91.03%. Head MRI detected 26, 12, and 19 cases, respectively, 57 cases in sum, with a detection rate of 73.08%. The detection rate of multimodal MRI was significantly higher than that of head MRI (P<0.05). The sensitivity and positive predictive value of multimodal MRI were higher than those of head MRI, and the consistency between multimodal MRI and postoperative pathological results was better than that of head MRI. Compared with the normal side, the DTI-FA and MRS-NAA/Cr in the epileptogenic zone were increased, and the fMRI activation volume was decreased. The fMRI activation volume was negatively correlated with the neurological deficit score, and DTI-FA and MRS-NAA/Cr were positively correlated with the neurological deficit score (P<0.05). In the Engel classification, the total effective rate of patients with refractory epilepsy was 71 cases (91.03%). Multivariate regression analysis showed that the standardized β values of DTI-FA, MRS-NAA/Cr, fMRI activation volume, and conventional MRI positivity were -0.42, 0.38, 0.28, and 0.19, respectively, indicating that there were differences in the contribution weights of different sequences in the epileptogenic zone (P<0.05). Conclusion: The detection rate and consistency of multimodal MRI imaging technology are higher than those of head MRI, and the multimodal MRI-guided strategy can improve the prognosis of refractory epilepsy and the total effective rate. The contribution weights of different sequences are different, which provides a reference for the clinical diagnosis of refractory epilepsy.
[1] Liu ZZ,Huang Y,Hong CG,et al.Autologous olfactory mucosa mesenchymal stem cells treatment improves the neural network in chronic refractory epilepsy[J].Stem Cell Res Ther,2023,14(1):237. [2] 梁明礼,叶敏,张文波,等.多模态影像结合颅内电极定位致痫灶在癫痫手术中的效果[J].中国实用神经疾病杂志,2022,25(4):443-447. [3] 李双双,高学军,马磊.癫痫患者心率变异性、静息态功能磁共振成像相关指标的变化及其之间的关系研究进展[J].实用心脑肺血管病杂志,2024,32(6):138-140. [4] 中华医学会神经病学分会脑电图与癫痫学组.中国老年癫痫患者管理专家共识[J].中华老年医学杂志,2022,41(8):885-892. [5] Lim SH,Guek TY,Woon FP,et al.National Institutes of health stroke scale:comparison of original and modified versions for singapore culture[J].Singapore Med,2023,64(9):563-566. [6] Sinka L,Abraira L,Imbach LL,et al.Association of mortality and risk of epilepsy with type of acute symptomatic seizure after ischemic stroke and an updated prognostic Model[J].JAMA Neurol,2023,80(6):605-613. [7] Jesse S,Müller HP,Huppertz HJ,et al.Neurodegeneration or dysfunction in phelan-Mcdermid syndrome A multimodal approach with CSF and computational MRI[J].Orphanet Rare Dis,2023,18(1):274. [8] 张建强,张辉,陈晓翼,等.多模态MRI参数及Hcy水平与早期脑梗死后认知功能障碍的关系[J].新疆医科大学学报,2023,46(7):931-936. [9] Du P,Liu X,Wu X,et al.Predicting histopathological grading of adult gliomas based on preoperative conventional multimodal MRI radiomics:a machine learning model[J].Brain Sci,2023,13(6):912. [10] Warrier V,Stauffer EM,Huang QQ,et al.Genetic insights into human cortical organization and development through genome-wide analyses of 2,347 neuroimaging phenotypes[J].Nat Genet,2023,55(9):1483-1493. [11] 刘志伟,王艳,刘志强,等.头颅核磁共振在脑血管性痴呆中的应用价值分析[J].世界复合医学,2023,9(5):55-58. [12] Khalilullah KMI,Agcaoglu O,Sui J,et al.Multimodal fusion of multiple rest fMRI networks and MRI gray matter via parallel multilink joint ICA reveals highly significant function/structure coupling in Alzheimer's disease[J].Hum Brain Mapp,2023,44(15):5167-5179. [13] Arnold TC,Kini LG,Bernabei JM,et al.Remote effects of temporal lobe epilepsy surgery:Long-term morphological changes after surgical resection[J].Epilepsia Open,2023,8(2):559-570. [14] Kim D,Woodham BL,Chen K,et al.Rapid MRI abdomen for assessment of clinically suspected acute appendicitis in the general adult population:a systematic review[J].Gastrointest Surg,2023,27(7):1473-1485.
2026, Vol. 32 
冀公网安备13080202000786号