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Ding Z, Hu S, Su TY, Choi JY, Morris S, Wang X, Sakaie K, Murakami H, Huppertz HJ, Blümcke I, Jones S, Najm I, Ma D, Wang ZI. Combining magnetic resonance fingerprinting with voxel-based morphometric analysis to reduce false positives for focal cortical dysplasia detection. Epilepsia 2024; 65:1631-1643. [PMID: 38511905 PMCID: PMC11166521 DOI: 10.1111/epi.17951] [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: 10/31/2023] [Revised: 02/09/2024] [Accepted: 03/04/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE We aim to improve focal cortical dysplasia (FCD) detection by combining high-resolution, three-dimensional (3D) magnetic resonance fingerprinting (MRF) with voxel-based morphometric magnetic resonance imaging (MRI) analysis. METHODS We included 37 patients with pharmacoresistant focal epilepsy and FCD (10 IIa, 15 IIb, 10 mild Malformation of Cortical Development [mMCD], and 2 mMCD with oligodendroglial hyperplasia and epilepsy [MOGHE]). Fifty-nine healthy controls (HCs) were also included. 3D lesion labels were manually created. Whole-brain MRF scans were obtained with 1 mm3 isotropic resolution, from which quantitative T1 and T2 maps were reconstructed. Voxel-based MRI postprocessing, implemented with the morphometric analysis program (MAP18), was performed for FCD detection using clinical T1w images, outputting clusters with voxel-wise lesion probabilities. Average MRF T1 and T2 were calculated in each cluster from MAP18 output for gray matter (GM) and white matter (WM) separately. Normalized MRF T1 and T2 were calculated by z-scores using HCs. Clusters that overlapped with the lesion labels were considered true positives (TPs); clusters with no overlap were considered false positives (FPs). Two-sample t-tests were performed to compare MRF measures between TP/FP clusters. A neural network model was trained using MRF values and cluster volume to distinguish TP/FP clusters. Ten-fold cross-validation was used to evaluate model performance at the cluster level. Leave-one-patient-out cross-validation was used to evaluate performance at the patient level. RESULTS MRF metrics were significantly higher in TP than FP clusters, including GM T1, normalized WM T1, and normalized WM T2. The neural network model with normalized MRF measures and cluster volume as input achieved mean area under the curve (AUC) of .83, sensitivity of 82.1%, and specificity of 71.7%. This model showed superior performance over direct thresholding of MAP18 FCD probability map at both the cluster and patient levels, eliminating ≥75% FP clusters in 30% of patients and ≥50% of FP clusters in 91% of patients. SIGNIFICANCE This pilot study suggests the efficacy of MRF for reducing FPs in FCD detection, due to its quantitative values reflecting in vivo pathological changes. © 2024 International League Against Epilepsy.
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Affiliation(s)
- Zheng Ding
- Epilepsy Center, Neurological Institute - Cleveland Clinic, Cleveland, Ohio
- Biomedical Engineering - Case Western Reserve University, Cleveland, Ohio
| | - Siyuan Hu
- Biomedical Engineering - Case Western Reserve University, Cleveland, Ohio
| | - Ting-Yu Su
- Epilepsy Center, Neurological Institute - Cleveland Clinic, Cleveland, Ohio
- Biomedical Engineering - Case Western Reserve University, Cleveland, Ohio
| | - Joon Yul Choi
- Epilepsy Center, Neurological Institute - Cleveland Clinic, Cleveland, Ohio
- Biomedical Engineering - Yonsei University, Wonju, Republic of Korea
| | - Spencer Morris
- Epilepsy Center, Neurological Institute - Cleveland Clinic, Cleveland, Ohio
- Biomedical Engineering - Case Western Reserve University, Cleveland, Ohio
| | - Xiaofeng Wang
- Quantitative Health Science - Cleveland Clinic, Cleveland, Ohio
| | - Ken Sakaie
- Imaging Institute - Cleveland Clinic, Cleveland, Ohio
| | - Hiroatsu Murakami
- Epilepsy Center, Neurological Institute - Cleveland Clinic, Cleveland, Ohio
| | | | - Ingmar Blümcke
- Epilepsy Center, Neurological Institute - Cleveland Clinic, Cleveland, Ohio
- Neuropathology - University Hospital Erlangen, Erlangen, Germany
| | - Stephen Jones
- Imaging Institute - Cleveland Clinic, Cleveland, Ohio
| | - Imad Najm
- Epilepsy Center, Neurological Institute - Cleveland Clinic, Cleveland, Ohio
| | - Dan Ma
- Biomedical Engineering - Case Western Reserve University, Cleveland, Ohio
| | - Zhong Irene Wang
- Epilepsy Center, Neurological Institute - Cleveland Clinic, Cleveland, Ohio
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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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Morgan AT, Scerri TS, Vogel AP, Reid CA, Quach M, Jackson VE, McKenzie C, Burrows EL, Bennett MF, Turner SJ, Reilly S, Horton SE, Block S, Kefalianos E, Frigerio-Domingues C, Sainz E, Rigbye KA, Featherby TJ, Richards KL, Kueh A, Herold MJ, Corbett MA, Gecz J, Helbig I, Thompson-Lake DGY, Liégeois FJ, Morell RJ, Hung A, Drayna D, Scheffer IE, Wright DK, Bahlo M, Hildebrand MS. Stuttering associated with a pathogenic variant in the chaperone protein cyclophilin 40. Brain 2023; 146:5086-5097. [PMID: 37977818 PMCID: PMC10689913 DOI: 10.1093/brain/awad314] [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: 05/12/2023] [Revised: 07/26/2023] [Accepted: 08/10/2023] [Indexed: 11/19/2023] Open
Abstract
Stuttering is a common speech disorder that interrupts speech fluency and tends to cluster in families. Typically, stuttering is characterized by speech sounds, words or syllables which may be repeated or prolonged and speech that may be further interrupted by hesitations or 'blocks'. Rare variants in a small number of genes encoding lysosomal pathway proteins have been linked to stuttering. We studied a large four-generation family in which persistent stuttering was inherited in an autosomal dominant manner with disruption of the cortico-basal-ganglia-thalamo-cortical network found on imaging. Exome sequencing of three affected family members revealed the PPID c.808C>T (p.Pro270Ser) variant that segregated with stuttering in the family. We generated a Ppid p.Pro270Ser knock-in mouse model and performed ex vivo imaging to assess for brain changes. Diffusion-weighted MRI in the mouse revealed significant microstructural changes in the left corticospinal tract, as previously implicated in stuttering. Quantitative susceptibility mapping also detected changes in cortico-striatal-thalamo-cortical loop tissue composition, consistent with findings in affected family members. This is the first report to implicate a chaperone protein in the pathogenesis of stuttering. The humanized Ppid murine model recapitulates network findings observed in affected family members.
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Affiliation(s)
- Angela T Morgan
- Murdoch Children’s Research Institute, Parkville 3052, Australia
- Department of Audiology and Speech Pathology, University of Melbourne, Parkville 3052, Australia
| | - Thomas S Scerri
- Murdoch Children’s Research Institute, Parkville 3052, Australia
- The Walter and Eliza Hall Institute of Medical Research, Parkville 3052, Australia
- Department of Medical Biology, University of Melbourne, Parkville 3052, Australia
| | - Adam P Vogel
- Department of Audiology and Speech Pathology, University of Melbourne, Parkville 3052, Australia
- Centre for Neuroscience of Speech, The University of Melbourne, Parkville 3053, Australia
- Clinical Trials, Redenlab Inc., Melbourne 3000, Australia
| | - Christopher A Reid
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, 3052, Parkville 3052, Australia
- Department of Medicine, Epilepsy Research Centre, University of Melbourne, Heidelberg 3084, Australia
| | - Mara Quach
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne 3004, Australia
| | - Victoria E Jackson
- The Walter and Eliza Hall Institute of Medical Research, Parkville 3052, Australia
- Department of Medical Biology, University of Melbourne, Parkville 3052, Australia
| | - Chaseley McKenzie
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, 3052, Parkville 3052, Australia
| | - Emma L Burrows
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, 3052, Parkville 3052, Australia
| | - Mark F Bennett
- The Walter and Eliza Hall Institute of Medical Research, Parkville 3052, Australia
- Department of Medical Biology, University of Melbourne, Parkville 3052, Australia
- Department of Medicine, Epilepsy Research Centre, University of Melbourne, Heidelberg 3084, Australia
| | | | - Sheena Reilly
- Murdoch Children’s Research Institute, Parkville 3052, Australia
- Menzies Health Institute Queensland, Griffith University, 4215 Southport, Australia
| | - Sarah E Horton
- Murdoch Children’s Research Institute, Parkville 3052, Australia
- Department of Audiology and Speech Pathology, University of Melbourne, Parkville 3052, Australia
| | - Susan Block
- Discipline of Speech Pathology, School of Allied Health, La Trobe University, Bundoora 3086, Australia
| | - Elaina Kefalianos
- Murdoch Children’s Research Institute, Parkville 3052, Australia
- Department of Audiology and Speech Pathology, University of Melbourne, Parkville 3052, Australia
| | - Carlos Frigerio-Domingues
- Laboratory of Communication Disorders, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD 20892-2320, USA
| | - Eduardo Sainz
- Laboratory of Communication Disorders, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD 20892-2320, USA
| | - Kristin A Rigbye
- Department of Medicine, Epilepsy Research Centre, University of Melbourne, Heidelberg 3084, Australia
| | - Travis J Featherby
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, 3052, Parkville 3052, Australia
| | - Kay L Richards
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, 3052, Parkville 3052, Australia
| | - Andrew Kueh
- The Walter and Eliza Hall Institute of Medical Research, Parkville 3052, Australia
- Department of Medical Biology, University of Melbourne, Parkville 3052, Australia
| | - Marco J Herold
- The Walter and Eliza Hall Institute of Medical Research, Parkville 3052, Australia
- Department of Medical Biology, University of Melbourne, Parkville 3052, Australia
| | - Mark A Corbett
- Adelaide Medical School, The University of Adelaide, Adelaide 5000, Australia
- Neurogenetics Research Program, South Australian Health and Medical Research Institute, Adelaide 5000, Australia
| | - Jozef Gecz
- Adelaide Medical School, The University of Adelaide, Adelaide 5000, Australia
- Neurogenetics Research Program, South Australian Health and Medical Research Institute, Adelaide 5000, Australia
| | - Ingo Helbig
- Department of Neurology, Children’s Hospital, Philadelphia, PA 19104, USA
| | - Daisy G Y Thompson-Lake
- Developmental Neurosciences Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Frédérique J Liégeois
- Developmental Neurosciences Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Robert J Morell
- Laboratory of Molecular Genetics, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD 20892, USA
- Genomics and Computational Biology Core, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD 20892, USA
| | - Andrew Hung
- School of Science, STEM College, RMIT University, Melbourne 3001, Australia
| | - Dennis Drayna
- Laboratory of Communication Disorders, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD 20892-2320, USA
| | - Ingrid E Scheffer
- Murdoch Children’s Research Institute, Parkville 3052, Australia
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, 3052, Parkville 3052, Australia
- Department of Medicine, Epilepsy Research Centre, University of Melbourne, Heidelberg 3084, Australia
- Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Parkville 3052, Australia
| | - David K Wright
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne 3004, Australia
| | - Melanie Bahlo
- The Walter and Eliza Hall Institute of Medical Research, Parkville 3052, Australia
- Department of Medical Biology, University of Melbourne, Parkville 3052, Australia
- School of Mathematics and Statistics, University of Melbourne, 3010 Parkville, Australia
| | - Michael S Hildebrand
- Murdoch Children’s Research Institute, Parkville 3052, Australia
- Department of Medicine, Epilepsy Research Centre, University of Melbourne, Heidelberg 3084, Australia
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Zhang M, Yu H, Cao G, Huang J, Lu Y, Zhang J, Liu N, Zhang W, Cheng Y, Kang G, Cai L. Enhanced focal cortical dysplasia detection in pediatric frontal lobe epilepsy with asymmetric radiomic and morphological features. Front Neurosci 2023; 17:1289897. [PMID: 38033536 PMCID: PMC10684781 DOI: 10.3389/fnins.2023.1289897] [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: 09/07/2023] [Accepted: 10/25/2023] [Indexed: 12/02/2023] Open
Abstract
Objective Focal cortical dysplasia (FCD) is the most common pathological cause for pediatric epilepsy, with frontal lobe epilepsy (FLE) being the most prevalent in the pediatric population. We attempted to utilize radiomic and morphological methods on MRI and PET to detect FCD in children with FLE. Methods Thirty-seven children with FLE and 20 controls were included in the primary cohort, and a five-fold cross-validation was performed. In addition, we validated the performance in an independent site of 12 FLE children. A two-stage experiments including frontal lobe and subregions were employed to detect the lesion area of FCD, incorporating the asymmetric feature between the left and right hemispheres. Specifically, for the radiomics approach, we used gray matter (GM), white matter (WM), GM and WM, and the gray-white matter boundary regions of interest to extract features. Then, we employed a Multi-Layer Perceptron classifier to achieve FCD lesion localization based on both radiomic and morphological methods. Results The Multi-Layer Perceptron model based on the asymmetric feature exhibited excellent performance both in the frontal lobe and subregions. In the primary cohort and independent site, the radiomics analysis with GM and WM asymmetric features had the highest sensitivity (89.2 and 91.7%) and AUC (98.9 and 99.3%) in frontal lobe. While in the subregions, the GM asymmetric features had the highest sensitivity (85.6 and 79.7%). Furthermore, relying on the highest sensitivity of GM and WM asymmetric features in frontal lobe, when integrated with the subregions results, our approach exhibited overlaps with GM asymmetric features (55.4 and 52.4%), as well as morphological asymmetric features (54.4 and 53.8%), both in the primary cohort and at the independent site. Significance This study demonstrates that a two-stage design based on the asymmetry of radiomic and morphological features can improve FCD detection. Specifically, incorporating regions of interest for GM, WM, GM, and WM, and the gray-white matter boundary significantly enhances the localization capabilities for lesion detection within the radiomics approach.
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Affiliation(s)
- Manli Zhang
- Key Laboratory of Universal Wireless Communications, Ministry of Education, School of Information and Communication Engineering, Beijing University of Posts and Telecommunications, Beijing, China
| | - Hao Yu
- Department of Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Gongpeng Cao
- Key Laboratory of Universal Wireless Communications, Ministry of Education, School of Information and Communication Engineering, Beijing University of Posts and Telecommunications, Beijing, China
| | - Jinguo Huang
- Key Laboratory of Universal Wireless Communications, Ministry of Education, School of Information and Communication Engineering, Beijing University of Posts and Telecommunications, Beijing, China
- School of Automation, Beijing University of Posts and Telecommunications, Beijing, China
| | - Yanzhu Lu
- Key Laboratory of Universal Wireless Communications, Ministry of Education, School of Information and Communication Engineering, Beijing University of Posts and Telecommunications, Beijing, China
| | - Jing Zhang
- Key Laboratory of Universal Wireless Communications, Ministry of Education, School of Information and Communication Engineering, Beijing University of Posts and Telecommunications, Beijing, China
| | - Nana Liu
- Key Laboratory of Universal Wireless Communications, Ministry of Education, School of Information and Communication Engineering, Beijing University of Posts and Telecommunications, Beijing, China
| | - Wenjing Zhang
- Key Laboratory of Universal Wireless Communications, Ministry of Education, School of Information and Communication Engineering, Beijing University of Posts and Telecommunications, Beijing, China
| | - Yintao Cheng
- Key Laboratory of Universal Wireless Communications, Ministry of Education, School of Information and Communication Engineering, Beijing University of Posts and Telecommunications, Beijing, China
| | - Guixia Kang
- Key Laboratory of Universal Wireless Communications, Ministry of Education, School of Information and Communication Engineering, Beijing University of Posts and Telecommunications, Beijing, China
| | - Lixin Cai
- Department of Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
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5
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Kiersnowski OC, Winston GP, Caciagli L, Biondetti E, Elbadri M, Buck S, Duncan JS, Thornton JS, Shmueli K, Vos SB. Quantitative susceptibility mapping identifies hippocampal and other subcortical grey matter tissue composition changes in temporal lobe epilepsy. Hum Brain Mapp 2023; 44:5047-5064. [PMID: 37493334 PMCID: PMC10502681 DOI: 10.1002/hbm.26432] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/04/2023] [Accepted: 07/07/2023] [Indexed: 07/27/2023] Open
Abstract
Temporal lobe epilepsy (TLE) is associated with widespread brain alterations. Using quantitative susceptibility mapping (QSM) alongside transverse relaxation rate (R 2 * ), we investigated regional brain susceptibility changes in 36 patients with left-sided (LTLE) or right-sided TLE (RTLE) secondary to hippocampal sclerosis, and 27 healthy controls (HC). We compared three susceptibility calculation methods to ensure image quality. Correlations of susceptibility andR 2 * with age of epilepsy onset, frequency of focal-to-bilateral tonic-clonic seizures (FBTCS), and neuropsychological test scores were examined. Weak-harmonic QSM (WH-QSM) successfully reduced noise and removed residual background field artefacts. Significant susceptibility increases were identified in the left putamen in the RTLE group compared to the LTLE group, the right putamen and right thalamus in the RTLE group compared to HC, and a significant susceptibility decrease in the left hippocampus in LTLE versus HC. LTLE patients who underwent epilepsy surgery showed significantly lower left-versus-right hippocampal susceptibility. SignificantR 2 * changes were found between TLE and HC groups in the amygdala, putamen, thalamus, and in the hippocampus. Specifically, decreased R2 * was found in the left and right hippocampus in LTLE and RTLE, respectively, compared to HC. Susceptibility andR 2 * were significantly correlated with cognitive test scores in the hippocampus, globus pallidus, and thalamus. FBTCS frequency correlated positively with ipsilateral thalamic and contralateral putamen susceptibility and withR 2 * in bilateral globi pallidi. Age of onset was correlated with susceptibility in the hippocampus and putamen, and withR 2 * in the caudate. Susceptibility andR 2 * changes observed in TLE groups suggest selective loss of low-myelinated neurons alongside iron redistribution in the hippocampi, predominantly ipsilaterally, indicating QSM's sensitivity to local pathology. Increased susceptibility andR 2 * in the thalamus and putamen suggest increased iron content and reflect disease severity.
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Affiliation(s)
- Oliver C. Kiersnowski
- Department of Medical Physics and Biomedical EngineeringUniversity College LondonLondonUK
| | - Gavin P. Winston
- Department of Clinical and Experimental EpilepsyUniversity College LondonLondonUK
- Department of Medicine, Division of NeurologyQueen's UniversityKingstonCanada
| | - Lorenzo Caciagli
- Department of Clinical and Experimental EpilepsyUniversity College LondonLondonUK
- Department of BioengineeringUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Emma Biondetti
- Department of Medical Physics and Biomedical EngineeringUniversity College LondonLondonUK
- Department of Neuroscience, Imaging and Clinical SciencesInstitute for Advanced Biomedical Technologies, “D'Annunzio” University of Chieti‐PescaraChietiItaly
| | - Maha Elbadri
- Department of NeurologyQueen Elizabeth HospitalBirminghamUK
| | - Sarah Buck
- Department of Clinical and Experimental EpilepsyUniversity College LondonLondonUK
| | - John S. Duncan
- Department of Clinical and Experimental EpilepsyUniversity College LondonLondonUK
| | - John S. Thornton
- Neuroradiological Academic UnitUCL Queen Square Institute of Neurology, University College LondonLondonUK
| | - Karin Shmueli
- Department of Medical Physics and Biomedical EngineeringUniversity College LondonLondonUK
| | - Sjoerd B. Vos
- Neuroradiological Academic UnitUCL Queen Square Institute of Neurology, University College LondonLondonUK
- Centre for Microscopy, Characterisation, and AnalysisThe University of Western AustraliaNedlandsAustralia
- Centre for Medical Image Computing, Computer Science departmentUniversity College LondonLondonUK
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6
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Chari A, Sedlacik J, Seunarine K, Piper RJ, Hales P, Shmueli K, Mankad K, Löbel U, Eltze C, Moeller F, Scott RC, Tisdall MM, Cross JH, Carmichael DW. Epileptogenic Tubers Are Associated with Increased Kurtosis of Susceptibility Values: A Combined Quantitative Susceptibility Mapping and Stereoelectroencephalography Pilot Study. AJNR Am J Neuroradiol 2023; 44:974-982. [PMID: 37474265 PMCID: PMC10411828 DOI: 10.3174/ajnr.a7929] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 06/07/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND AND PURPOSE Prior studies have found an association between calcification and the epileptogenicity of tubers in tuberous sclerosis complex. Quantitative susceptibility mapping is a novel tool sensitive to magnetic susceptibility alterations due to tissue calcification. We assessed the utility of quantitative susceptibility mapping in identifying putative epileptogenic tubers in tuberous sclerosis complex using stereoelectroencephalography data as ground truth. MATERIALS AND METHODS We studied patients with tuberous sclerosis complex undergoing stereoelectroencephalography at a single center who had multiecho gradient-echo sequences available. Quantitative susceptibility mapping and R2* values were extracted for all tubers on the basis of manually drawn 3D ROIs using T1- and T2-FLAIR sequences. Characteristics of quantitative susceptibility mapping and R2* distributions from implanted tubers were compared using binary logistic generalized estimating equation models designed to identify ictal (involved in seizure onset) and interictal (persistent interictal epileptiform activity) tubers. These models were then applied to the unimplanted tubers to identify potential ictal and interictal tubers that were not sampled by stereoelectroencephalography. RESULTS A total of 146 tubers were identified in 10 patients, 76 of which were sampled using stereoelectroencephalography. Increased kurtosis of the tuber quantitative susceptibility mapping values was associated with epileptogenicity (P = .04 for the ictal group and P = .005 for the interictal group) by the generalized estimating equation model. Both groups had poor sensitivity (35.0% and 44.1%, respectively) but high specificity (94.6% and 78.6%, respectively). CONCLUSIONS Our finding of increased kurtosis of quantitative susceptibility mapping values (heavy-tailed distribution) was highly specific, suggesting that it may be a useful biomarker to identify putative epileptogenic tubers in tuberous sclerosis complex. This finding motivates the investigation of underlying tuber mineralization and other properties driving kurtosis changes in quantitative susceptibility mapping values.
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Affiliation(s)
- A Chari
- From Developmental Neurosciences (A.C., K. Seunarine, R.J.P., M.M.T., J.H.C.), Great Ormond Street Institute of Child Health
- Departments of Neurosurgery (A.C., K. Seunarine, R.J.P. M.M.T.)
| | | | - K Seunarine
- From Developmental Neurosciences (A.C., K. Seunarine, R.J.P., M.M.T., J.H.C.), Great Ormond Street Institute of Child Health
- Departments of Neurosurgery (A.C., K. Seunarine, R.J.P. M.M.T.)
| | - R J Piper
- From Developmental Neurosciences (A.C., K. Seunarine, R.J.P., M.M.T., J.H.C.), Great Ormond Street Institute of Child Health
- Departments of Neurosurgery (A.C., K. Seunarine, R.J.P. M.M.T.)
| | - P Hales
- Neuroradiology (J.S., P.H., K.M., U.L.)
| | - K Shmueli
- Department of Medical Physics and Bioengineering (K. Shmueli), University College London, London, UK
| | - K Mankad
- Neuroradiology (J.S., P.H., K.M., U.L.)
| | - U Löbel
- Neuroradiology (J.S., P.H., K.M., U.L.)
| | - C Eltze
- Neurology (C.E., R.C.S., J.H.C.)
| | - F Moeller
- Neurophysiology (F.M.), Great Ormond Street Hospital, London, UK
| | - R C Scott
- Neurology (C.E., R.C.S., J.H.C.)
- Department of Pediatric Neurology (R.C.S.), Nemours Children's Hospital, Wilmington, Delaware
| | - M M Tisdall
- From Developmental Neurosciences (A.C., K. Seunarine, R.J.P., M.M.T., J.H.C.), Great Ormond Street Institute of Child Health
- Departments of Neurosurgery (A.C., K. Seunarine, R.J.P. M.M.T.)
| | - J H Cross
- From Developmental Neurosciences (A.C., K. Seunarine, R.J.P., M.M.T., J.H.C.), Great Ormond Street Institute of Child Health
- Neurology (C.E., R.C.S., J.H.C.)
| | - D W Carmichael
- Engineering and Physical Sciences Research Council/Wellcome Centre for Medical Engineering and Department of Biomedical Engineering (D.W.C.), School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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Cheng J, Zheng Q, Xu M, Xu Z, Zhu L, Liu L, Han S, Chen W, Feng Y, Cheng J. New 3D phase-unwrapping method based on voxel clustering and local polynomial modeling: application to quantitative susceptibility mapping. Quant Imaging Med Surg 2023; 13:1550-1562. [PMID: 36915306 PMCID: PMC10006161 DOI: 10.21037/qims-22-525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 12/08/2022] [Indexed: 12/28/2022]
Abstract
Background To develop an accurate and robust 3-dimensional (3D) phase-unwrapping method that works effectively in the presence of severe noise, disconnected regions, rapid phase changes, and open-ended lines for quantitative susceptibility mapping (QSM). Methods We developed a 3D phase-unwrapping method based on voxel clustering and local polynomial modeling named CLOSE3D, which firstly explores the 26-neighborhood to calculate local variation of the phasor and the phase, and then according to the local variation of the phasor, clusters the phase data into easy-to-unwrap blocks and difficult-to-unwrap residual voxels. Next, CLOSE3D sequentially performs intrablock, interblock, and residual-voxel unwrapping by using the region-growing local polynomial modeling method. CLOSED3D was evaluated in simulation and using in vivo brain QSM data, and was compared with classical region-growing and region-expanding labeling for unwrapping estimates methods. Results The simulation experiments showed that CLOSE3D achieved accurate phase-unwrapping results with a mean error ratio <0.39%, even in the presence of serious noise, disconnected regions, and rapid phase changes. The error ratios of region-growing (P=0.000 and P=0.000) and region-expanding labeling for unwrapping estimates (P=0.007, P=0.014) methods were both significantly higher than that of CLOSE3D, when the noise level was ≥60%. The results of the in vivo brain QSM experiments showed that CLOSE3D unwrapped the phase data and accurately reconstructed quantitative susceptibility data, even with serious noise, rapid-varying phase, or an open-ended cutline. Conclusions CLOSE3D achieves phase unwrapping with high accuracy and robustness, which will help phase-related 3D magnetic resonance imaging (MRI) applications such as QSM and susceptibility weighted imaging.
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Affiliation(s)
- Junying Cheng
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qian Zheng
- College of software Engineering, Zhengzhou University of Light Industry, Zhengzhou, China
| | - Man Xu
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhongbiao Xu
- Department of Radiotherapy, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangzhou, China
| | - Li Zhu
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Liang Liu
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shaoqiang Han
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wufan Chen
- School of Biomedical Engineering and Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, China
| | - Yanqiu Feng
- School of Biomedical Engineering and Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, China
| | - Jingliang Cheng
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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