Preliminary Study Of Interictal Cerebral Perfusion In Generalizedtonic Clonic Seizures With Three-Dimensional Pseudo-Continuous Arterial Spin Labeling MR Imaging

Objective: Using 3D arterial spin labeling perfusion imaging of functional magnetic resonance imaging method, to study the interictal cerebral perfusion in patients with generalized tonic clonic seizures based on voxel in the resting state, detection the abnormal of local perfusion in brain tissue of patients in the interictal period, and find the correlation between the abnormal CBF areas,disease duration and the age of onset. Provide important clues to the attack mechanism and clinical diagnosis of GTCS, to explore the clinical value for GTCS patients.Methods: Collect 20 cases of generalized tonic clonic epilepsy patients as the research object and 20 cases of healthy people as control group, gender, age, handedness were matched with patients with epilepsy. Using GE DISCOVERY MR 750 scan all research objects generation the whole brain CBF images. Using SPM8 statistical package based on MATLAB to pretreat all the CBF images include Timing correction, head correction, spatial normalization and spatial smoothing. Voxel based statistical analysis was performed between the two groups. Using the two sample t test analysis method comparative CBF changes inpatients with GTCS. Select the bilateral thalamus, bilateral inferior temporal gyrus, bilateral parahippocampal gyrus, bilateral temporal pole(including temporal pole superior temporal gyrus and temporal pole Middle temporal gyrus) 10 regions of interest(ROI),extracted the mean cerebral blood flow information of ROI. Study on the correlation between disease duration and the age of onset. Using Spearman correlation in SPSS19.0 statistical analysis software to explore the CBF value correlation between disease duration and the age of onset, when P<0.05 considered statistically significant difference.Results:(1)Compared with the normal control group, the CBF of GTCS patients in bilateral brainstem, right cerebellum, right inferior temporal gyrus, right parahippocampal gyrus, right orbital frontal gyrus, right superior frontal gyrus, middle frontal gyrus, inferior frontal gyrus and triangular left temporal pole and thalamus decreased.The bilateral superior parietal lobule, bilateral precuneus, bilateral precentral gyrus, bilateral postcentral gyrus, left dorsolateral frontal gyrus and right superior parietal gyrus showed increased CBF area; increased CBF was observed in the bilateral superior parietal lobule, bilateral precuneus, bilateral precentral gyrus, bilateral postcentral gyrus, left dorsolateral frontal gyrus and right superior parietal gyrus.(2)The results of correlation analysis showed that, with the disease duration was negatively related to the CBF value in bilateral temporal pole superior temporal gyrus and temporal pole Middle temporal gyrus of GTCS group(P<0.05), the right temporal pole middle temporal gyrus had most significant correlation, the correlation coefficient r was-0.7333, P value was 0.0043; Bilateral thalamus, bilateral temporal gyrus, bilateral parahippocampal gyrus CBF value had no correlation with disease duration; Bilateral thalamus, bilateral temporal gyrus, bilateral parahippocampal gyrus, bilateral temporal temporal gyrus, middle temporal gyrus, temporal pole CBF value had no correlation with the age of onset.Conclusion: 3D ASL using voxel based analysis method, can detect related brain areas perfusion abnormalities sensitive in patients with GTCS, Local perfusion defect may be due to the epileptic foci area where neuronal damage or recurrent seizures lead to the corresponding brain cortex atrophy. while the local high perfusion region in the future the compensatory mechanism of nerve and vascular research patients with GTCS provides an effective imaging method. With the extension of the course, the bilateral temporal pole temporal gyrus, middle temporal gyrus, temporal pole cerebral blood flow decreased gradually, suggesting that the pathophysiological changes with disease duration prolonged, bilateral temporal pole under the long-term damage of epilepsy, neuronal loss and cortical atrophy also tends to be serious. While the high local perfusion area provide an effective imaging method for the research of the compensatory mechanism of the nerves and blood vessels in patients with GTCS. With the prolongation of the duration, bilateral temporal pole superior temporal gyrus, middle temporal gyrus, temporal pole cerebral blood flow decreased gradually, suggesting that the pathophysiology of disease: with the extension of the course, the bilateral temporal pole under the long-term damage of epilepsy, neuronal loss and cortical atrophy also tends to be serious.3D ASL can provides a reference to reveal the pathogenesis, pathophysiology of GTCS,also can be used as a valuable method to study the changes of cerebral blood flow in patients with GTCS.