Quantitative susceptibility mapping identifies hippocampal and other subcortical grey matter tissue composition changes in temporal lobe epilepsy

The statistical impact of ROI referencing on quantitative susceptibility mapping

In quantitative susceptibility mapping (QSM), it is impossible to define an absolute reference for the reconstructed susceptibility values. Therefore, it has been suggested to use a relative reference, such as the mean susceptibility within an anatomical ROI. We investigated the theoretical basis of referencing, and what impact it may have on statistical ROI comparisons, particularly for clinical applications. We analysed a clinical epilepsy study and in-silico QSM reconstruction challenge data with various reference regions. The results are analysed as in a clinical study and resulting statistical variations are investigated from a theoretical point of view. We found that referencing has an impact on the significance of clinical findings. These effects may arise from a change in the precision of test statistics due to referencing. We also show potential biasing of results from referencing. Our findings suggest there may not be one "optimal" reference region, and care should always be taken with reference region selection depending on the specific pathology or cohort under investigation. Not explicitly referencing is less likely to lead to false positives than cherry picking a reference region to maximize statistically significant results. We encourage results to be published with their reference to facilitate future comparisons of datasets from different sources.

Quantitative susceptibility mapping of iron deposition in sporadic cerebral cavernous malformation-related epilepsy

OBJECTIVE

To evaluate iron deposition patterns in patients with cerebral cavernous malformation-related epilepsy (CRE) using quantitative susceptibility mapping (QSM) for detailed analysis of iron distribution associated with a history of epilepsy and severity.

METHODS

This study is part of the Quantitative Susceptibility Biomarker and Brain Structural Property for Cerebral Cavernous Malformation Related Epilepsy (CRESS) cohort, a prospective multicenter study. QSM was used to quantify iron deposition in patients with sporadic cerebral cavernous malformation (CCMs). Lesions were segmented into intralesional, perilesional, and extralesional areas, with mean susceptibility values calculated for each subregion and analyzed in relation to epilepsy severity and duration.

RESULTS

Among the 46 patients studied, those with a history of epilepsy had significantly higher iron deposition values in the perilesional (p =.012) and extralesional areas (p =.01), as well as a greater extent of iron deposition (p <.001) compared to those without epilepsy. The extent of iron deposition effectively distinguished patients with and without epilepsy, with an area under the curve (AUC) of 0.901 (95% confidence interval [CI]: 0.816-0.985). Among patients with epilepsy, iron deposition in the extralesional area was positively correlated with the severity of epilepsy (r2 = 0.181, p =.043), and the extent of iron deposition was positively correlated with the duration of epilepsy (r2 =.214, p =.026).

SIGNIFICANCE

This study highlights QSM as a non-invasive tool for assessing iron deposition in CRE, identifying distinct subregional iron deposition patterns linked to epilepsy status and severity.

Paramagnetic susceptibility measured by magnetic resonance imaging as an in vivo biomarker for iron pathology in epilepsy

Epilepsy, a neurological disorder marked by recurrent, unprovoked seizures, is often linked to dysregulated iron metabolism, resulting in iron overload and subsequent cellular dysfunction or death within epileptogenic regions. We proposed a specific, noninvasive technique using paramagnetic susceptibility imaging via magnetic resonance imaging to quantify in vivo brain iron levels, aiming to enhance our understanding of epilepsy pathology and improve diagnostic accuracy. Our imaging and histopathological studies demonstrated that paramagnetic susceptibility is a sensitive biomarker for iron quantification in epilepsy. This method effectively detects iron abnormality from various causes and highlights that iron alters within epileptogenic zones, indicating the presence of potentially salvageable tissue. Furthermore, iron accumulation was observed to disrupt cortical laminar structures in epileptogenic zones and was associated with the proliferation of central nervous system cells, particularly astrocytes. Paramagnetic susceptibility imaging provides previously unknown insights into epilepsy, offering potential applications in diagnostics, monitoring, and personalized treatment strategies.

Comparing repeatability metrics for quantitative susceptibility mapping in the head and neck

OBJECTIVE

Quantitative susceptibility mapping (QSM) is a technique that has been demonstrated to be highly repeatable in the brain. As QSM is applied to other parts of the body, it is necessary to investigate metrics for quantifying repeatability, to enable optimization of repeatable QSM reconstruction pipelines beyond the brain.

MATERIALS AND METHODS

MRI data were acquired in the head and neck (HN) region in ten healthy volunteers, who underwent six acquisitions across two sessions. QSMs were reconstructed using six representative state-of-the-art techniques. Repeatability of the susceptibility values was compared using voxel-wise metrics (normalized root mean squared error and XSIM) and ROI-based metrics (within-subject and between-subject standard deviation, coefficient of variation (CV), intraclass correlation coefficient (ICC)).

RESULTS

Both within-subject and between-subject variations were smaller than the variation between QSM dipole inversion methods, in most ROIs. autoNDI produced the most repeatable susceptibility values, with ICC > 0.75 in three of six HN ROIs with an average ICC of 0.66 across all ROIs. Joint consideration of standard deviation and ICC offered the best metric of repeatability for comparisons between QSM methods, given typical distributions of positive and negative QSM values.

DISCUSSION

Repeatability of QSM in the HN region is highly dependent on the dipole inversion method chosen, but the most repeatable methods (autoNDI, QSMnet, TFI) are only moderately repeatable in most HN ROIs.

Magnetic susceptibility components reveal different aspects of neurodegeneration in alpha-synucleinopathies

Nigrostriatal dopaminergic degeneration in alpha-synucleinopathies is indirectly reflected by low dopamine transporter (DaT) uptake through [123I]FP-CIT-SPECT. Bulk magnetic susceptibility (χ) in the substantia nigra, from MRI-based quantitative susceptibility mapping (QSM), is a potential biomarker of nigrostriatal degeneration, however, QSM cannot disentangle paramagnetic (e.g. iron) and diamagnetic (e.g. myelin) sources. Using the susceptibility source-separation technique DECOMPOSE, paramagnetic component susceptibility (PCS) and diamagnetic component susceptibility (DCS) were studied in prodromal and overt alpha-synucleinopathies, and their relationships with DaT-SPECT specific binding ratio (SBR) and clinical scores. 78 participants were included (23 controls, 30 prodromal and 25 overt alpha-synucleinopathies). Prodromal patients were subdivided into groups with positive or negative DaT-SPECT (SBR Z-scores below or above -1, respectively). Correlations of putamen and caudate SBR Z-scores with PCS and DCS in the substantia nigra, putamen, and caudate were investigated. Increased PCS was observed in the substantia nigra of prodromal alpha-synucleinopathy patients with positive DaT-SPECT compared to controls and prodromal patients with negative DaT-SPECT. SBR Z-scores in the putamen correlated with increased PCS in the substantia nigra and reduced |DCS| in the putamen, which may reflect dopaminergic degeneration ascribable to iron accumulation and nigrostriatal neuron axonal loss, respectively.

Subcortical Alterations in Newly Diagnosed Epilepsy and Associated Changes in Brain Connectivity and Cognition

Patients with chronic focal epilepsy commonly exhibit subcortical atrophy, particularly of the thalamus. The timing of these alterations remains uncertain, though preliminary evidence suggests that observable changes may already be present at diagnosis. It is also not yet known how these morphological changes are linked to the coherence of white matter pathways throughout the brain, or to neuropsychological function often compromised before antiseizure medication treatment. This study investigates localized atrophy in subcortical regions using surface shape analysis in individuals with newly diagnosed focal epilepsy (NDfE) and assesses their implications on brain connectivity and cognitive function. We collected structural (T1w) and diffusion-weighted MRI and neuropsychological data from 104 patients with NDfE and 45 healthy controls (HCs) matched for age, sex, and education. A vertex-based shape analysis was performed on subcortical structures to compare patients with NDfE and HC, adjusting for age, sex, and intracranial volume. The mean deformation of significance areas (pcor < 0.05) was used to identify white matter pathways associated with overall shape alterations in patients relative to controls using correlational tractography. Additionally, the relationship between significant subcortical shape values and neuropsychological outcomes was evaluated using a generalized canonical correlation approach. Shape analysis revealed bilateral focal inward deformation (a proxy for localized atrophy) in anterior areas of the right and left thalamus and right pallidum in patients with NDfE compared to HC (FWE corrected). No structures showed areas of outward deformation in patients. The connectometry analysis revealed that fractional anisotropy (FA) was positively correlated with thalamic and pallidal shape deformation, that is, reduced FA was associated with inward deformation in tracts proximal to and or connecting with the thalamus including the fornix, frontal, parahippocampal, and corticothalamic pathways. Thalamic and pallidal shape changes were also related to increased depression and anxiety and reduced memory and cognitive function. These findings suggest that atrophy of the thalamus, which has previously been associated with the generation and maintenance of focal seizures, may present at epilepsy diagnosis and relate to alterations in both white matter connectivity and cognitive performance. We suggest that at least some alterations in brain structure and consequent impact on cognitive and affective processes are the result of early epileptogenic processes rather than exclusively due to the chronicity of longstanding epilepsy, recurrent seizures, and treatment with antiseizure medication.

Reliability of quantitative magnetic susceptibility imaging metrics for cerebral cortex and major subcortical structures

BACKGROUND AND PURPOSE

Susceptibility estimates derived from quantitative susceptibility mapping (QSM) images for the cerebral cortex and major subcortical structures are variably reported in brain magnetic resonance imaging (MRI) studies, as average of all (μ all ${{{{\mu}}}_{{\mathrm{all}}}}$ ), absolute (μ abs ${{{{\mu}}}_{{\mathrm{abs}}}}$ ), or positive- (μ p ${{{{\mu}}}_{\mathrm{p}}}$ ) and negative-only (μ n ${{{{\mu}}}_{\mathrm{n}}}$ ) susceptibility values using a region of interest (ROI) approach. This pilot study presents a reliability analysis of currently used ROI-QSM metrics and an alternative ROI-based approach to obtain voxel-weighted ROI-QSM metrics (μ wp ${{{{\mu}}}_{{\mathrm{wp}}}}$ andμ wn ${{{{\mu}}}_{{\mathrm{wn}}}}$ ).

METHODS

Ten healthy subjects underwent repeated (test-retest) 3-dimensional multi-echo gradient-echo (3DMEGE) 3 Tesla MRI measurements. Complex-valued 3DMEGE images were acquired and reconstructed with slice thicknesses of 1 and 2 mm (3DMEGE1, 3DMEGE2) along with 3DT1-weighted isometric (voxel 1 mm3) images for independent registration and ROI segmentation. Agreement, consistency, and reproducibility of ROI-QSM metrics were assessed through Bland-Altman analysis, intraclass correlation coefficient, and interscan and intersubject coefficient of variation (CoV).

RESULTS

All ROI-QSM metrics exhibited good to excellent consistency and test-retest agreement with no proportional bias. Interscan CoV was higher forμ all ${{{{\mu}}}_{{\mathrm{all}}}}$ in comparison to the other metrics where it was below 15%, in both 3DMEGE1 and 3DMEGE2 datasets. Intersubject CoV forμ all ${{{{\mu}}}_{{\mathrm{all}}}}$ andμ abs ${{{{\mu}}}_{{\mathrm{abs}}}}$ exceeded 50% in all ROIs.

CONCLUSIONS

Among the evaluated ROI-QSM metrics,μ all ${{{{\mu}}}_{{\mathrm{all}}}}$ andμ abs ${{{{\mu}}}_{{\mathrm{abs}}}}$ estimates were less reliable, whereas separating positive and negative values (usingμ p , μ n , μ wp , μ wn ${{{{\mu}}}_{\mathrm{p}}},\ {{{{\mu}}}_{\mathrm{n}}},\ {{{{\mu}}}_{{\mathrm{wp}}}},\ {{{{\mu}}}_{{\mathrm{wn}}}}$ ) improved the reproducibility within, and the comparability between, subjects, even when reducing the slice thickness. These preliminary findings may offer valuable insights toward standardizing ROI-QSM metrics across different patient cohorts and imaging settings in future clinical MRI studies.

Improving quantitative susceptibility mapping for the identification of traumatic brain injury neurodegeneration at the individual level

BACKGROUND

Emerging evidence suggests that traumatic brain injury (TBI) is a major risk factor for developing neurodegenerative disease later in life. Quantitative susceptibility mapping (QSM) has been used by an increasing number of studies in investigations of pathophysiological changes in TBI. However, generating artefact-free quantitative susceptibility maps in brains with large focal lesions, as in the case of moderate-to-severe TBI (ms-TBI), is particularly challenging. To address this issue, we utilized a novel two-pass masking technique and reconstruction procedure (two-pass QSM) to generate quantitative susceptibility maps (QSMxT; Stewart et al., 2022, Magn Reson Med.) in combination with the recently developed virtual brain grafting (VBG) procedure for brain repair (Radwan et al., 2021, NeuroImage) to improve automated delineation of brain areas. We used QSMxT and VBG to generate personalised QSM profiles of individual patients with reference to a sample of healthy controls.

METHODS

Chronic ms-TBI patients (N = 8) and healthy controls (N = 12) underwent (multi-echo) GRE, and anatomical MRI (MPRAGE) on a 3T Siemens PRISMA scanner. We reconstructed the magnetic susceptibility maps using two-pass QSM from QSMxT. We then extracted values of magnetic susceptibility in grey matter (GM) regions (following brain repair via VBG) across the whole brain and determined if they deviate from a reference healthy control group [Z-score < -3.43 or > 3.43, relative to the control mean], with the aim of obtaining personalised QSM profiles.

RESULTS

Using two-pass QSM, we achieved susceptibility maps with a substantial increase in quality and reduction in artefacts irrespective of the presence of large focal lesions, compared to single-pass QSM. In addition, VBG minimised the loss of GM regions and exclusion of patients due to failures in the region delineation step. Our findings revealed deviations in magnetic susceptibility measures from the HC group that differed across individual TBI patients. These changes included both increases and decreases in magnetic susceptibility values in multiple GM regions across the brain.

CONCLUSIONS

We illustrate how to obtain magnetic susceptibility values at the individual level and to build personalised QSM profiles in ms-TBI patients. Our approach opens the door for QSM investigations in more severely injured patients. Such profiles are also critical to overcome the inherent heterogeneity of clinical populations, such as ms-TBI, and to characterize the underlying mechanisms of neurodegeneration at the individual level more precisely. Moreover, this new personalised QSM profiling could in the future assist clinicians in assessing recovery and formulating a neuroscience-guided integrative rehabilitation program tailored to individual TBI patients.