目的 目前对左侧颞叶癫痫(LTLE)、右侧颞叶癫痫(RTLE)患者半球间的功能协调性及相应结构变化尚未明确.本研究探讨LTLE和RTLE患者两大脑半球间功能同伦性及结构性变化.资料与方法 收集2013年10月-2015年10月在广西医科大学第一附属医院确诊为右利手的单侧颞叶癫痫患者43例,其中左侧颞叶癫痫(LTLE) 21例,右侧颞叶癫痫(RTLE) 22例;同时期收集正常志愿者24例(NC组).采用静息态功能磁共振(rs-fMRI)及扩散张量成像(DTT)扫描,经体素-镜像同伦连接(VMHC)计算3组存在VMHC值改变的脑区;纳入LTLE 10例、RTLE 16例及NC 20例进行DTI扫描,提取部分各项异性(FA)值进行比较.结果 LTLE组在默认网络的相关脑区VMHC值异常,其FA值与NC组比较差异无统计学意义(t=1.43,P＞0.05);RTLE组在双侧海马旁脑回VMHC值升高.VMHC差异脑区作为ROI进行DTI检测,可显示连接双侧海马旁回的纤维束,其FA值明显低于NC组,差异有统计学意义(t=10.55,P＜0.01).结论 LTLE和RTLE患者左右半球间部分脑区的功能同伦性连接出现变化,两者间不尽相同.其中,RTLE患者的双侧海马旁回还出现结构损害.%Purpose To investigate the alterations of homotopic functional connectivity and interhemispheric structural connectivity in patients with unilateral temporal lobe epilepsy (unilateral TLE).Materials and Methods Resting-state functional MR imaging data were acquired from patients in the first affliated hospital of Guang Zhou Medical University who were enrolled from Oct.2013 to Oct.2015 with unilateral temporal lobe epilepsy (n=43) [21 left TLE(LTLE) and 22 right TLE(RTLE)] and normal controls (NC) (n=24).We mainly concerned about the functional connectivity between any pair of symmetric interhemispheric voxels which were measured by voxel-mirrored homotopic connectivity (VMHC).Structural magnetic resonance images were acquired in 10 LTLE patients,16 RTLE patients and 20 NCs.Homotopic regions showing abnormal functional connectivity in patients were adopted as regions of interest for DTI.The FA values were compared between groups.Two-sample t test were used.Results Compared with NC group,the LTLE patients showed increased interhemispheric functional connectivity among the bilateral angular gyri,occipital gyri and superior parietal gyri,and decreased functional connectivity between the bilateral supplementary motor areas,middle temporal gyri,medial frontal gyri and inferior parietal lobules.Compared with control subjects,RTLE patients exhibited increased interhemispheric functional connectivity among bilateral inferior occipital gyri,parahippocampa gyri,cerebellum,as well as decreased functional connectivity among the bilateral middle temporal gyri,precentral gyri and inferi or frontalgyri.Statistical results indicated that the FA value of the commissural fiber bundles connecting the bilateral hippocampal gyri was smaller in RTLE patients than NC patients (t=10.55,P＜0.01).The FA value of the association fibers connecting the bilateral hippocampal gyrus had no significant difference between the LTLE group and NC group.Conclusion The increase or decrease of VMHC value in some brain regions in TLE suggested that there were changes in the functional synchronization and coordination in the two hemispheres in patients with unilateral TLE.In the RTLE patients,some brain regions which had abnormal interhemispheric functional connectivity also had structural damage.
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