張志強(qiáng)靜息fmri及對(duì)癲癇的應(yīng)用研究

1、靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究張志強(qiáng) 盧光明,南京軍 區(qū)南京總醫(yī)院南京大學(xué)醫(yī)學(xué)院臨床學(xué)院,醫(yī)學(xué)影像科,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究腦靜息態(tài)低頻振蕩活動(dòng)與r-fMRI癲癇病生基礎(chǔ)及fMRI研究低頻振幅fMRI研究及在癲癇病中應(yīng)用靜息態(tài)腦網(wǎng)絡(luò)fMRI研究及癲癇病中應(yīng)用,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ

2、JinLing Hos.,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究概念大腦活動(dòng)? 外在反應(yīng)式的（reflexible）? 內(nèi)在產(chǎn)生的（intrinsic）靜息態(tài)腦活動(dòng)? 指在缺乏明顯的輸入/輸出情況下，大腦表現(xiàn)出的自發(fā)神經(jīng)活動(dòng)（spontaneous neuronalactivity, SNA）。,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing

3、Hos.,,,,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究表現(xiàn)形式神經(jīng)電活動(dòng)? BOLD & LFP,? R-BOLD & SCPRaichle, 2010 Trends in Cogi. Sci.,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究

4、神經(jīng)電活動(dòng)-EEGDelta 13Gamma >20,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究0.05-500Hz1/f 分布,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.

5、,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究—Spontaneous low-frequency fluctuation, LFF—Cordes, et al. 2001fMRI0.01-0.08 Hz,-10,-5,0,5,10,15,20,25,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究物理

6、性質(zhì)頻率波幅相位,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究功能連接：腦網(wǎng)絡(luò)時(shí)間,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用

7、研究方法與技術(shù)基于連接(connectivity)的腦網(wǎng)絡(luò)研究? 功能連接技術(shù)—觀察空間遠(yuǎn)距離神經(jīng)集合活動(dòng)的時(shí)間同步性（temporal coherence）—反映的是不同神經(jīng)集合 之間的相互影響– Interaction, Modulation, Inhibition—空間大尺度（遠(yuǎn)距離）,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ

8、JinLing Hos.,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究實(shí)現(xiàn)方法? 基于種子點(diǎn)的技術(shù)—觀察各種子點(diǎn)之間的時(shí)間同步性—相關(guān)分析（cross-correlation）—偏相關(guān) (cross-coherence),南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究

9、Biswal et al., MRM, 1995,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,,,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究正相關(guān)負(fù)相關(guān),南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究

10、ROI(PCC)-basedfunctionalconnectivityAnti-correlatedTwo systemsFransson 2005, HBM,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,,,,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ J

11、inLing Hos.,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究Fox et al., 2005, PNAStask-negative & task positive systems,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究Fox et al.,2005 , PNASCorrelatedAnti-cor

12、related,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究,Laufs et al., 2003, PNASCombined EEG南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,睜眼：beta閉眼：alphaDept. of Med. Img., NJ JinLing Hos.,,,,,,,,靜息態(tài)

13、fMRI及對(duì)癲癇的應(yīng)用研究,?,ICA算法,ICA（independent component analysis）分析—一種數(shù)據(jù)驅(qū)動(dòng)的分析方法，假定信號(hào)源統(tǒng)計(jì)獨(dú)立的條件下，對(duì)信號(hào)進(jìn)行盲分離?！恍枰闰?yàn)假設(shè)（比如預(yù)先知道大腦網(wǎng)絡(luò)的個(gè)數(shù)、每個(gè)網(wǎng)絡(luò)空間分布信息等）生理信號(hào)1生理信號(hào)2,fMRI信號(hào)南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,頭動(dòng)噪聲Dept. of Me

14、d. Img., NJ JinLing Hos.,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究,ICA檢出,功能網(wǎng)絡(luò)/激活區(qū),,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究Greicius et al.,2004,PNASIndependent component analysis, ICA,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ Jin

15、Ling Hos.,,,,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究resting-state networks, RSNSmith et al., 2009, PNAS,,,,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ Jin

16、Ling Hos.,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究RSNsRaichle, 2010, Trend in Cognitive Sciences,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究6 RSNsCombined EEGMantini, et al., 2007,

17、PNAS,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,,,,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究DMN存在的結(jié)構(gòu)學(xué)證據(jù)Greicius et al., 2009, Cerebral Cor

18、tex,,,,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究振幅研究Power,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究,?,ALFF,,,—Amplitude of low-frequency fluctuationZang et al

19、., 2007 Brain Dev.,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,,,,,,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究,?,ALFF的生理意義—一段時(shí)間內(nèi)自發(fā)神經(jīng)活動(dòng)的 “程度”,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究腦靜息態(tài)低頻振蕩活動(dòng)與r-fMR

20、I癲癇病生基礎(chǔ)及fMRI研究低頻振幅fMRI研究及在癲癇病中應(yīng)用靜息態(tài)腦網(wǎng)絡(luò)fMRI研究及癲癇病中應(yīng)用,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究癲癇簡(jiǎn)介定義? 是一組由大腦神經(jīng)元異常放電引起的短暫的中樞神經(jīng)系功能失常為特征的慢性疾病，具有突然發(fā)生，反復(fù)發(fā)作的特

21、征。分類? 原發(fā)性/癥狀性? 癥狀分型：全面發(fā)作、部分發(fā)作? 綜合征分型：顳葉癲癇、額葉癲癇、青少年失神性癲癇……,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究,癲癇病理生理,電生理特征,? 異常的自發(fā)神經(jīng)活動(dòng)—是否等同于刺激/任務(wù)誘發(fā)的腦活動(dòng)？? 局部特征—高波幅的棘/尖/慢波—局部神經(jīng)元高同步性活動(dòng),南

22、京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究發(fā)作期癲癇活動(dòng) Ictal activity? 直接與癲癇發(fā)放相關(guān)。? 多表現(xiàn)為陣發(fā)高幅癲癇波間期癇樣發(fā)放（interictal epileptoform discharges,IEDs）? 亞臨床發(fā)作，不表現(xiàn)為明顯的癲癇發(fā)作癥狀。? 多表現(xiàn)為單發(fā)棘慢波,

23、南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究? 病理灶-PF? 癲癇源灶-EF? 刺激區(qū)-IZEF PFIZ,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究大尺度

24、網(wǎng)絡(luò)特征? 癲癇活動(dòng)的傳播— 部分繼發(fā)全面發(fā)作,?,功能抑制—廣泛的功能缺失，包括記憶、語言……,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,,,,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究顳葉癲癇? 顳葉癲癇網(wǎng)絡(luò)Blumenfeld et al., Cerebral cortex, 200

25、4,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,,,,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究癲癇的治療內(nèi)科抗癲癇藥物治療? 終生服藥，負(fù)作用大外科治療? 癲癇灶切除術(shù)—對(duì)于癲癇源灶明確的對(duì)象施行單純病灶切除? 胼胝體切開術(shù)—病灶未明或不能

26、切除的 全面發(fā)作型癲癇? 多處軟腦膜下橫切術(shù)—部位明確但不宜切除的局灶癲癇? ……,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究癲癇的診斷及神經(jīng)影像研究臨床III期評(píng)價(jià)? 無創(chuàng)? 有創(chuàng)? 術(shù)中針對(duì)外科治療的診斷? 癲癇灶定位檢測(cè)——主要目的? 癲癇活動(dòng)傳播的檢測(cè)? 癲癇腦功能評(píng)價(jià),南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.

27、,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究當(dāng)前的癲癇神經(jīng)影像學(xué)診斷和研究方法,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究BOLD-fMRI 對(duì)癲癇活動(dòng)的研究以時(shí)間定空間? 對(duì)于癲癇，僅需在MRI,timetime,掃描的同時(shí)，獲得間期癇樣發(fā)放（IEDs）的時(shí)間信息即可。

28、南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,BlBlockkEvent-RelatedDept. of Med. Img., NJ JinLing Hos.,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究同步腦電聯(lián)合功能磁共振成像技術(shù),南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研

29、究EEG-fMRI原理＋,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究EEG-fMRI例1，男28歲，右側(cè)海馬硬化,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用

30、研究EEG-fMRI 部分性癲癇的活動(dòng)定位Liu Y, et al., Neurological Science, 2008,,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究IEDs相關(guān)的BOLD負(fù)激活,?,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med

31、. Img., NJ JinLing Hos.,Functional suspension of the Default-mode networkGotman et al., 2005, PNAS,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究EEG-fMRI面臨問題,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLi

32、ng Hos.,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究MRI對(duì)EEG圖像造成嚴(yán)重的影響,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究EEG讀圖困難,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing H

33、os.,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究癲癇具有特異的hrf特征? 不同腦區(qū)的癲癇hrf有一定的差異Kang et al., 2003,Neuroimage,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究EEG-fMRI癲癇活動(dòng)檢測(cè)效能f

34、MRI結(jié)果與癲癇灶一致,無EEG檢出,?激活區(qū)不一致,無EEG檢出無激活定位不一致一致,無BOLD激活,[1] Aghakhani Y, et al., ClinicalNeurophysiology. 2006.[2] Laufs, H., et al., Brain Res. 2006.南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,,,,靜息態(tài)f

35、MRI及對(duì)癲癇的應(yīng)用研究腦靜息態(tài)低頻振蕩活動(dòng)與r-fMRI癲癇病生基礎(chǔ)及fMRI研究低頻振幅fMRI研究及在癲癇病中應(yīng)用靜息態(tài)腦網(wǎng)絡(luò)fMRI研究及癲癇病中應(yīng)用,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,,,,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,靜息態(tài)fMRI及對(duì)

36、癲癇的應(yīng)用研究背景時(shí)間聚類分析（temporal clustering analysis, TCA）? TCA可以檢測(cè)出癲癇活動(dòng)時(shí)引起最大反應(yīng)簇的時(shí)間點(diǎn)? 把此檢測(cè)到的時(shí)間用于GLM模型，進(jìn)而達(dá)到定位Morgan et al., Neuroimage, 2004,,,,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLin

37、g Hos.,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究ICA檢測(cè)癲癇活動(dòng)? 結(jié)合EEG-fMRI，獲得IEDs時(shí)間信息后，不用GLM模型，而用空間ICA方法，把IEDs時(shí)間信息與ICs的時(shí)間序列進(jìn)行相關(guān)，挑出與IEDs最相關(guān)的空間成分Rodionov et al., Neuroimage, 2007, 38:488-500,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究

38、基于ALFF的fMRI對(duì)mTLE的研究生理機(jī)制模型? ALFF反映SNA的活動(dòng)程度IEDs可否引起ALFF的增高則可以用于檢測(cè)癲癇活動(dòng),南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,,,,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,靜息態(tài)fMRI及對(duì)癲癇

39、的應(yīng)用研究材料與方法受試者? 26 名右側(cè)mTLE患者—10 女, 16 男—年齡: 15-35 years, 平均：23.8 years— 右側(cè)癲癇波表現(xiàn)—右側(cè)海馬硬化Zhangg et al.,, 2010,,Hum. Brain Mapp.,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究Material &

40、MethodsParticipants—22名左側(cè)MTLE—99 女, 13男—平均年齡: 25.6 yrs—左側(cè)癲癇波—左側(cè)海馬硬化,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究方法與材料數(shù)據(jù)采集 GE-signa 1.5 Tesla MR scanner—功能像：GRE-EPI s

41、equence for BOLD-functional data—TR/ TE=2000/ 40ms; thickness/ gap= 5.0/ 0 mm;FA=80°; 23 slices; 250 time points, 500 seconds; Matrix:64×64.– 結(jié)構(gòu)像? T1FLAIR for anatomical location;; the s

42、ameorientation with the functional acquisition,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究數(shù)據(jù)處理? Spatial preprocessing (SPM 2, http://www.fil.ion.ucl.ac.uk/spm)—Slice timing

43、—Head motion Realignment—Normalization: resampled to 3mm×3mm×3mm—Smooth: FWHM=8mm,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究同步腦電數(shù)據(jù)采集? EEG equipment: BP 32 cha

44、nnel Ag/ AgCl—Frequency: 5000Hz腦電數(shù)據(jù)處理與分析? Noises filtering: Brain Vision Analyzer 1.2,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究ALFF數(shù)據(jù)分析? REST (http://resting-fmri.sourceforge.

45、net )? Detrend? Band filter (0.08-0.01)? Mean ALFF value? Single-subject analysis—The control group—The patient groups,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究2階組分析? Grou

46、p comparisons—Left mTLE VS Controls—Right mTLE VS Controls? 2-sample t-test based single-subject analysis—11 patient VS Controls,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究結(jié)果和討論1

47、癲癇“活動(dòng)”檢測(cè),ControlsDept. of Med. Img., NJ JinLing Hos.,? Patients (left mTLE) VSthalamusmMTL南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究? Patients (right mTLE

48、) VS Controls—Is the Increased ALFF induced by epilepticactivation?,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究結(jié)果和討論2描繪顳葉癲癇網(wǎng)絡(luò)? Decreased ALFF & Default mode? Functional in

49、hibition?,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究描繪顳葉癲癇網(wǎng)絡(luò)Tae et al., Neuroimage, 2005,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,,,,靜息態(tài)fMRI及對(duì)

50、癲癇的應(yīng)用研究描繪顳葉癲癇網(wǎng)絡(luò)Tae et al., Neuroimage, 2005,ALFF南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Interictal,IctalDept. of Med. Img., NJ JinLing Hos.,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究結(jié)果

51、和討論3ALFF和IEDs的關(guān)系(from EEG)? 6 patients who had undergone simultaneous EEGPatient 1Patient 2……Patient 5Patient 61000 TRs10 segments in each session,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究ALF

52、F VS IEDs (from EEG)? ALFF value was calculated in each segment? ALFF values were correlated with the IED numbersPearson correlationanalysis,ALFF南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,IED numberDept. of Med. Img.,

53、 NJ JinLing Hos.,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究結(jié)果和討論3? ALFF與IEDs次數(shù)呈明顯相關(guān)的腦區(qū),南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究,結(jié)果和討論4,癲癇活動(dòng)的定側(cè)ROI法分析? 雙側(cè)內(nèi)側(cè)顳葉內(nèi)的ALFF平均值? 左-右/左+右,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究,癲癇活動(dòng)

54、的定側(cè),結(jié)果和討論4,? 比較計(jì)算半球間的ALFF不同=,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究結(jié)果和討論4ALFF 在mTLE腦中的不對(duì)稱左側(cè)mTLE右側(cè)mTLE,Ipsilateral hippocampus南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)

55、影像科,Ipsilateral thalamusDept. of Med. Img., NJ JinLing Hos.,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究Hemispheric asymmetry in the healthy controls? The physiological asymmetry in the controlsshould be taken account into,南

56、京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究=mTLE==Controls,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究Excluding the possible

57、 effect of the physiologicalasymmetry,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究結(jié)果和討論5單例個(gè)體分析—實(shí)際臨床指導(dǎo)意義? 2-sample t-test performed byusing SPM? 1 patient VS 27 Co

58、ntrols,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究Case 1left mTLE,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究Case 2right mTL

59、E,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究Case 3right mTLE,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究Case 4left mTLE,南

60、京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究臨床定側(cè)判斷? Left or Right? Accurate rate = ALFF / Clinical assessment? View assessment by 3 Radiologists? Consistent analysis: kappa test,南京軍

61、區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究Methods consideration,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究腦靜息態(tài)低頻振蕩活動(dòng)與r-fMRI癲癇病生基礎(chǔ)及fMRI研究低

62、頻振幅fMRI研究及在癲癇病中應(yīng)用靜息態(tài)腦網(wǎng)絡(luò)fMRI研究及癲癇病中應(yīng)用,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究癲癇腦靜息網(wǎng)絡(luò)的研究相比其他腦功能異常性疾病，癲癇的r-fMRI相對(duì)較少? 不是純粹/常規(guī)的 Resting-state，因?yàn)橛凶园l(fā)的間期癇樣發(fā)放（IEDs） 的影響,

63、?,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,IEDs難以預(yù)知，并且與正常SNAs的關(guān)系不明IEDs對(duì)FC的影響，超過SNAs的影響或增高、或降低,,,,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究癲癇功能連接研究? 左側(cè)顳葉癲癇語言區(qū)FC的改

64、變Waits et al., Ann Neurol 2006;59:335–343,,,,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究? 單側(cè)內(nèi)側(cè)顳葉癲癇患者 顳葉內(nèi)部病變側(cè)FC下降，而對(duì)側(cè)代償性上升

65、Bettus G, et al., Hum Brain Mapp. 2009, 30, 1580-91.,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究? 采用離散余弦函數(shù)多元回歸方式研究發(fā)現(xiàn)，全面發(fā)放的患者DMN自發(fā)神經(jīng)活動(dòng)受影響，而部分性發(fā)作的患者則不明顯Lui, et al., J. Magn. Reson. Imaging 2008;27:1214–12

66、20.,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究,癲癇DMN網(wǎng)絡(luò)研究,mTLE,? 海馬硬化--------------------記憶功能? 外側(cè)顳葉受影響- ---------語言功能,? 額葉功能結(jié)構(gòu)受影響-----高級(jí)認(rèn)知能力下降,mTLE DMN,,,,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究mTLE患者DMN改變的研究,?

67、?,前研究采用EEG-fMRI [1]方法發(fā)現(xiàn)：全面發(fā)放的癲癇類型容易引起DMN的改變，而部分性發(fā)作的不易引起但不同文獻(xiàn)[2]及我們前期研究發(fā)現(xiàn)，部分性癲癇亦有DMN區(qū)的負(fù)激活[1] Aghakhani Y, et al., ClinicalNeurophysiology. 2006, 117: 177–191.[2] Laufs, H., et al., Hum Brain

68、Mapp.2007, 28, 1023-32,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,,,,南京軍區(qū)南京總醫(yī)院醫(yī)學(xué)影像科,Dept. of Med. Img., NJ JinLing Hos.,靜息態(tài)fMRI及對(duì)癲癇的應(yīng)用研究? 采用種子點(diǎn)的FC方法對(duì)mTLE研究Frings et al