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目的采用磁共振弥散张量成像技术研究癫癎患者智能损害的相关脑区及病理改变,探讨其可能的发生机制。方法对44例癫癎患者和20名健康人进行韦氏成人量表和磁共振弥散张量成像检查。结果癫癎组患者的全量表智商(FIQ,98.19±17.76)、语言智商(VIQ,100.52±17.63)、操作智商(PIQ,95.10±16.72)均显著低于对照组(VIQ:109.77±13.54、PIQ:108.11±12.17、FIQ:109.81±10.57)。癫癎智能缺损患者胼胝体膝部平均扩散率(MD 值)高于癫癎智能正常组,双侧内囊前肢、左侧内囊膝部、左侧外囊、双侧枕叶白质和双侧壳核的各向异性(FA)值低于癫癎智能正常组,差异有统计学意义(P<0.05)。相关分析发现,右枕叶 FA 值与 FIQ 呈正相关;右侧额叶 MD 值与 VIQ 呈负相关;右侧枕叶 FA 值与 VIQ 呈正相关;两侧枕叶 FA 值均与 PIQ 正相关。结论本组癫癎患者在 FIQ、VIQ、PIQ 均存在损害。癫癎患者伴有智能缺损的胼胝体膝部平均扩散率增加,双侧内囊前肢、左侧内囊膝部、左侧外囊、双侧枕叶白质和双侧壳核各向异性减低;枕叶的各向异性减低与FIQ 减低有关,额叶平均扩散率增加与 VIQ 减低有关,皮质下白质在认知中可能起较重要的作用。
Objective To study the relevant brain regions and pathological changes of intelligence impairment in patients with epilepsy by diffusion-weighted MR imaging and to explore its possible mechanism. Methods 44 adult patients with epilepsy and 20 healthy people were measured by Wechsler adult scale and magnetic resonance diffusion tensor imaging. Results The scores of FIQ (98.19 ± 17.76), VIQ (100.52 ± 17.63) and PIQ (95.10 ± 16.72) in the epilepsy group were significantly lower than those in the control group (VIQ: 109.77 ± 13.54, PIQ : 108.11 ± 12.17, FIQ: 109.81 ± 10.57). The mean diffusivity (MD) of the corpus callosum in patients with epilepsy was significantly higher than that in the normal group of epilepsy, bilateral frontal medulla, left knee, left lateral capsule, bilateral occipital white matter and bilateral The anisotropy (FA) of the nucleus was lower than that of the normal epilepsy group (P <0.05). Correlation analysis showed that FA value of right occipital lobe was positively correlated with FIQ; right frontal lobe MD value was negatively correlated with VIQ; right occipital lobe FA value was positively correlated with VIQ; both occipital lobe FA values were positively correlated with PIQ. Conclusion This group of patients with epilepsy in FIQ, VIQ, PIQ are damaged. In patients with epilepsy, the mean diffusivity of the knee in the corpus callosum increased with the increase of the anisotropy. The anisotropy of the frontal and bilateral internal capsule of the left internal capsule, the left external capsule, The decrease of anisotropy of leaf is related to the decrease of FIQ. The increase of frontal lobe average diffusivity is related to the decrease of VIQ. The subcortical white matter may play a more important role in cognition.