| Objective: The objective of this study was to evaluate the lateralization value of conventional MRI-FLAIR sequence combined with short TE(TE=30ms)glutamic acid spectrum in patient with temporal lobe epilepsy by comparison with the clinicopathological results.Methods: Using a Siemens Trio Tim 3.0T MRI scanner,routine MRI scans(T1WI,T2 WI,and FLAIR sequences,T1 WI and T2 WI sequences including axial position and FLAIR sequence including parallel and vertical hippocampus positions)and short TE(TE=30ms)MRS were performed on 29 patients with unilateral TLE and 29 healthy individuals..The FLAIR sequence was used for the lateralizaion of the epileptic focus.The hippocampus volume narrower than the contralateral side,the lateral ventricle temporal horn enlargement,higher FLAIR signal than the contralateral side and the disappearance of the superficial sulcus of the hippocampal head were defined as the affected side.While patients with no positive finding was defined as negative.The Siemens Syngovia workstation was used to measure the Glu/Cr ratio in TLE group and control group.The ROC curve was used to identify the threshold value of the glutamate spectrum diagnosis and to evaluate the diagnostic efficiency of glutamic acid spectrum.The correlation between the Glu/Cr ratio of TLE group and the course and age of disease were analyzed.The diagnostic value of the three methods was compared,including FLAIR sequence,the glutamic acid spectrum and the combination of the two methods.Results: 1.The manifestation of hippocampus sclerosis on FLAIR sequences included:(1).The volume of hippocampus was narrower than the contralateral side;(2).The lateral ventricle temporal horn was enlarged compared to the contralateral side;(3).The signal on FLAIR sequence was higher than the contralateral side;(4).The superficial sulcus of the head of the hippocampus disappeared.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of FLAIR sequence for lateralization were 77.78%,96.77%,95.45%,83.33% and 87.93%.2.The Glu/Cr ratio in the hippocampus of the affected side in the TLE group was significantly higher than that of the healthy side in the TLE group,and the difference was statistically significant(P=0.000).The Glu/Cr ratio in the hippocampus of the affected hippocampus in the TLE group was higher than that of the control group,and the difference was statistically significant(P=0.000).The Glu/Cr ratio in the hippocampus of the healthy side in the TLE group was lower than that of the control group,and the difference was statistically significant(P=0.000).The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of glutamic acid spectrum for identifying epileptic focus were 92.60%,90.30%,89.29%,93.33% and 91.38%.3.The best threshold value of Glu/Cr ratio in glutamic acid spectrum for diagnosing temporal lobe epilepsy was 1.975.4.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of combined two methods for identifying epileptic focus were 100%,90.32%,90.00%,100% and 98.28%.5.The area under ROC curve using FLAIR sequence,glutamic acid spectrum and combined two methods were 0.873,0.879 and 0.984.The combination of the two methods had the best diagnostic efficiency.6.There was no significant relationship between the Glu/Cr ratio and the course of the patient in the TLE group(P=0.776).7.There was no significant relationship between the Glu/Cr ratio and the age of the patients in the TLE group(P=0.139).Conclusion: 1.FLAIR sequence and glutamic acid spectrum have good clinical diagnostic value in the localization of temporal lobe epilepsy,and the clinical diagnostic efficiency of glutamic acid spectrum is slightly higher than that of FLAIR sequence.2.The combination of the two methods is the most effective which could improve the sensitivity and accuracy for lateralization of epileptic focus. |
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