1
|
Lee DA, Lee HJ, Park KM. Brain connectivity in status epilepticus as a predictor of outcome: A diffusion tensor imaging study. J Neuroimaging 2024; 34:393-401. [PMID: 38499979 DOI: 10.1111/jon.13196] [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: 01/03/2024] [Revised: 03/04/2024] [Accepted: 03/05/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND AND PURPOSE We aimed to explore structural connectivity in status epilepticus. METHODS We enrolled participants who underwent diffusion tensor imaging. We applied graph theory to investigate structural connectivity. We compared the structural connectivity measures between patients and healthy controls and between patients with poor (modified Rankin Scale [mRS] >3) and good (mRS ≤3) admission outcomes. RESULTS We enrolled 28 patients and 31 healthy controls (age 65.5 vs.62.0 years, p = .438). Of these patients, 16 and 12 showed poor and good admission outcome (age 65.5 vs.62.0 years, p = .438). The assortative coefficient (-0.113 vs. -0.121, p = .021), mean clustering coefficient (0.007 vs.0.006, p = .009), global efficiency (0.023 vs.0.020, p = .009), transitivity (0.007 vs.0.006, p = .009), and small-worldness index (0.006 vs.0.005, p = .021) were higher in patients with status epilepticus than in healthy controls. The assortative coefficient (-0.108 vs. -0.119, p = .042), mean clustering coefficient (0.007 vs.0.006, p = .042), and transitivity (0.008 vs.0.007, p = .042) were higher in patients with poor admission outcome than in those with good admission outcome. MRS score was positively correlated with structural connectivity measures, including the assortative coefficient (r = 0.615, p = .003), mean clustering coefficient (r = 0.544, p = .005), global efficiency (r = 0.515, p = .007), transitivity (r = 0.547, p = .007), and small-worldness index (r = 0.435, p = .024). CONCLUSION We revealed alterations in structural connectivity, showing increased integration and segregation in status epilepticus, which might be related with neuronal synchronization. This effect was more pronounced in patients with a poor admission outcome, potentially reshaping our understanding for comprehension of status epilepticus mechanisms and the development of more targeted treatments.
Collapse
Affiliation(s)
- Dong Ah Lee
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Ho-Joon Lee
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Kang Min Park
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| |
Collapse
|
2
|
Leon-Rojas J, Cornell I, Rojas-Garcia A, D’Arco F, Panovska-Griffiths J, Cross H, Bisdas S. The role of preoperative diffusion tensor imaging in predicting and improving functional outcome in pediatric patients undergoing epilepsy surgery: a systematic review. BJR Open 2021; 3:20200002. [PMID: 34381942 PMCID: PMC8320117 DOI: 10.1259/bjro.20200002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/19/2021] [Accepted: 03/23/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Diffusion tensor imaging (DTI) is a useful neuroimaging technique for surgical planning in adult patients. However, no systematic review has been conducted to determine its utility for pre-operative analysis and planning of Pediatric Epilepsy surgery. We sought to determine the benefit of pre-operative DTI in predicting and improving neurological functional outcome after epilepsy surgery in children with intractable epilepsy. METHODS A systematic review of articles in English using PubMed, EMBASE and Scopus databases, from inception to January 10, 2020 was conducted. All studies that used DTI as either predictor or direct influencer of functional neurological outcome (motor, sensory, language and/or visual) in pediatric epilepsy surgical candidates were included. Data extraction was performed by two blinded reviewers. Risk of bias of each study was determined using the QUADAS 2 Scoring System. RESULTS 13 studies were included (6 case reports/series, 5 retrospective cohorts, and 2 prospective cohorts) with a total of 229 patients. Seven studies reported motor outcome; three reported motor outcome prediction with a sensitivity and specificity ranging from 80 to 85.7 and 69.6 to 100%, respectively; four studies reported visual outcome. In general, the use of DTI was associated with a high degree of favorable neurological outcomes after epilepsy surgery. CONCLUSION Multiple studies show that DTI helps to create a tailored plan that results in improved functional outcome. However, more studies are required in order to fully assess its utility in pediatric patients. This is a desirable field of study because DTI offers a non-invasive technique more suitable for children. ADVANCES IN KNOWLEDGE This systematic review analyses, exclusively, studies of pediatric patients with drug-resistant epilepsy and provides an update of the evidence regarding the role of DTI, as part of the pre-operative armamentarium, in improving post-surgical neurological sequels and its potential for outcome prediction.
Collapse
Affiliation(s)
| | - Isabel Cornell
- Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Trust, London, UK
| | | | - Felice D’Arco
- Department of Pediatric Neuroradiology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | | | - Helen Cross
- Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Trust, London, UK
- NeurALL Research Group, Universidad Internacional del Ecuador, Medical School, Quito, Ecuador
- Department of Applied Health Research, University College London, London, UK
- Department of Pediatric Neuroradiology, Great Ormond Street Hospital for Children NHS Trust, London, UK
- Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, UK
| | | |
Collapse
|
3
|
Assadsangabi R, Ozturk A, Kantamneni T, Azizi N, Asaikar SM, Hacein-Bey L. Neuroimaging of Childhood Epilepsy: Focal versus Generalized Epilepsy. JOURNAL OF PEDIATRIC EPILEPSY 2021. [DOI: 10.1055/s-0040-1722301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AbstractNeuroimaging plays an increasingly crucial role in delineating the pathophysiology, and guiding the evaluation, management and monitoring of epilepsy. Imaging contributes to adequately categorizing seizure/epilepsy types in complex clinical situations by demonstrating anatomical and functional changes associated with seizure activity. This article reviews the current status of multimodality neuroimaging in the pediatric population, including focal lesions which may result in focal epileptic findings, focal structural abnormalities that may manifest as generalized epileptiform discharges, and generalized epilepsy without evidence of detectable focal abnormalities.
Collapse
Affiliation(s)
- Reza Assadsangabi
- Department of Neuroradiology, Radiology, University of California Davis School of Medicine, Sacramento, California, United States
| | - Arzu Ozturk
- Department of Neuroradiology, Radiology, University of California Davis School of Medicine, Sacramento, California, United States
| | - Trishna Kantamneni
- Department of Neurology, University of California Davis School of Medicine, Sacramento, California, United States
| | - Nazarin Azizi
- Department of Neuroradiology, Radiology, University of California Davis School of Medicine, Sacramento, California, United States
| | - Shailesh M. Asaikar
- Child & Adolescent Neurology Consultants, Sacramento, California, United States
| | - Lotfi Hacein-Bey
- Department of Neuroradiology, Radiology, University of California Davis School of Medicine, Sacramento, California, United States
| |
Collapse
|
4
|
Machine Learning for the Classification of Alzheimer’s Disease and Its Prodromal Stage Using Brain Diffusion Tensor Imaging Data: A Systematic Review. Processes (Basel) 2020. [DOI: 10.3390/pr8091071] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Alzheimer’s disease is notoriously the most common cause of dementia in the elderly, affecting an increasing number of people. Although widespread, its causes and progression modalities are complex and still not fully understood. Through neuroimaging techniques, such as diffusion Magnetic Resonance (MR), more sophisticated and specific studies of the disease can be performed, offering a valuable tool for both its diagnosis and early detection. However, processing large quantities of medical images is not an easy task, and researchers have turned their attention towards machine learning, a set of computer algorithms that automatically adapt their output towards the intended goal. In this paper, a systematic review of recent machine learning applications on diffusion tensor imaging studies of Alzheimer’s disease is presented, highlighting the fundamental aspects of each work and reporting their performance score. A few examined studies also include mild cognitive impairment in the classification problem, while others combine diffusion data with other sources, like structural magnetic resonance imaging (MRI) (multimodal analysis). The findings of the retrieved works suggest a promising role for machine learning in evaluating effective classification features, like fractional anisotropy, and in possibly performing on different image modalities with higher accuracy.
Collapse
|
5
|
Mancini M, Vos SB, Vakharia VN, O'Keeffe AG, Trimmel K, Barkhof F, Dorfer C, Soman S, Winston GP, Wu C, Duncan JS, Sparks R, Ourselin S. Automated fiber tract reconstruction for surgery planning: Extensive validation in language-related white matter tracts. Neuroimage Clin 2019; 23:101883. [PMID: 31163386 PMCID: PMC6545442 DOI: 10.1016/j.nicl.2019.101883] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/18/2019] [Accepted: 05/25/2019] [Indexed: 12/30/2022]
Abstract
Diffusion MRI and tractography hold great potential for surgery planning, especially to preserve eloquent white matter during resections. However, fiber tract reconstruction requires an expert with detailed understanding of neuroanatomy. Several automated approaches have been proposed, using different strategies to reconstruct the white matter tracts in a supervised fashion. However, validation is often limited to comparison with manual delineation by overlap-based measures, which is limited in characterizing morphological and topological differences. In this work, we set up a fully automated pipeline based on anatomical criteria that does not require manual intervention, taking advantage of atlas-based criteria and advanced acquisition protocols available on clinical-grade MRI scanners. Then, we extensively validated it on epilepsy patients with specific focus on language-related bundles. The validation procedure encompasses different approaches, including simple overlap with manual segmentations from two experts, feasibility ratings from external multiple clinical raters and relation with task-based functional MRI. Overall, our results demonstrate good quantitative agreement between automated and manual segmentation, in most cases better performances of the proposed method in qualitative terms, and meaningful relationships with task-based fMRI. In addition, we observed significant differences between experts in terms of both manual segmentation and external ratings. These results offer important insights on how different levels of validation complement each other, supporting the idea that overlap-based measures, although quantitative, do not offer a full perspective on the similarities and differences between automated and manual methods.
Collapse
Affiliation(s)
- Matteo Mancini
- Centre for Medical Image Computing, University College London, London, United Kingdom.
| | - Sjoerd B Vos
- Centre for Medical Image Computing, University College London, London, United Kingdom; Epilepsy Society MRI Unit, Chalfont St Peter, United Kingdom
| | - Vejay N Vakharia
- Department of Clinical and Experimental Epilepsy, University College London, London, United Kingdom; National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Aidan G O'Keeffe
- Department of Statistical Science, University College London, London, UK
| | - Karin Trimmel
- Epilepsy Society MRI Unit, Chalfont St Peter, United Kingdom; Department of Clinical and Experimental Epilepsy, University College London, London, United Kingdom; National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Frederik Barkhof
- Centre for Medical Image Computing, University College London, London, United Kingdom; Brain Repair and Rehabilitation, University College London, London, UK; Radiology & Nuclear Medicine, VU University Medical Centre, Amsterdam, Netherlands
| | - Christian Dorfer
- Department of Neurosurgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Salil Soman
- Harvard Medical School, Beth Israel Deaconess Medical Center, Department of Radiology, Boston, MA 00215, United States
| | - Gavin P Winston
- Epilepsy Society MRI Unit, Chalfont St Peter, United Kingdom; Department of Clinical and Experimental Epilepsy, University College London, London, United Kingdom; Department of Medicine, Division of Neurology, Queen's University, Kingston, Ontario, Canada
| | - Chengyuan Wu
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - John S Duncan
- Epilepsy Society MRI Unit, Chalfont St Peter, United Kingdom; Department of Clinical and Experimental Epilepsy, University College London, London, United Kingdom; National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Rachel Sparks
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Sebastien Ourselin
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| |
Collapse
|
6
|
Juhász C, John F. Utility of MRI, PET, and ictal SPECT in presurgical evaluation of non-lesional pediatric epilepsy. Seizure 2019; 77:15-28. [PMID: 31122814 DOI: 10.1016/j.seizure.2019.05.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 02/12/2019] [Accepted: 05/10/2019] [Indexed: 12/12/2022] Open
Abstract
Children with epilepsy and normal structural MRI pose a particular challenge in localization of epileptic foci for surgical resection. Many of these patients have subtle structural lesions such as mild cortical dysplasia that can be missed by conventional MRI but may become detectable by optimized and advanced MRI acquisitions and post-processing. Specificity of objective analytic techniques such as voxel-based morphometry remains an issue. Combination of MRI with functional imaging approaches can improve the accuracy of detecting epileptogenic brain regions. Analysis of glucose positron emission tomography (PET) combined with high-resolution MRI can optimize detection of hypometabolic cortex associated with subtle cortical malformations and can also enhance presurgical evaluation in children with epileptic spasms. Additional PET tracers may detect subtle epileptogenic lesions and cortex with enhanced specificity in carefully selected subgroups with various etiologies; e.g., increased tryptophan uptake can identify epileptogenic cortical dysplasia in the interictal state. Subtraction ictal SPECT can be also useful to delineate ictal foci in those with non-localizing PET or after failed surgical resection. Presurgical delineation of language and motor cortex and the corresponding white matter tracts is increasingly reliable by functional MRI and DTI techniques; with careful preparation, these can be useful even in young and sedated children. While evidence-based pediatric guidelines are still lacking, the data accumulated in the last decade strongly indicate that multimodal imaging with combined analysis of MRI, PET, and/or ictal SPECT data can optimize the detection of subtle epileptogenic lesions and facilitate seizure-free outcome while minimizing the postsurgical functional deficit in children with normal conventional MRI.
Collapse
Affiliation(s)
- Csaba Juhász
- Department of Pediatrics, Wayne State University, PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, 3901 Beaubien St., Detroit, Michigan, 48201, USA; Departments of Neurology and Neurosurgery, Wayne State University, 4201 St. Antoine St., Detroit, Michigan, 48201, USA.
| | - Flóra John
- Department of Pediatrics, Wayne State University, PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, 3901 Beaubien St., Detroit, Michigan, 48201, USA; Department of Neurology, University of Pécs, H-7623, Rét u. 2., Pécs, Hungary.
| |
Collapse
|
7
|
Coryell J, Gaillard WD, Shellhaas RA, Grinspan ZM, Wirrell EC, Knupp KG, Wusthoff CJ, Keator C, Sullivan JE, Loddenkemper T, Patel A, Chu CJ, Massey S, Novotny EJ, Saneto RP, Berg AT. Neuroimaging of Early Life Epilepsy. Pediatrics 2018; 142:peds.2018-0672. [PMID: 30089657 PMCID: PMC6510984 DOI: 10.1542/peds.2018-0672] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We assessed the adherence to neuroimaging guidelines and the diagnostically relevant yield of neuroimaging in newly presenting early life epilepsy (ELE). METHODS There were 775 children with a new diagnosis of epilepsy (<3 years old at onset) who were recruited through the ELE study at 17 US pediatric epilepsy centers (2012-2015) and managed prospectively for 1 year. The data were analyzed to assess the proportion of children who underwent neuroimaging, the type of neuroimaging, and abnormalities. RESULTS Of 725 children (93.5%) with neuroimaging, 714 had an MRI (87% with seizure protocols) and 11 had computed tomography or ultrasound only. Etiologically relevant abnormalities were present in 290 individuals (40%) and included: an acquired injury in 97 (13.4%), malformations of cortical development in 56 (7.7%), and other diffuse disorders of brain development in 51 (7.0%). Neuroimaging was abnormal in 160 of 262 (61%) children with abnormal development at diagnosis versus 113 of 463 (24%) children with typical development. Neuroimaging abnormalities were most common in association with focal seizure semiology (40%), spasms (47%), or unclear semiology (42%). In children without spasms or focal semiology with typical development, 29 of 185 (16%) had imaging abnormalities. Pathogenic genetic variants were identified in 53 of 121 (44%) children with abnormal neuroimaging in whom genetic testing was performed. CONCLUSIONS Structural abnormalities occur commonly in ELE, and adherence to neuroimaging guidelines is high at US pediatric epilepsy centers. These data support the universal adoption of imaging guidelines because the yield is substantially high, even in the lowest risk group.
Collapse
Affiliation(s)
- Jason Coryell
- Departments of Pediatrics, Oregon Health and Sciences University, Portland, Oregon,Departments of Neurology, Oregon Health and Sciences University, Portland, Oregon
| | - William D. Gaillard
- Department of Neurology, Children’s National Health System and School of Medicine, The George Washington University, Washington, District of Columbia
| | | | - Zachary M. Grinspan
- Health Information Technology Evaluation Collaborative, Weill Cornell Medicine and New York–Presbyterian Hospital, New York, New York
| | | | - Kelly G. Knupp
- Department of Pediatrics and Neurology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | - Cynthia Keator
- Jane and John Justin Neurosciences Center, Cook Children’s Health Care System, Fort Worth, Texas
| | - Joseph E. Sullivan
- Department of Neurology, University of California, San Francisco, San Francisco, California
| | - Tobias Loddenkemper
- Division of Epilepsy and Clinical Neurophysiology, Boston Children’s Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Anup Patel
- Department of Pediatrics, The Ohio State University and Nationwide Children’s Hospital, Columbus, Ohio
| | - Catherine J. Chu
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Shavonne Massey
- Departments of Neurology, Perelman School of Medicine, University of Pennsylvania and Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Departments of Pediatrics, Perelman School of Medicine, University of Pennsylvania and Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Edward J. Novotny
- Departments of Division of Pediatric Neurology, Neurology, Seattle Children’s Research Institute, Seattle Children’s Hospital and University of Washington, Seattle, Washington,Departments of Pediatrics, Seattle Children’s Research Institute, Seattle Children’s Hospital and University of Washington, Seattle, Washington,Center for Integrative Brain Research, Seattle Children’s Research Institute, Seattle Children’s Hospital and University of Washington, Seattle, Washington
| | - Russel P. Saneto
- Departments of Division of Pediatric Neurology, Neurology, Seattle Children’s Research Institute, Seattle Children’s Hospital and University of Washington, Seattle, Washington
| | - Anne T. Berg
- Epilepsy Center, Ann and Robert H. Lurie Children’s Hospital of Chicago and Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| |
Collapse
|
8
|
Essayed WI, Zhang F, Unadkat P, Cosgrove GR, Golby AJ, O'Donnell LJ. White matter tractography for neurosurgical planning: A topography-based review of the current state of the art. Neuroimage Clin 2017; 15:659-672. [PMID: 28664037 PMCID: PMC5480983 DOI: 10.1016/j.nicl.2017.06.011] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 04/17/2017] [Accepted: 06/08/2017] [Indexed: 12/13/2022]
Abstract
We perform a review of the literature in the field of white matter tractography for neurosurgical planning, focusing on those works where tractography was correlated with clinical information such as patient outcome, clinical functional testing, or electro-cortical stimulation. We organize the review by anatomical location in the brain and by surgical procedure, including both supratentorial and infratentorial pathologies, and excluding spinal cord applications. Where possible, we discuss implications of tractography for clinical care, as well as clinically relevant technical considerations regarding the tractography methods. We find that tractography is a valuable tool in variable situations in modern neurosurgery. Our survey of recent reports demonstrates multiple potentially successful applications of white matter tractography in neurosurgery, with progress towards overcoming clinical challenges of standardization and interpretation.
Collapse
Affiliation(s)
- Walid I Essayed
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Fan Zhang
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Prashin Unadkat
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - G Rees Cosgrove
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Alexandra J Golby
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Lauren J O'Donnell
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
| |
Collapse
|