Objective To determine the value of 1 H-MR spectroscopy in lateralization of patients with temporal lobe epilepsy (TLE) . Methods Fifty-seven patients with nonlesional TLE and 20 controls were investigated by high resolution MRI and 1 H-MRS . Hippocampal volume and the ratios of NAA/Cr+Cho were measured and compared between two groups . Lateralization of the patients was classified by the predominance of interictal epileptiform discharges (IED) . The lateralization rate was compared be-tween diffirent methods . Results Fourty-one patients(71 .9% ) were lateralized to one temporal lobe ac-cording to characteristic of the interictal EEG ,with 24 patients diagnosed as left temporal lobe epilepsy (L-TLE) and 17 as right temporal lobe epilepsy (R-TLE) . The other 16 patients were diagnosed as bilateral temporal lobe epilepsy (B-TLE) . (1)NAA/(Cho+ Cr) ratios decreased in bilateral hippocampus in 56 TLE patients(98 .2% ) compared with controls . NAA/(Cho+Cr) ratios were significantly lower in the ipsilateral (affected) compared with contralateral (non-affected) hippocampus in both L-TLE group (P<0 .001) and R-TLE group(P< 0 .001) . (2)Hippocampus atrophy was found in 28 TLE patients (49 .1% ) and 4 of them were bilateral . (3)28 patients (49 .1% ) were lateralized by hippocampal volume and 15 of them were accordant with IEDs (coincidence rate 53 .6% ) ,while 41 patients (71 .9% ) were lat-eralized by 1 H-MRS abnormalities and 32 of them were accordant with IEDs (coincidence rate 78 .0% ) . Conclusions Temporal lobe epilepsy is associated with widespread metabolic abnormalities in bilateral hip-pocampus . The degree of NAA/(Cho+Cr) ratios reduction is more sensitive than hippocampal volume in evaluating hippocampal dysfunction . 1 H-MRS can be used in hemispheric lateralization of nonleisional TLE .%目的：分析颞叶癫痫病例的海马磁共振波谱（1 H-MRS）成像、海马体积测量与脑电图间的关系，探讨1 H-M RS在颞叶癫痫海马硬化定侧中的应用价值。方法收集非病灶性颞叶癫痫患者57例和相匹配的正常健康人20例，测定双侧海马体积及海马1 H-MRS的NAA/（Cr＋Cho）值。根据发作间歇期癫痫性放电（IEDs）优势对病例进行定侧，探讨1 H-M RS对颞叶癫痫海马硬化定侧的应用价值。结果根据IEDs能够提供定侧信息的有41例（71．9％），其中左侧颞叶癫痫组（L-TLE）24例，右侧颞叶癫痫组（R-TLE）17例，双侧颞叶癫痫组（B-TLE）16例。海马测量分析结果如下：（1）癫痫组中有56例（98．2％）双侧海马NAA/（Cr＋Cho）值均低于对照组。病灶侧海马NAA/（Cr＋Cho）值小于对侧海马（P均＜0．001）。（2）海马体积测量发现海马萎缩的有28例（49．1％），其中4例双侧海马萎缩；而海马1 H-M RS 异常56例（98．2％）。两种检查手段的阳性检出率差别有统计学意义（P＜0．001）。（3）根据海马体积提供定位价值的有28例（49．1％），其中15例与IEDs定位符合（符合率53．6％）；1 H-MRS结果（双侧差值＞0．04）提供定位价值的有41例（71．9％），其中32例与IEDs定位符合（符合率78．0％），比海马体积符合率高（P＜0．05）。结论（1）颞叶癫痫伴有较为普遍的双侧生化物质的改变，表现为NAA/（Cr＋Cho）值下降。（2）海马1 H-MRS显示的生化改变对于颞叶癫痫的异常发现较海马体积测量更为敏感。（3）海马1 H-M RS有较高的定侧能力。
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