Application Of MRI Multimodal Imaging In Medial Temporal Lobe Epilepsy

Objective: To explore the diagnostic value of magnetic resonance multimodal imaging in medial temporal lobe epilepsy with hippocampal sclerosis,and to provide more reliable imaging reference for clinical diagnosis and treatment selection.Methods: 50 patients with medial temporal lobe epilepsy(MTLE-HS)with hippocampal sclerosis were collected from the General Hospital of Ningxia Medical University from October 2020 to December 2022,and 45 patients matched in age and sex were collected as healthy control group.All subjects underwent conventional MRI scanning,Synthetic magnetic resonance imaging(MAGi C),high-definition diffusion-weighted imaging(MUSE-DWI)based on composite sensitivity coding and three-dimensional arterial spin labeling imaging(3D-ASL)on a GE Signa Architect 3.0T magnetic resonance scanner.The differences of Sy MRI quantitative parameters(T1,T2,PD),apparent diffusion coefficient(ADC)and cerebral blood flow(CBF)between the affected hippocampus,the contralateral hippocampus and the control hippocampus in HS group were compared by ANOVA or Kruskal-Wallis H test.Multivariate logistics regression analysis was used to analyze the parameters with differences between HS group and control group,and receiver operating characteristic curve(ROC)and area under curve(AUC)were used to evaluate the diagnostic efficacy of single parameter and multi-parameter combination in MTLE-HS.Results: The values of T1,T2,ADC and CBF were statistically different among the affected side,the contralateral side and the control group as a whole(P < 0.01),and there was no statistical difference among the three groups(P > 0.05).The results of pairwise comparison between groups showed that the values of T1,T2 and ADC of the affected side were higher than those of the contralateral side and the control group,and the CBF of the affected side was lower than that of the contralateral side and the control group,and the differences were statistically significant(P<0.05).There was no significant difference in T1,T2,PD,ADC and CBF between the contralateral and control groups(P > 0.05).Multivariate logistics regression results show that logistics regression showed that T2,ADC and CBF were independent diagnostic parameters of MTLE-HS(P < 0.05),and ROC curve analysis showed that the AUC of T2,ADC and CBF in diagnosing MTLE-HS were 0.891,0.852 and0.837,respectively.De Long test showed that there was no statistical difference in AUC among T2,ADC and CBF,and the combination of the three parameters could improve the diagnostic efficiency of MTLE-HS with AUC of 0.940,and the sensitivity,specificity,positive predictive value and negative predictive value were 84.0%,97.8%,97.7% and 84.4%respectively.Conclusion: Multi-modal MRI imaging can provide more imaging help for the detection of epileptic foci in MTLE patients.As a new imaging sequence,Sy MRI can be an effective imaging marker parameter for diagnosing HS.In addition,the parameters of3D-ASL imaging and MUSE-DWI imaging,such as CBF and ADC,have the same clinical value in diagnosing HS.The diagnostic efficiency of T2,ADC and CBF for HS is equivalent,and the diagnostic efficiency of the multi-parameter T2+ADC+CBF combined model constructed by them is better than that of single parameter of each imaging sequence.MRI multimodal imaging can be used as a new effective strategy to improve the detection of epileptic foci in MTLE patients and provide more surgical opportunities for patients.