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Jin J, Zhou Y, Chen L, Chen Z. Ultrafast T 2 and T 2* mapping using single-shot spatiotemporally encoded MRI with reduced field of view and spiral out-in-out-in trajectory. Med Phys 2024. [PMID: 38896823 DOI: 10.1002/mp.17268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 05/15/2024] [Accepted: 06/11/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND T2 and T2* mapping are crucial components of quantitative magnetic resonance imaging, offering valuable insights into tissue characteristics and pathology. Single-shot methods can achieve ultrafast T2 or T2* mapping by acquiring multiple readout echo trains. However, the extended echo trains pose challenges, such as compromised image quality and diminished quantification accuracy. PURPOSE In this study, we develop a single-shot method for ultrafast T2 and T2* mapping with reduced echo train length. METHODS The proposed method is based on ultrafast single-shot spatiotemporally encoded (SPEN) MRI combined with reduced field of view (FOV) and spiral out-in-out-in (OIOI) trajectory. Specifically, a biaxial SPEN excitation scheme was employed to excite the spin signal into the spatiotemporal encoding domain. The OIOI trajectory with high acquisition efficiency was employed to acquire signals within targeted reduced FOV. Through non-Cartesian super-resolved (SR) reconstruction, 12 aliasing-free images with different echo times were obtained within 150 ms. These images were subsequently fitted to generate T2 or T2* mapping simultaneously using a derived model. RESULTS Accurate and co-registered T2 and T2* maps were generated, closely resembling the reference maps. Numerical simulations demonstrated substantial consistency (R2 > 0.99) with the ground truth values. A mean difference of 0.6% and 1.7% was observed in T2 and T2*, respectively, in in vivo rat brain experiments compared to the reference. Moreover, the proposed method successfully obtained T2 and T2* mappings of rat kidney in free-breathing mode, demonstrating its superiority over multishot methods lacking respiratory navigation. CONCLUSIONS The results suggest that the proposed method can achieve ultrafast and accurate T2 and T2* mapping, potentially facilitating the application of T2 and T2* mapping in scenarios requiring high temporal resolution.
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Affiliation(s)
- Junxian Jin
- Department of Electronic Science, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, School of Electronic Science and Engineering, National Model Microelectronics College, Xiamen University, Xiamen, China
| | - Yang Zhou
- Key Laboratory for Magnetic Resonance and Multimodality Imaging of Guangdong Province, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, China
| | - Lin Chen
- Department of Electronic Science, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, School of Electronic Science and Engineering, National Model Microelectronics College, Xiamen University, Xiamen, China
| | - Zhong Chen
- Department of Electronic Science, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, School of Electronic Science and Engineering, National Model Microelectronics College, Xiamen University, Xiamen, China
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Casella C, Vecchiato K, Cromb D, Guo Y, Winkler AM, Hughes E, Dillon L, Green E, Colford K, Egloff A, Siddiqui A, Price A, Grande LC, Wood TC, Malik S, Teixeira RPAG, Carmichael DW, O'Muircheartaigh J. Widespread, depth-dependent cortical microstructure alterations in pediatric focal epilepsy. Epilepsia 2024; 65:739-752. [PMID: 38088235 DOI: 10.1111/epi.17861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 12/11/2023] [Accepted: 12/11/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVE Tissue abnormalities in focal epilepsy may extend beyond the presumed focus. The underlying pathophysiology of these broader changes is unclear, and it is not known whether they result from ongoing disease processes or treatment-related side effects, or whether they emerge earlier. Few studies have focused on the period of onset for most focal epilepsies, childhood. Fewer still have utilized quantitative magnetic resonance imaging (MRI), which may provide a more sensitive and interpretable measure of tissue microstructural change. Here, we aimed to determine common spatial modes of changes in cortical architecture in children with heterogeneous drug-resistant focal epilepsy and, secondarily, whether changes were related to disease severity. METHODS To assess cortical microstructure, quantitative T1 and T2 relaxometry (qT1 and qT2) was measured in 43 children with drug-resistant focal epilepsy (age range = 4-18 years) and 46 typically developing children (age range = 2-18 years). We assessed depth-dependent qT1 and qT2 values across the neocortex, as well as their gradient of change across cortical depths. We also determined whether global changes seen in group analyses were driven by focal pathologies in individual patients. Finally, as a proof-of-concept, we trained a classifier using qT1 and qT2 gradient maps from patients with radiologically defined abnormalities (MRI positive) and healthy controls, and tested whether this could classify patients without reported radiological abnormalities (MRI negative). RESULTS We uncovered depth-dependent qT1 and qT2 increases in widespread cortical areas in patients, likely representing microstructural alterations in myelin or gliosis. Changes did not correlate with disease severity measures, suggesting they may represent antecedent neurobiological alterations. Using a classifier trained with MRI-positive patients and controls, sensitivity was 71.4% at 89.4% specificity on held-out MRI-negative patients. SIGNIFICANCE These findings suggest the presence of a potential imaging endophenotype of focal epilepsy, detectable irrespective of radiologically identified abnormalities.
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Affiliation(s)
- Chiara Casella
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Department for Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Katy Vecchiato
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Department for Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Daniel Cromb
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Yourong Guo
- Department for Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Anderson M Winkler
- Department of Human Genetics, University of Texas Rio Grande Valley, Brownsville, Texas, USA
| | - Emer Hughes
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Louise Dillon
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Elaine Green
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Kathleen Colford
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Alexia Egloff
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Ata Siddiqui
- Department of Radiology, Guy's and Saint Thomas' Hospitals NHS Trust, London, UK
| | - Anthony Price
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Lucilio Cordero Grande
- Department of Biomedical Engineering, King's College London, London, UK
- Biomedical Image Technologies, Telecommunication Engineering School (ETSIT), Technical University of Madrid, Bioengineering, Biomaterials and Nanomedicine Networking Biomedical Research Centre, National Institute of Health Carlos III, Madrid, Spain
| | - Tobias C Wood
- Department of Neuroimaging, King's College London, London, UK
| | - Shaihan Malik
- Department of Biomedical Engineering, King's College London, London, UK
| | | | | | - Jonathan O'Muircheartaigh
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Department for Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- Medical Research Council (MRC) Centre for Neurodevelopmental Disorders, London, UK
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3
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Mann L, Rosenow F, Strzelczyk A, Hattingen E, Willems LM, Harter PN, Weber K, Mann C. The impact of referring patients with drug-resistant focal epilepsy to an epilepsy center for presurgical diagnosis. Neurol Res Pract 2023; 5:65. [PMID: 38093325 PMCID: PMC10720126 DOI: 10.1186/s42466-023-00288-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 10/13/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Epilepsy surgery is an established treatment for drug-resistant focal epilepsy (DRFE) that results in seizure freedom in about 60% of patients. Correctly identifying an epileptogenic lesion in magnetic resonance imaging (MRI) is challenging but highly relevant since it improves the likelihood of being referred for presurgical diagnosis. The epileptogenic lesion's etiology directly relates to the surgical intervention's indication and outcome. Therefore, it is vital to correctly identify epileptogenic lesions and their etiology presurgically. METHODS We compared the final histopathological diagnoses of all patients with DRFE undergoing epilepsy surgery at our center between 2015 and 2021 with their MRI diagnoses before and after presurgical diagnosis at our epilepsy center, including MRI evaluations by expert epilepsy neuroradiologists. Additionally, we analyzed the outcome of different subgroups. RESULTS This study included 132 patients. The discordance between histopathology and MRI diagnoses significantly decreased from 61.3% for non-expert MRI evaluations (NEMRIs) to 22.1% for epilepsy center MRI evaluations (ECMRIs; p < 0.0001). The MRI-sensitivity improved significantly from 68.6% for NEMRIs to 97.7% for ECMRIs (p < 0.0001). Identifying focal cortical dysplasia (FCD) and amygdala dysplasia was the most challenging for both subgroups. 65.5% of patients with negative NEMRI were seizure-free 12 months postoperatively, no patient with negative ECMRI achieved seizure-freedom. The mean duration of epilepsy until surgical intervention was 13.6 years in patients with an initial negative NEMRI and 9.5 years in patients with a recognized lesion in NEMRI. CONCLUSIONS This study provides evidence that for patients with DRFE-especially those with initial negative findings in a non-expert MRI-an early consultation at an epilepsy center, including an ECMRI, is important for identifying candidates for epilepsy surgery. NEMRI-negative findings preoperatively do not preclude seizure freedom postoperatively. Therefore, patients with DRFE that remain MRI-negative after initial NEMRI should be referred to an epilepsy center for presurgical evaluation. Nonreferral based on NEMRI negativity may harm such patients and delay surgical intervention. However, ECMRI-negative patients have a reduced chance of becoming seizure-free after epilepsy surgery. Further improvements in MRI technique and evaluation are needed and should be directed towards improving sensitivity for FCDs and amygdala dysplasias.
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Affiliation(s)
- Leonhard Mann
- Epilepsy Center Rhine-Main, Center of Neurology and Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.
- Department of Neuroradiology, University Hospital Frankfurt, Goethe University Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany.
| | - Felix Rosenow
- Epilepsy Center Rhine-Main, Center of Neurology and Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University, Frankfurt am Main, Germany
| | - Adam Strzelczyk
- Epilepsy Center Rhine-Main, Center of Neurology and Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University, Frankfurt am Main, Germany
| | - Elke Hattingen
- Department of Neuroradiology, University Hospital Frankfurt, Goethe University Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
| | - Laurent M Willems
- Epilepsy Center Rhine-Main, Center of Neurology and Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University, Frankfurt am Main, Germany
| | - Patrick N Harter
- Neurological Institute (Edinger Institute), University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
- Centre for Neuropathology and Prion-Research, Ludwig-Maximilians-Universität München, München, Germany
| | - Katharina Weber
- Neurological Institute (Edinger Institute), University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Frankfurt Cancer Institute (FCI), Frankfurt am Main, Germany
- Center for Tumor Diseases, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Catrin Mann
- Epilepsy Center Rhine-Main, Center of Neurology and Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University, Frankfurt am Main, Germany
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Poojar P, Qian E, Jin Z, Fung M, Maddocks AB, Geethanath S. Tailored magnetic resonance fingerprinting of post-operative pediatric brain tumor patients. Clin Imaging 2023; 102:53-59. [PMID: 37549563 DOI: 10.1016/j.clinimag.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 07/05/2023] [Accepted: 07/21/2023] [Indexed: 08/09/2023]
Abstract
PURPOSE Brain and spinal cord tumors are the second most common cancer in children and account for one out of four cancers diagnosed. However, the long acquisition times associated with acquiring both data types prohibit using quantitative MR (qMR) in pediatric imaging protocols. This study aims to demonstrate the tailored magnetic resonance fingerprinting's (TMRF) ability to simultaneously provide quantitative maps (T1, T2) and multi-contrast qualitative images (T1 weighted, T1 FLAIR, T2 weighted) rapidly in pediatric brain tumor patients. METHODS In this work, we imaged five pediatric patients with brain tumors (resected/residual) using TMRF at 3 T. We compared the TMRF-derived T2 weighted images with those from the vendor-supplied sequence (as the gold standard, GS) for healthy and pathological tissue signal intensities. The relaxometric maps from TMRF were subjected to a region of interest (ROI) analysis to differentiate between healthy and pathological tissues. We performed the Wilcoxon rank sum test to check for significant differences between the two tissue types. RESULTS We found significant differences (p < 0.05) in both T1 and T2 ROI values between the two tissue types. A strong correlation was found between the TMRF-based T2 weighted and GS signal intensities for the healthy (correlation coefficient, r = 0.99) and pathological tissues (r = 0.88). CONCLUSION The TMRF implementation provides the two relaxometric maps and can potentially save ~2 min if it replaces the T2-weighted imaging in the current protocol.
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Affiliation(s)
- Pavan Poojar
- Accessible Magnetic Resonance Laboratory, Biomedical Imaging and Engineering Institute, Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Enlin Qian
- Columbia Magnetic Resonance Research Center, Columbia University, New York, NY, United States
| | - Zhezhen Jin
- Department of Biostatistics, Columbia University, New York, NY, United States
| | - Maggie Fung
- GE Healthcare Applied Sciences Laboratory East, New York, NY, United States
| | - Alexis B Maddocks
- Columbia University Irving Medical Center, New York, NY, United States
| | - Sairam Geethanath
- Accessible Magnetic Resonance Laboratory, Biomedical Imaging and Engineering Institute, Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
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Hamid C, Maiworm M, Wagner M, Knake S, Nöth U, Deichmann R, Gracien RM, Seiler A. Focal epilepsy without overt epileptogenic lesions: no evidence of microstructural brain tissue damage in multi-parametric quantitative MRI. Front Neurol 2023; 14:1175971. [PMID: 37528856 PMCID: PMC10389268 DOI: 10.3389/fneur.2023.1175971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/03/2023] [Indexed: 08/03/2023] Open
Abstract
Background and purpose In patients with epilepsies of structural origin, brain atrophy and pathological alterations of the tissue microstructure extending beyond the putative epileptogenic lesion have been reported. However, in patients without any evidence of epileptogenic lesions on diagnostic magnetic resonance imaging (MRI), impairment of the brain microstructure has been scarcely elucidated. Using multiparametric quantitative (q) magnetic resonance imaging MRI, we aimed to investigate diffuse impairment of the microstructural tissue integrity in MRI-negative focal epilepsy patients. Methods 27 MRI-negative patients with focal epilepsy (mean age 33.1 ± 14.2 years) and 27 matched healthy control subjects underwent multiparametric qMRI including T1, T2, and PD mapping at 3 T. After tissue segmentation based on synthetic anatomies, mean qMRI parameter values were extracted from the cerebral cortex, the white matter (WM) and the deep gray matter (GM) and compared between patients and control subjects. Apart from calculating mean values for the qMRI parameters across the respective compartments, voxel-wise analyses were performed for each tissue class. Results There were no significant differences for mean values of quantitative T1, T2, and PD obtained from the cortex, the WM and the deep GM between the groups. Furthermore, the voxel-wise analyses did not reveal any clusters indicating significant differences between patients and control subjects for the qMRI parameters in the respective compartments. Conclusions Based on the employed methodology, no indication for an impairment of the cerebral microstructural tissue integrity in MRI-negative patients with focal epilepsy was found in this study. Further research will be necessary to identify relevant factors and mechanisms contributing to microstructural brain tissue damage in various subgroups of patients with epilepsy.
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Affiliation(s)
- Celona Hamid
- Department of Neurology, Goethe University Hospital, Frankfurt, Germany
- Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
- Center for Personalized Translational Epilepsy Research (CePTER) Consortium, Frankfurt, Germany
| | - Michelle Maiworm
- Department of Neurology, Goethe University Hospital, Frankfurt, Germany
- Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
| | - Marlies Wagner
- Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
- Center for Personalized Translational Epilepsy Research (CePTER) Consortium, Frankfurt, Germany
- Institute of Neuroradiology, Goethe University Hospital, Frankfurt, Germany
| | - Susanne Knake
- Center for Personalized Translational Epilepsy Research (CePTER) Consortium, Frankfurt, Germany
- Epilepsy Center Hessen and Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Ulrike Nöth
- Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
- Center for Personalized Translational Epilepsy Research (CePTER) Consortium, Frankfurt, Germany
| | - Ralf Deichmann
- Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
- Center for Personalized Translational Epilepsy Research (CePTER) Consortium, Frankfurt, Germany
| | - René-Maxime Gracien
- Department of Neurology, Goethe University Hospital, Frankfurt, Germany
- Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
- Center for Personalized Translational Epilepsy Research (CePTER) Consortium, Frankfurt, Germany
| | - Alexander Seiler
- Department of Neurology, Goethe University Hospital, Frankfurt, Germany
- Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
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Sufianov A, Simfukwe K, Iakimov IA, Sufianov RA, Rassi MS, Mastronardi L, Borba LAB, Campero A, Rangel CC, Baldoncini M. Usefulness of Intraoperative ultrasound for cortical dysplasia type I treatment - A single-center experience. Surg Neurol Int 2023; 14:62. [PMID: 36895230 PMCID: PMC9990806 DOI: 10.25259/sni_926_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 12/13/2022] [Indexed: 03/11/2023] Open
Abstract
Background Focal cortical dysplasias (FCD) cause a subgroup of malformations of cortical development that has been closely linked to cause drug intractable epilepsy. Attaining adequate and safe resection of the dysplastic lesion has proved to be a viable option to archive meaningful seizure control. Of the three types of FCD (types I, II, and III), type I has the least detectable architectural and radiological abnormalities. This makes it challenging (preoperatively and intraoperatively) to achieve adequate resection. Intraoperatively, ultrasound navigation has proven an effective tool during the resection of these lesions. We evaluate our institutional experience in surgical management of FCD type I using intraoperative ultrasound (IoUS). Methods Our work is a retrospective and descriptive study, where we analyzed patients diagnosed with refractory epilepsy who underwent IoUS-guided epileptogenic tissue resection. The surgical cases analyzed were from January 2015 to June 2020 at the Federal Center of Neurosurgery, Tyumen, only patients with histological confirmation of postoperative CDF type I were included in the study. Results Of the 11 patients with histologically diagnosed FCD type I, 81.8% of the patients postoperatively had a significant reduction in seizure frequency (Engel outcome I-II). Conclusion IoUS is a critical tool for detecting and delineating FCD type I lesions, which is necessary for effective post-epilepsy surgery results.
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Affiliation(s)
- Albert Sufianov
- Department of Neurosurgery, Federal Center of Neurosurgery, Tyumen, Russian Federation
| | - Keith Simfukwe
- Department of Neurosurgery, First Moscow Medical University, Moscow, Russian Federation
| | - Iurii A Iakimov
- Department of Neurosurgery, First Moscow Medical University, Tyumen, Russian Federation
| | - Rinat A Sufianov
- Department of Neurosurgery, First Moscow Medical University, Moscow, Russian Federation
| | - Marcio S Rassi
- Department of Neurosurgery, Camargo Cancer Center, Sao Paulo, Brazil
| | | | - Luis A B Borba
- Department of Neurosurgery, Mackenzie Evangelical University Hospital, Curitiba, Brazil
| | - Alvaro Campero
- Department of Neurosurgery, Hospital Padilla de Tucuman, Tucuman, Mexico
| | - Carlos Castillo Rangel
- Department of Neurosurgery, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico City, Mexico
| | - Matias Baldoncini
- Department of Neurosurgery, San Fernando Hospital, San Fernando, Buenos Aires, Argentina
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Tang Y, Su TY, Choi JY, Hu S, Wang X, Sakaie K, Murakami H, Alexopoulos A, Griswold M, Jones S, Najm I, Ma D, Wang ZI. Characterizing Thalamic and Basal Ganglia Nuclei in Medically Intractable Focal Epilepsy by MR Fingerprinting. Epilepsia 2022; 63:1998-2010. [PMID: 35661353 DOI: 10.1111/epi.17318] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/11/2022] [Accepted: 06/02/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Magnetic resonance fingerprinting (MRF) is a novel, quantitative and noninvasive technique to measure brain tissue properties. We aim to use MRF for characterizing normal-appearing thalamic and basal ganglia nuclei in the epileptic brain. METHODS A 3D MRF protocol (1mm3 isotropic resolution) was acquired from 48 patients with unilateral medically refractory focal epilepsy and 39 healthy controls (HCs). Whole-brain T1 and T2 maps (containing T1 and T2 relaxation times) were reconstructed for each subject. Ten subcortical nuclei in the thalamus and basal ganglia were segmented as regions of interest (ROIs), within which the mean T1 and T2 values, as well as their coefficient of variation (CV) were compared between the patients and HCs at group level. Subgroup and correlation analyses were performed to examine the relationship between significant MRF measures and various clinical characteristics. Using significantly abnormal MRF measures from the group-level analyses, support vector machine (SVM) and logistic regression machine learning models were built and tested with 5-fold and 10-fold cross-validations, to separate patients from HCs, and to separate patients with left-sided and right-sided epilepsy, at individual level. RESULTS MRF revealed increased T1 mean value in the ipsilateral thalamus and nucleus accumbens; increased T1 CV in bilateral thalamus, bilateral pallidum, and ipsilateral caudate; and increased T2 CV in the ipsilateral thalamus in patients compared to HCs (P<0.05, FDR corrected). The SVM classifier produced 78.2% average accuracy to separate individual patients from HCs, with AUC of 0.83. The logistic regression classifier produced 67.4% average accuracy to separate patients with left-sided and right-sided epilepsy, with AUC of 0.72. SIGNIFICANCE MRF revealed bilateral tissue-property changes in the normal-appearing thalamus and basal ganglia, with ipsilateral predominance and thalamic preference, suggesting subcortical involvement/impairment in patients with medically intractable focal epilepsy. The individual-level performance of the MRF-based machine-learning models suggests potential opportunities for predicting lateralization.
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Affiliation(s)
- Yingying Tang
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.,Charles Shor Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
| | - Ting Yu Su
- Charles Shor Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA.,Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Joon Yul Choi
- Charles Shor Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
| | - Siyuan Hu
- Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Xiaofeng Wang
- Quantitative Health Science, Cleveland Clinic, Cleveland, OH, USA
| | - Ken Sakaie
- Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | | | - Mark Griswold
- Radiology, Case Western Reserve University, Cleveland, OH, USA
| | - Stephen Jones
- Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Imad Najm
- Charles Shor Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
| | - Dan Ma
- Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Zhong Irene Wang
- Charles Shor Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
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Wang X, Deng D, Zhou C, Li H, Guan X, Fang L, Cai Q, Wang W, Zhou Q. Focal Cortical Dysplasia Type Ⅲ Related Medically Refractory Epilepsy: MRI Findings and Potential Predictors of Surgery Outcome. Diagnostics (Basel) 2021; 11:diagnostics11122225. [PMID: 34943462 PMCID: PMC8699898 DOI: 10.3390/diagnostics11122225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 11/16/2022] Open
Abstract
This study aims to explore the relationship between neuropathologic and the post-surgical prognosis of focal cortical dysplasia (FCD) typed-Ⅲ-related medically refractory epilepsy. A total of 266 patients with FCD typed-Ⅲ-related medically refractory epilepsy were retrospectively studied. Presurgical clinical data, type of surgery, and postsurgical seizure outcome were analyzed. The minimum post-surgical follow-up was 1 year. A total of 266 patients of FCD type Ⅲ were included in this study and the median follow-up time was 30 months (range, 12~48 months). Age at onset ranged from 1.0 years to 58.0 years, with a median age of 12.5 years. The number of patients under 12 years old was 133 (50%) in patients with FCD type Ⅲ. A history of febrile seizures was present in 42 (15.8%) cases. In the entire postoperative period, 179 (67.3%) patients were seizure-free. Factors with p < 0.15 in univariate analysis, such as age of onset of epilepsy (p = 0.145), duration of epilepsy (p = 0.004), febrile seizures (p = 0.150), being MRI-negative (p = 0.056), seizure type (p = 0.145) and incomplete resection, were included in multivariate analysis. Multivariate analyses revealed that MRI-negative findings of FCD (OR 0.34, 95% CI 0.45-0.81, p = 0.015) and incomplete resection (OR 0.12, 95% CI 0.05-0.29, p < 0.001) are independent predictors of unfavorable seizure outcomes. MRI-negative finding of FCD lesions and incomplete resection were the most important predictive factors for poor seizure outcome in patients with FCD type Ⅲ.
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Affiliation(s)
- Xiaozhuan Wang
- Department of Radiology, Academy of Orthopedics Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China; (X.W.); (D.D.); (H.L.); (X.G.); (L.F.); (Q.C.)
| | - Dabiao Deng
- Department of Radiology, Academy of Orthopedics Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China; (X.W.); (D.D.); (H.L.); (X.G.); (L.F.); (Q.C.)
- Department of Radiology, Guangdong 999 Brain Hospital, Guangzhou 510510, China
| | - Chengqian Zhou
- Department of Psychiatry and Behavioral Science, School of Medicine, John Hopkins University, Baltimore, MD 21278, USA;
| | - Honglin Li
- Department of Radiology, Academy of Orthopedics Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China; (X.W.); (D.D.); (H.L.); (X.G.); (L.F.); (Q.C.)
| | - Xueqin Guan
- Department of Radiology, Academy of Orthopedics Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China; (X.W.); (D.D.); (H.L.); (X.G.); (L.F.); (Q.C.)
| | - Liguang Fang
- Department of Radiology, Academy of Orthopedics Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China; (X.W.); (D.D.); (H.L.); (X.G.); (L.F.); (Q.C.)
| | - Qinxin Cai
- Department of Radiology, Academy of Orthopedics Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China; (X.W.); (D.D.); (H.L.); (X.G.); (L.F.); (Q.C.)
| | - Wensheng Wang
- Department of Radiology, Guangdong 999 Brain Hospital, Guangzhou 510510, China
- Correspondence: (W.W.); (Q.Z.)
| | - Quan Zhou
- Department of Radiology, Academy of Orthopedics Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China; (X.W.); (D.D.); (H.L.); (X.G.); (L.F.); (Q.C.)
- Correspondence: (W.W.); (Q.Z.)
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Maiworm M, Nöth U, Hattingen E, Steinmetz H, Knake S, Rosenow F, Deichmann R, Wagner M, Gracien RM. Improved Visualization of Focal Cortical Dysplasia With Surface-Based Multiparametric Quantitative MRI. Front Neurosci 2020; 14:622. [PMID: 32612511 PMCID: PMC7308728 DOI: 10.3389/fnins.2020.00622] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/19/2020] [Indexed: 01/09/2023] Open
Abstract
Purpose In the clinical routine, detection of focal cortical dysplasia (FCD) by visual inspection is challenging. Still, information about the presence and location of FCD is highly relevant for prognostication and treatment decisions. Therefore, this study aimed to develop, describe and test a method for the calculation of synthetic anatomies using multiparametric quantitative MRI (qMRI) data and surface-based analysis, which allows for an improved visualization of FCD. Materials and Methods Quantitative T1-, T2- and PD-maps and conventional clinical datasets of patients with FCD and epilepsy were acquired. Tissue segmentation and delineation of the border between white matter and cortex was performed. In order to detect blurring at this border, a surface-based calculation of the standard deviation of each quantitative parameter (T1, T2, and PD) was performed across the cortex and the neighboring white matter for each cortical vertex. The resulting standard deviations combined with measures of the cortical thickness were used to enhance the signal of conventional FLAIR-datasets. The resulting synthetically enhanced FLAIR-anatomies were compared with conventional MRI-data utilizing regions of interest based analysis techniques. Results The synthetically enhanced FLAIR-anatomies showed higher signal levels than conventional FLAIR-data at the FCD sites (p = 0.005). In addition, the enhanced FLAIR-anatomies exhibited higher signal levels at the FCD sites than in the corresponding contralateral regions (p = 0.005). However, false positive findings occurred, so careful comparison with conventional datasets is mandatory. Conclusion Synthetically enhanced FLAIR-anatomies resulting from surface-based multiparametric qMRI-analyses have the potential to improve the visualization of FCD and, accordingly, the treatment of the respective patients.
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Affiliation(s)
- Michelle Maiworm
- Department of Neurology, Goethe University, Frankfurt, Germany.,Department of Neuroradiology, Goethe University, Frankfurt, Germany.,Brain Imaging Center, Goethe University, Frankfurt, Germany.,Center for Personalized Translational Epilepsy Research Consortium (CePTER), Frankfurt, Germany
| | - Ulrike Nöth
- Brain Imaging Center, Goethe University, Frankfurt, Germany.,Center for Personalized Translational Epilepsy Research Consortium (CePTER), Frankfurt, Germany
| | - Elke Hattingen
- Department of Neuroradiology, Goethe University, Frankfurt, Germany.,Center for Personalized Translational Epilepsy Research Consortium (CePTER), Frankfurt, Germany
| | - Helmuth Steinmetz
- Department of Neurology, Goethe University, Frankfurt, Germany.,Center for Personalized Translational Epilepsy Research Consortium (CePTER), Frankfurt, Germany
| | - Susanne Knake
- Center for Personalized Translational Epilepsy Research Consortium (CePTER), Frankfurt, Germany.,Department of Neurology, Philipps University of Marburg, Marburg, Germany
| | - Felix Rosenow
- Department of Neurology, Goethe University, Frankfurt, Germany.,Center for Personalized Translational Epilepsy Research Consortium (CePTER), Frankfurt, Germany.,Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, Goethe University, Frankfurt, Germany
| | - Ralf Deichmann
- Brain Imaging Center, Goethe University, Frankfurt, Germany.,Center for Personalized Translational Epilepsy Research Consortium (CePTER), Frankfurt, Germany
| | - Marlies Wagner
- Department of Neuroradiology, Goethe University, Frankfurt, Germany.,Center for Personalized Translational Epilepsy Research Consortium (CePTER), Frankfurt, Germany
| | - René-Maxime Gracien
- Department of Neurology, Goethe University, Frankfurt, Germany.,Brain Imaging Center, Goethe University, Frankfurt, Germany.,Center for Personalized Translational Epilepsy Research Consortium (CePTER), Frankfurt, Germany
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