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目的用磁共振弥散张量成像技术研究额叶癫患者执行功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32例成人额叶癫患者和75例正常健康对照者进行神经心理检查,并对18例常规影像无病灶的额叶癫患者和20例正常健康对照者进行弥散张量成像扫描及统计分析。结果额叶癫患者组语义流畅性明显差于对照组,数字广度测验得分和90min正确填写数字符号个数明显低于对照组。与对照组比较,额叶癫患者右侧额叶MD值明显高于对照组;右侧外囊、尾状核和双侧丘脑的FA值明显低于对照组,差异具有显著性意义。相关分析显示双侧内囊前肢、左侧外囊、左枕叶皮质下白质FA值与语义流畅性呈正相关。左侧内囊膝部、内囊后肢和丘脑MD值与MMSE呈负相关;双侧内囊前肢、左侧外囊、额叶、枕叶相应白质内FA值与MMSE呈正相关。结论DTI显示额叶癫患者右侧额叶MD值明显增高、右侧外囊、尾状核和双侧丘脑的FA值明显减低,提示额叶癫患者在上述区域可能存在细微病理改变,执行功能可能超出前额叶的范围。
Objective To study the related brain regions and pathological changes in executive function impairment of frontal lobe epilepsy by diffusion-weighted MR imaging and to explore its possible mechanism. Methods Neuropsychological tests were performed on 32 adult frontal lobe epilepsy patients and 75 normal controls. Disperse tensor imaging scans were performed on 18 normal frontal lobe epilepsy patients and 20 healthy controls. Statistical Analysis. Results The semantic flu of frontal lobe epilepsy group was significantly worse than that of the control group. The score of digital breadth test and the number of correctly filled digits in 90 minutes were significantly lower than that of the control group. Compared with the control group, the frontal lobe of frontal lobe in patients with frontal lobe epilepsy was significantly higher than the control group; right outer capsule, caudate nucleus and bilateral thalamus FA value was significantly lower than the control group, the difference was significant. Correlation analysis showed that FA values of the bilateral white matter forelimb, left outer capsule and left occipital lobe were positively correlated with semantic fluency. The values of MD in the left internal capsule knee, the internal capsule hindlimb and the thalamus were negatively correlated with MMSE. The FA values of the white matter in the frontal, left external capsule, frontal and occipital lobe of bilateral internal capsule were positively correlated with MMSE. Conclusions DTI shows that the frontal lobe of frontal lobe in patients with frontal lobe epilepsy significantly increased MD values, right outer capsule, caudate nucleus and bilateral thalamus FA value significantly reduced, suggesting that frontal lobe epilepsy patients may have minor pathological changes in these areas, The executive function may exceed the range of the prefrontal lobes.