Abstract: Objective We explored the multimodal imaging characteristics of cortical tuber in patients with tuberous sclerosis complex (TSC)for better preoperative diagnosis and surgical decision-making.Methods Patients with TSC related epilepsy (TRE)from January 2015 to December 2021 from Beijing Tiantan Hospital and Beijing Fengtai Hospital were included retrospectively.Their clinical demographics and multimodal neuroimaging data were collected.We firstly quantitatively calculated the multimodal neuroimaging signals ofcortical tubers and normal cortex,as well as the volumes of cortical tubers.We then performed the inter-group comparison and correlation analysis between multimodal neuroimaging signals of cortical tubers and normal cortex.Results Finally,31 patients with diagnosis of TSC and verification of responsible tubers after multidisciplinary preoperative evaluationwere included.The quantitative results showed that,comparedwith homotopic cortex,tubers displayed significantly higher T2w-FLAIR density signal (Student's t=3.643,PFDR<0.001) and lower PET metabolic value (Student's t =-6.162,PFDR<0.001).Moreover,responsible tubers shown significant correlation between T1wMPRAGE and FDG-PET (Pearson R=-0.512,PFDR= 0.027) and significantly larger volume than that of non-responsible tubers (Mann Whitney U=3.378,P＜0.001).Conclusion T₂w-FLAIRsignal of TSC tubers is significantly higher than that of normal cortex,which is helpful to diagnosis.The characteristic structure-metabolism coupling and larger volume,render its value in preoperative evaluation and surgicaldecision-making.

Key words: Tuberous sclerosis complex-related epilepsy, Multimodal neuroimaging, Epilepsy surgery, Responsible tuber

摘要： 目的 探讨结节性硬化症(tuberous sclerosis complex,TSC)皮质结节的多模态影像特点,以期更好指导术前诊断和手术决策。方法 回顾性纳入2015年1月至2021年12月首都医科大学附属北京天坛医院和北京丰台医院神经外科收治的TSC相关癫痫患者,收集临床资料和多模态神经影像数据,量化计算的皮质结节和正常皮质的多模态影像信号和体积,并进行模态间横向组间比较和相关性分析。结果 最终纳入31例患者,术前多学科术前评估诊断TSC和界定责任结节。量化结果显示TSC结节的T2w-FLAIR密度信号值显著高于同位皮质(Student's t=3.643,PFDR<0.001)而PET代谢信号显著降低(Student's t =-6.162,PFDR<0.001),责任结节的T1w-MPRAGE和FDG-PET(Pearson R=-0.512,PFDR=0.027)存在显著负相关,并且责任结节的平均体积显著大于非责任结节(Mann-Whitney U=3.378,P＜0.001)。结论 TSC结节T2w-FLAIR显著高于正常皮质,有助于提高临床检出率。责任TSC结节体积明显大于其他结节,并具有结构-代谢耦合特点,在术前评估和临床决策中具有重要价值。

关键词: 结节性硬化相关癫痫, 多模态神经影像, 癫痫外科, 责任结节