1
|
Zhao Y, Lin J, Qi X, Cao D, Zhu F, Chen L, Tan Z, Mo T, Zeng H. To explore the potential mechanisms of cognitive impairment in children with MRI-negative pharmacoresistant epilepsy due to focal cortical dysplasia: A pilot study from gray matter structure view. Heliyon 2024; 10:e26609. [PMID: 38404806 PMCID: PMC10884915 DOI: 10.1016/j.heliyon.2024.e26609] [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: 05/26/2023] [Revised: 01/22/2024] [Accepted: 02/15/2024] [Indexed: 02/27/2024] Open
Abstract
Objectives To investigate the characteristics of brain structure in children with focal cortical dysplasia (FCD)-induced pharmacoresistant epilepsy, and explore the potential mechanisms of cognitive impairment from the view of gray matter alteration. Methods 25 pharmacoresistant pediatric patients with pathologically confirmed focal cortical dysplasia (FCD), and 25 gender-matched healthy controls were included in this study. 3.0T MRI data and intelligence tests using the Wechsler Intelligence Scale for Children-Forth Edition (WISC-IV) were generated for all subjects. Voxel-based morphometry (VBM)-diffeomorphic anatomical registration through exponentiated lie algebra (DARTEL) and surface-based morphometry (SBM) analyses were performed to analyze gray matter volume and cortical structure. Two-sample t-tests were used to compare the differences in gray matter volume (P<0.05, FWE) and cortical thickness (P<0.001, FWE) between the two groups. Also, the Spearman rank correlation analyses were employed to determine the relationship between structural alterations and neuropsychological results. Results The WISC-IV scores of the FCD group were significantly lower than those of the HC group in terms of full-scale intelligence quotient (FSIQ), verbal comprehension index (VCI), perceptual reasoning index (PRI), working memory index (WMI), and processing speed index (PSI) (all P<0.01). Compared with the HC group, in the FCD group, the gray matter volume (GMV) reduced significantly in the left cerebellum_8, cerebellum_Crus2, and bilateral thalamus (P<0.05, FWE); the GMV increased in the bilateral medial frontal gyrus, right precuneus, and left inferior temporal gyrus (P<0.05, FWE), and the cortical thickness increased in the bilateral frontal, parietal, and temporal areas (P<0.001, FWE). Correlation analyses showed that the age of seizure onset had positive correlations with the WISC-IV scores significantly. Meanwhile, the cortex thicknesses of the left pars opercularis gyrus, left middle temporal gyrus, and right inferior temporal gyrus had negative correlations with the WISC-IV scores significantly. Conclusion FCD patients showed subtle structural abnormalities in multiple brain regions, with significant involvement of the primary visual cortex and language function cortex. And we also demonstrated a crucial correlation between gray matter structural alteration and cognitive impairment.
Collapse
Affiliation(s)
- Yilin Zhao
- Department of Radiology, Shenzhen Children's Hospital, Shenzhen, China
- Department of Radiology, West China Xiamen Hospital of Sichuan University, Xiamen, China
| | - Jieqiong Lin
- Department of Radiology, Shenzhen Children's Hospital, Shenzhen, China
| | - Xinxin Qi
- Department of Radiology, Shenzhen Children's Hospital, Shenzhen, China
- China Medical University, Shenyang, China
| | - Dezhi Cao
- Department of Neurology, Shenzhen Children's Hospital, Shenzhen, China
| | - Fengjun Zhu
- Department of Neurology, Shenzhen Children's Hospital, Shenzhen, China
| | - Li Chen
- Department of Neurology, Shenzhen Children's Hospital, Shenzhen, China
| | - Zeshi Tan
- Department of Neurology, Shenzhen Children's Hospital, Shenzhen, China
| | - Tong Mo
- Department of Radiology, Shenzhen Children's Hospital, Shenzhen, China
| | - Hongwu Zeng
- Department of Radiology, Shenzhen Children's Hospital, Shenzhen, China
| |
Collapse
|
2
|
Wang C, Shen Y, Cheng M, Zhu Z, Lv Y, Zhang X, Feng Z, Yang Z, Zhao X. Cortical gray-white matter contrast abnormalities in male children with attention deficit hyperactivity disorder. Front Hum Neurosci 2023; 17:1303230. [PMID: 38188507 PMCID: PMC10768013 DOI: 10.3389/fnhum.2023.1303230] [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: 09/27/2023] [Accepted: 12/08/2023] [Indexed: 01/09/2024] Open
Abstract
Purpose Presently, research concerning alterations in brain structure among individuals with attention deficit hyperactivity disorder (ADHD) predominantly focuses on entire brain volume and cortical thickness. In this study, we extend our examination to the cortical microstructure of male children with ADHD. To achieve this, we employ the gray-white matter tissue contrast (GWC) metric, allowing for an assessment of modifications in gray matter density and white matter microstructure. Furthermore, we explore the potential connection between GWC and the severity of disorder in male children by ADHD. Methods We acquired 3DT1 sequences from the public ADHD-200 database. In this study, we conducted a comparative analysis between 43 male children diagnosed with ADHD and 50 age-matched male controls exhibiting typical development trajectories. Our investigation entailed assessing differences in GWC and cortical thickness. Additionally, we explored the potential correlation between GWC and the severity of ADHD. To delineate the cerebral landscape, each hemisphere was subdivided into 34 cortical regions using freesurfer 7.2.0. For quantification, GWC was computed by evaluating the intensity contrast of non-normalized T1 images above and below the gray-white matter interface. Results Our findings unveiled elevated GWC within the bilateral lingual, bilateral insular, left transverse temporal, right parahippocampal and right pericalcarine regions in male children with ADHD when contrasted with their healthy counterparts. Moreover, the cortical thickness in the ADHD group no notable distinctions that of control group in all areas. Intriguingly, the GWC of left transverse temporal demonstrated a negative correlation with the extent of inattention experienced by male children with ADHD. Conclusion Utilizing GWC as a metric facilitates a more comprehensive assessment of microstructural brain changes in children with ADHD. The fluctuations in GWC observed in specific brain regions might serve as a neural biomarker, illuminating structural modifications in male children grappling with ADHD. This perspective enriches our comprehension of white matter microstructure and cortical density in these children. Notably, the inverse correlation between the GWC of the left transverse temporal and inattention severity underscores the potential role of structural and functional anomalies within this region in ADHD progression. Enhancing our insight into ADHD-related brain changes holds significant promise in deciphering potential neuropathological mechanisms.
Collapse
Affiliation(s)
- Changhao Wang
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan International Joint Laboratory of Neuroimaging, Zhengzhou, China
| | - Yanyong Shen
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan International Joint Laboratory of Neuroimaging, Zhengzhou, China
| | - Meiying Cheng
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan International Joint Laboratory of Neuroimaging, Zhengzhou, China
| | - Zitao Zhu
- Medicine Division, Wuhan University, Wuhan, China
| | - Yuan Lv
- Medical Research Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Henan Joint International Laboratory of Glioma Metabolism and Microenvironment Research, Henan Provincial Department of Science and Technology, Zhengzhou, Henan, China
- Institute of Neuroscience, Zhengzhou University, Zhengzhou, Henan, China
| | - Xiaoxue Zhang
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan International Joint Laboratory of Neuroimaging, Zhengzhou, China
| | - Zhanqi Feng
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan International Joint Laboratory of Neuroimaging, Zhengzhou, China
| | - Zhexuan Yang
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan International Joint Laboratory of Neuroimaging, Zhengzhou, China
| | - Xin Zhao
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan International Joint Laboratory of Neuroimaging, Zhengzhou, China
| |
Collapse
|
3
|
Abula Y, Abulimiti A, Liu Z, Yimiti Y, Abula Y, Jiang L, Wang Y, Kasimu M. The Role of the Three-Dimensional Edge-Enhancing Gradient Echo Sequence at 3T MRI in the Detection of Focal Cortical Dysplasia: A Technical Case Report and Literature Review. Neuropediatrics 2022; 53:436-439. [PMID: 35777662 PMCID: PMC9643069 DOI: 10.1055/a-1889-8639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Focal cortical dysplasia (FCD) is a most common cause of intractable focal epilepsy in children. Surgery is considered as a radical option for such patients with the prerequisite of lesion detection. Magnetic resonance imaging (MRI) plays a significant role in detection of FCDs in epilepsy patients; however, the detection of FCDs even in epilepsy dedicated MRI sequence shows relatively low positive rate. Last year, Middlebrooks et al introduced the novel three-dimensional Edge-Enhancing Gradient Echo (3D-EDGE) MRI sequence and using this sequence successfully identified five cases of FCDs which indicates its potential role in those epilepsy patients who may have FCDs. CASE PRESENTATION We present a 14-year-old, right-handed, male patient who has suffered from drug-resistant epilepsy over the past 3 years. It was unable to localize the lesion of the seizure, even using the series of epilepsy dedicated MRI sequences. Inspired by the previous report, the lesion of the seizure was successfully targeted by 3D-EDGE sequence. Combined with intraoperative navigation and precisely removed the lesion. He was uneventfully recovered with no signs of cerebral dysfunction and no seizure recurrence 8 months after surgery. CONCLUSION The 3D-EDGE sequences show a higher sensitivity for FCD detection in epilepsy patients compared with a series of epilepsy-dedicated MRI protocols. We confirmed that the study by Middlebrooks et al is of great clinical value. If the findings on routine MRI sequences or even epilepsy-dedicated MRI sequences were reported as negative, however, the semiology, video-electroencephalography, and fluorodeoxyglucose-positron emission tomography results suggest a local abnormality, and the results are concordant with each other, a 3D-EDGE sequence may be a good option.
Collapse
Affiliation(s)
- Yaeraili Abula
- Department of Functional Neurosurgery, Neurosurgery Centre, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Ailanuer Abulimiti
- Department of Neurology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - ZhengQing Liu
- Department of Neurosurgery, Kashgar Prefecture First People's Hospital of Kashi, Kashgar, Xinjiang, China
| | - Yasen Yimiti
- Department of Medical Image, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Yaermaimaiti Abula
- Department of Functional Neurosurgery, Neurosurgery Centre, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Lei Jiang
- Department of Functional Neurosurgery, Neurosurgery Centre, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - YunLing Wang
- Department of Medical Image, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Maimaitijiang Kasimu
- Department of Functional Neurosurgery, Neurosurgery Centre, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China,Address for correspondence Maimaitijiang Kasimu, MD Department of Functional Neurosurgery, Neurosurgery Centre, The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054, XinjiangChina
| |
Collapse
|
4
|
Demerath T, Donkels C, Reisert M, Heers M, Rau A, Schröter N, Schulze-Bonhage A, Reinacher P, Scheiwe C, Shah MJ, Beck J, Vlachos A, Haas CA, Urbach H. Gray-White Matter Blurring of the Temporal Pole Associated With Hippocampal Sclerosis: A Microstructural Study Involving 3 T MRI and Ultrastructural Histopathology. Cereb Cortex 2021; 32:1882-1893. [PMID: 34515307 DOI: 10.1093/cercor/bhab320] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Hippocampal sclerosis (HS) is often associated with gray-white matter blurring (GMB) of the anterior temporal lobe. In this study, twenty patients with unilateral temporal lobe epilepsy and HS were studied with 3 T MRI including T1 MP2RAGE and DTI/DMI sequences. Anterior temporal lobe white matter T1 relaxation times and diffusion measures were analyzed on the HS side, on the contralateral side, and in 10 normal controls. Resected brain tissue of three patients without GMB and four patients with GMB was evaluated ultrastructurally regarding axon density and diameter, the relation of the axon diameter to the total fiber diameter (G-ratio), and the thickness of the myelin sheath. Hippocampal sclerosis GMB of the anterior temporal lobe was related to prolonged T1 relaxation and axonal loss. A less pronounced reduction in axonal fraction was also found on imaging in GMB-negative temporal poles compared with normal controls. Contralateral values did not differ significantly between patients and normal controls. Reduced axonal density and axonal diameter were histopathologically confirmed in the temporopolar white matter with GMB compared to temporal poles without. These results confirm that GMB can be considered an imaging correlate for disturbed axonal maturation that can be quantified with advanced diffusion imaging.
Collapse
Affiliation(s)
- T Demerath
- Department of Neuroradiology, Medical Center-University of Freiburg, Faculty of Medicine, 79106 Freiburg, Germany
| | - C Donkels
- Department of Neurosurgery, Experimental Epilepsy Research, Medical Center-University of Freiburg, Faculty of Medicine, 79106 Freiburg, Germany
| | - M Reisert
- Department of Medical Physics, Medical Center-University of Freiburg, Faculty of Medicine, 79106 Freiburg, Germany.,Deparment of Stereotactic and Functional Neurosurgery, Medical Center-University of Freiburg, 79106 Freiburg, Germany
| | - M Heers
- Epilepsy Center, Medical Center-University of Freiburg, 79106 Freiburg, Germany
| | - A Rau
- Department of Neuroradiology, Medical Center-University of Freiburg, Faculty of Medicine, 79106 Freiburg, Germany
| | - N Schröter
- Department of Neurology, Medical Center-University of Freiburg, 79106 Freiburg, Germany
| | - A Schulze-Bonhage
- Epilepsy Center, Medical Center-University of Freiburg, 79106 Freiburg, Germany
| | - P Reinacher
- Deparment of Stereotactic and Functional Neurosurgery, Medical Center-University of Freiburg, 79106 Freiburg, Germany.,Fraunhofer Institute for Laser Fraunhofer Institute for Laser Technology (ILT), Aachen, Germany
| | - C Scheiwe
- Department of Neurosurgery, Medical Center-University of Freiburg, 79106 Freiburg, Germany
| | - M J Shah
- Department of Neurosurgery, Medical Center-University of Freiburg, 79106 Freiburg, Germany
| | - J Beck
- Department of Neurosurgery, Medical Center-University of Freiburg, 79106 Freiburg, Germany.,Center for Basics in NeuroModulation, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - A Vlachos
- Department of Neuroanatomy, Institute of Anatomy and Cell Biology, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany.,Center for Basics in NeuroModulation, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - C A Haas
- Department of Neurosurgery, Experimental Epilepsy Research, Medical Center-University of Freiburg, Faculty of Medicine, 79106 Freiburg, Germany.,Center for Basics in NeuroModulation, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - H Urbach
- Department of Neuroradiology, Medical Center-University of Freiburg, Faculty of Medicine, 79106 Freiburg, Germany
| |
Collapse
|
5
|
Blackmon K, Waechter R, Landon B, Noël T, Macpherson C, Donald T, Cudjoe N, Evans R, Burgen KS, Jayatilake P, Oyegunle V, Pedraza O, Abdel Baki S, Thesen T, Dlugos D, Chari G, Patel AA, Grossi-Soyster EN, Krystosik AR, LaBeaud AD. Epilepsy surveillance in normocephalic children with and without prenatal Zika virus exposure. PLoS Negl Trop Dis 2020; 14:e0008874. [PMID: 33253174 PMCID: PMC7728266 DOI: 10.1371/journal.pntd.0008874] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 12/10/2020] [Accepted: 10/12/2020] [Indexed: 12/16/2022] Open
Abstract
Children with Congenital Zika Syndrome and microcephaly are at high risk for epilepsy; however, the risk is unclear in normocephalic children with prenatal Zika virus (ZIKV) exposure [Exposed Children (EC)]. In this prospective cohort study, we performed epilepsy screening in normocephalic EC alongside a parallel group of normocephalic unexposed children [Unexposed Children (UC)]. We compared the incidence rate of epilepsy among EC and UC at one year of life to global incidence rates. Pregnant women were recruited from public health centers during the ZIKV outbreak in Grenada, West Indies and assessed for prior ZIKV infection using a plasmonic-gold platform that measures IgG antibodies in serum. Normocephalic children born to mothers with positive ZIKV results during pregnancy were classified as EC and those born to mothers with negative ZIKV results during and after pregnancy were classified as UC. Epilepsy screening procedures included a pediatric epilepsy screening questionnaire and video electroencephalography (vEEG). vEEG was collected using a multi-channel microEEG® system for a minimum of 20 minutes along with video recording of participant behavior time-locked to the EEG. vEEGs were interpreted independently by two pediatric epileptologists, who were blinded to ZIKV status, via telemedicine platform. Positive screening cases were referred to a local pediatrician for an epilepsy diagnostic evaluation. Epilepsy screens were positive in 2/71 EC (IR: 0.028; 95% CI: 0.003-0.098) and 0/71 UC. In both epilepsy-positive cases, questionnaire responses and interictal vEEGs were consistent with focal, rather than generalized, seizures. Both children met criteria for a clinical diagnosis of epilepsy and good seizure control was achieved with carbamazepine. Our results indicate that epilepsy rates are modestly elevated in EC. Given our small sample size, results should be considered preliminary. They support the use of epilepsy screening procedures in larger epidemiological studies of children with congenital ZIKV exposure, even in the absence of microcephaly, and provide guidance for conducting epilepsy surveillance in resource limited settings.
Collapse
Affiliation(s)
- Karen Blackmon
- Mayo Clinic, Department of Psychiatry and Psychology, Jacksonville, Florida, United States of America
- Windward Islands Research and Education Foundation, St George’s University, St George’s, Grenada, West Indies
- * E-mail:
| | - Randall Waechter
- Windward Islands Research and Education Foundation, St George’s University, St George’s, Grenada, West Indies
- St George’s University School of Medicine, Department of Physiology, Neuroscience, and Behavioral Sciences, St. George’s, Grenada, West Indies
| | - Barbara Landon
- Windward Islands Research and Education Foundation, St George’s University, St George’s, Grenada, West Indies
| | - Trevor Noël
- Windward Islands Research and Education Foundation, St George’s University, St George’s, Grenada, West Indies
| | - Calum Macpherson
- Windward Islands Research and Education Foundation, St George’s University, St George’s, Grenada, West Indies
| | | | - Nikita Cudjoe
- Windward Islands Research and Education Foundation, St George’s University, St George’s, Grenada, West Indies
| | - Roberta Evans
- Windward Islands Research and Education Foundation, St George’s University, St George’s, Grenada, West Indies
| | - Kemi S. Burgen
- Windward Islands Research and Education Foundation, St George’s University, St George’s, Grenada, West Indies
| | - Piumi Jayatilake
- St George’s University School of Medicine, Department of Physiology, Neuroscience, and Behavioral Sciences, St. George’s, Grenada, West Indies
| | - Vivian Oyegunle
- St George’s University School of Medicine, Department of Physiology, Neuroscience, and Behavioral Sciences, St. George’s, Grenada, West Indies
| | - Otto Pedraza
- Mayo Clinic, Department of Psychiatry and Psychology, Jacksonville, Florida, United States of America
| | - Samah Abdel Baki
- Biosignal Group Inc., Boston, Massachusetts, United States of America
| | - Thomas Thesen
- New York University School of Medicine, Department of Neurology, New York, New York, United States of America
- Department of Biomedical Sciences, University of Houston College of Medicine, USA
| | - Dennis Dlugos
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Geetha Chari
- SUNY Downstate Health Sciences University, Brooklyn, New York, United States of America
| | - Archana A. Patel
- Boston Children’s Hospital, Department of Neurology, Boston, Massachusetts, United States of America
| | - Elysse N. Grossi-Soyster
- Stanford University School of Medicine, Department of Pediatrics, Stanford, California, United States of America
| | - Amy R. Krystosik
- Stanford University School of Medicine, Department of Pediatrics, Stanford, California, United States of America
| | - A. Desiree LaBeaud
- Stanford University School of Medicine, Department of Pediatrics, Stanford, California, United States of America
| |
Collapse
|
6
|
Middlebrooks EH, Lin C, Westerhold E, Okromelidze L, Vibhute P, Grewal SS, Gupta V. Improved detection of focal cortical dysplasia using a novel 3D imaging sequence: Edge-Enhancing Gradient Echo (3D-EDGE) MRI. NEUROIMAGE-CLINICAL 2020; 28:102449. [PMID: 33032066 PMCID: PMC7552096 DOI: 10.1016/j.nicl.2020.102449] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/18/2020] [Accepted: 09/22/2020] [Indexed: 11/29/2022]
Abstract
Detection of focal cortical dysplasia remains a substantial challenge in radiology. 3D-EDGE is a novel MR method to directly image abnormalities of gray-white boundary. 3D-EDGE had a significantly higher contrast for FCD than FLAIR and MP2RAGE.
Epilepsy is a common neurological disorder with focal cortical dysplasia (FCD) being one of the most common lesional causes. Detection of FCD by MRI is a major determinant of surgical outcome. Evolution of MRI sequences and hardware has greatly increased the detection rate of FCD, but these gains have largely been related to the more visible Type IIb FCD, with Type I and IIa remaining elusive. While most sequence improvements have relied on increasing contrast between gray and white matter, we propose a novel imaging approach, 3D Edge-Enhancing Gradient Echo (3D-EDGE), to directly image the gray-white boundary. By acquiring images at an inversion time where gray and white matter have equal signal but opposite phases, voxels with a mixture of gray and white matter (e.g., at the gray-white boundary) will have cancellation of longitudinal magnetization producing a thin area of signal void at the normal boundary. By creating greater sensitivity for minor changes in T1 relaxation, microarchitectural abnormalities present in FCD produce greater contrast than on other common MRI sequences. 3D-EDGE had a significantly greater contrast ratio between lesion and white matter for FCD compared to MP2RAGE (98% vs 17%; p = 0.0006) and FLAIR (98% vs 19%; p = 0.0006), which highlights its potential to improve outcomes in epilepsy. We present a discussion of the framework for 3D-EDGE, optimization strategies, and analysis of a series of FCDs to highlight the benefit of 3D-EDGE in FCD detection compared to commonly used sequences in epilepsy.
Collapse
Affiliation(s)
- Erik H Middlebrooks
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA; Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA.
| | - Chen Lin
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | | | | | | | | | - Vivek Gupta
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| |
Collapse
|
7
|
Lin H, Leng X, Qin C, Wang W, Zhang C, Qiu S. Altered White Matter Structural Network in Frontal and Temporal Lobe Epilepsy: A Graph-Theoretical Study. Front Neurol 2020; 11:561. [PMID: 32625164 PMCID: PMC7311567 DOI: 10.3389/fneur.2020.00561] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 05/18/2020] [Indexed: 01/28/2023] Open
Abstract
Temporal lobe epilepsy (TLE) and frontal lobe epilepsy (FLE) are the largest subgroup of partial epilepsy, and focal cortical dysplasias (FCDs) are highly epileptogenic brain lesions and are a frequent cause for antiepileptic drug (AED)-resistant focal epilepsies that mostly occur in the temporal and frontal lobes. We performed a graph-theoretical study based on the diffusion tensor imaging (DTI) data of patients with FLE or TLE caused by FCDs or lesions with high suspicion of FCDs and evaluated their cognitive function by the Chinese version of the Montreal Cognitive Assessment-Basic (MoCA-BC). The construction of the white matter structural network and graph-theoretical analysis was performed by Pipeline for Analysing Brain Diffusion Images (PANDA) and Graph-theoretical Network Analysis (GRETNA). We used the nonparametric analysis of covariance to compare the differences in diffusion metrics, network attributes and nodal attributes among FLE, TLE, and healthy control (HC) groups and then performed post hoc pairwise comparisons. Nonparametric Spearman partial correlation analysis was performed to analyse the correlation of network attributes with the age of onset, duration of disease, and MoCA-BC scores in patients with FLE and TLE. The results showed that the white matter structural network in patients with FLE and TLE was impaired in a more extensive set of regions than the FCD location. The similarities in white matter alterations between FLE and TLE suggested that their epileptogenic network might affect the fronto-temporal white matter tracts and thalamo-occipital connections, which might be responsible for the overlapping cognitive deficits in FLE and TLE. The white matter impairments in patients with FLE were more severe than those in patients with TLE, which might be explained by more affected nodes in the areas of DMN in patients with FLE.
Collapse
Affiliation(s)
- Huan Lin
- Department of Radiology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Xi Leng
- Department of Radiology, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Chunhong Qin
- Department of Radiology, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wensheng Wang
- Department of Radiology, Guangdong 999 Brain Hospital, Guangzhou, China
| | - Chi Zhang
- Department of Radiology, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shijun Qiu
- Department of Radiology, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| |
Collapse
|
8
|
DiGiacomo P, Maclaren J, Aksoy M, Tong E, Carlson M, Lanzman B, Hashmi S, Watkins R, Rosenberg J, Burns B, Skloss TW, Rettmann D, Rutt B, Bammer R, Zeineh M. A within-coil optical prospective motion-correction system for brain imaging at 7T. Magn Reson Med 2020; 84:1661-1671. [PMID: 32077521 DOI: 10.1002/mrm.28211] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 01/18/2020] [Accepted: 01/21/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE Motion artifact limits the clinical translation of high-field MR. We present an optical prospective motion correction system for 7 Tesla MRI using a custom-built, within-coil camera to track an optical marker mounted on a subject. METHODS The camera was constructed to fit between the transmit-receive coils with direct line of sight to a forehead-mounted marker, improving upon prior mouthpiece work at 7 Tesla MRI. We validated the system by acquiring a 3D-IR-FSPGR on a phantom with deliberate motion applied. The same 3D-IR-FSPGR and a 2D gradient echo were then acquired on 7 volunteers, with/without deliberate motion and with/without motion correction. Three neuroradiologists blindly assessed image quality. In 1 subject, an ultrahigh-resolution 2D gradient echo with 4 averages was acquired with motion correction. Four single-average acquisitions were then acquired serially, with the subject allowed to move between acquisitions. A fifth single-average 2D gradient echo was acquired following subject removal and reentry. RESULTS In both the phantom and human subjects, deliberate and involuntary motion were well corrected. Despite marked levels of motion, high-quality images were produced without spurious artifacts. The quantitative ratings confirmed significant improvements in image quality in the absence and presence of deliberate motion across both acquisitions (P < .001). The system enabled ultrahigh-resolution visualization of the hippocampus during a long scan and robust alignment of serially acquired scans with interspersed movement. CONCLUSION We demonstrate the use of a within-coil camera to perform optical prospective motion correction and ultrahigh-resolution imaging at 7 Tesla MRI. The setup does not require a mouthpiece, which could improve accessibility of motion correction during 7 Tesla MRI exams.
Collapse
Affiliation(s)
- Phillip DiGiacomo
- Department of Bioengineering, Stanford University, Stanford, California
| | - Julian Maclaren
- Department of Radiology, Stanford University, Stanford, California
| | - Murat Aksoy
- Department of Radiology, Stanford University, Stanford, California
| | - Elizabeth Tong
- Department of Radiology, Stanford University, Stanford, California
| | - Mackenzie Carlson
- Department of Bioengineering, Stanford University, Stanford, California
| | - Bryan Lanzman
- Department of Radiology, Stanford University, Stanford, California
| | - Syed Hashmi
- Department of Radiology, Stanford University, Stanford, California
| | - Ronald Watkins
- Department of Radiology, Stanford University, Stanford, California
| | | | - Brian Burns
- Applied Sciences Lab West, GE Healthcare, Menlo Park, California
| | | | - Dan Rettmann
- MR Applications and Workflow, GE Healthcare, Rochester, Minnesota
| | - Brian Rutt
- Department of Bioengineering, Stanford University, Stanford, California.,Department of Radiology, Stanford University, Stanford, California
| | - Roland Bammer
- Department of Radiology, University of Melbourne, Melbourne, Australia
| | - Michael Zeineh
- Department of Radiology, Stanford University, Stanford, California
| |
Collapse
|
9
|
Blackmon K, Barr WB, Morrison C, MacAllister W, Kruse M, Pressl C, Wang X, Dugan P, Liu AA, Halgren E, Devinsky O, Thesen T. Cortical gray-white matter blurring and declarative memory impairment in MRI-negative temporal lobe epilepsy. Epilepsy Behav 2019; 97:34-43. [PMID: 31181427 PMCID: PMC8162756 DOI: 10.1016/j.yebeh.2019.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 04/06/2019] [Accepted: 05/08/2019] [Indexed: 11/26/2022]
Abstract
Magnetic resonance imaging (MRI)-negative temporal lobe epilepsy (TLE) may be a distinct syndrome from TLE with mesial temporal sclerosis (TLE-MTS). Imaging and neuropsychological features of TLE-MTS are well-known; yet, these features are only beginning to be described in MRI-negative TLE. This study examined whether a quantitative measure of cortical gray and white matter blurring (GWB) was elevated in the temporal lobes ipsilateral to the seizure onset zone of individuals with MRI-negative TLE relative to TLE-MTS and healthy controls (HCs) and whether GWB elevations were associated with neuropsychological comorbidity. Gray-white matter blurring from 34 cortical regions and hippocampal volumes were quantified and compared across 28 people with MRI-negative TLE, 15 people with TLE-MTS, and 51 HCs. Declarative memory was assessed with standard neuropsychological tests and the intracarotid amobarbital procedure (IAP). In the group with MRI-negative TLE (left and right onsets combined), hippocampal volumes were within normal range but GWB was elevated, relative to HCs, across several mesial and lateral temporal lobe regions ipsilateral to the seizure onset zone. Gray-white matter blurring did not differ between the groups with TLE-MTS and HC or between the groups with TLE-MTS and MRI-negative TLE. The group with MRI-negative TLE could not be distinguished from the group with TLE-MTS on any of the standard neuropsychological tests; however, ipsilateral hippocampal volumes and IAP memory scores were lower in the group with TLE-MTS than in the group with MRI-negative TLE. The group with left MRI-negative TLE had lower general cognitive abilities and verbal fluency relative to the HC group, which adds to the characterization of neuropsychological comorbidities in left MRI-negative TLE. In addition, ipsilateral IAP memory performance was reduced relative to contralateral memory performance in MRI-negative TLE, indicating some degree of ipsilateral memory dysfunction. There was no relationship between hippocampal volume and IAP memory scores in MRI-negative TLE; however, decreased ipsilateral IAP memory scores were correlated with elevated GWB in the ipsilateral superior temporal sulcus of people with left MRI-negative TLE. In sum, GWB elevations in the ipsilateral temporal lobe of people with MRI-negative TLE suggest that GWB may serve as a marker for reduced structural integrity in regions in or near the seizure onset zone. Although mesial temporal abnormalities might be the major driver of memory dysfunction in TLE-MTS, a loss of structural integrity in lateral temporal lobe regions may contribute to IAP memory dysfunction in MRI-negative TLE.
Collapse
Affiliation(s)
- Karen Blackmon
- New York University School of Medicine, Department of Neurology, Epilepsy Division, New York, NY 10016, United States of America; St. George's University School of Medicine, Department of Physiology, Neuroscience, and Behavioral Sciences, West Indies, Grenada.
| | - William B. Barr
- New York University School of Medicine, Department of Neurology, Epilepsy Division, New York, NY 10016, United States of America
| | - Chris Morrison
- New York University School of Medicine, Department of Neurology, Epilepsy Division, New York, NY 10016, United States of America
| | - William MacAllister
- New York University School of Medicine, Department of Neurology, Epilepsy Division, New York, NY 10016, United States of America,University of Calgary, Alberta Children’s Hospital, Calgary, Alberta, Canada
| | - Michelle Kruse
- St. George’s University School of Medicine, Department of Physiology, Neuroscience, and Behavioral Sciences, West Indies, Grenada
| | - Christina Pressl
- New York University School of Medicine, Department of Neurology, Epilepsy Division, New York, NY 10016, United States of America,The Rockefeller University, Laboratory of Neural Systems, New York, NY 10065, United States of America
| | - Xiuyuan Wang
- New York University School of Medicine, Department of Neurology, Epilepsy Division, New York, NY 10016, United States of America,New York University School of Medicine, Department of Radiology, New York, NY 10016, United States of America
| | - Patricia Dugan
- New York University School of Medicine, Department of Neurology, Epilepsy Division, New York, NY 10016, United States of America
| | - Anli A. Liu
- New York University School of Medicine, Department of Neurology, Epilepsy Division, New York, NY 10016, United States of America
| | - Eric Halgren
- University of California San Diego, Multimodal Imaging Laboratory, San Diego, CA 92093, United States of America
| | - Orrin Devinsky
- New York University School of Medicine, Department of Neurology, Epilepsy Division, New York, NY 10016, United States of America
| | - Thomas Thesen
- New York University School of Medicine, Department of Neurology, Epilepsy Division, New York, NY 10016, United States of America,St. George’s University School of Medicine, Department of Physiology, Neuroscience, and Behavioral Sciences, West Indies, Grenada
| |
Collapse
|
10
|
MTOR pathway in focal cortical dysplasia type 2: What do we know? Epilepsy Behav 2018; 85:157-163. [PMID: 29945038 DOI: 10.1016/j.yebeh.2018.05.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 05/08/2018] [Accepted: 05/09/2018] [Indexed: 01/15/2023]
Abstract
Focal cortical dysplasia (FCD) is the most commonly encountered developmental malformation that causes refractory epilepsy. Focal cortical dysplasia type 2 is one of the most usual neuropathological findings in tissues resected therapeutically from patients with drug-resistant epilepsy. Unlike other types of FCD, it is characterized by laminar disorganization and dysplastic neurons, which compromise the organization of the six histologically known layers in the cortex; the morphology and/or cell location can also be altered. A comprehensive review about the pathogenesis of this disease is important because of the necessity to update the results reported over the past years. Here, we present an updated review through Pubmed about the mammalian target of rapamycin (MTOR) pathway in FCD type 2. A wide variety of aspects was covered in 44 articles related to molecular and cellular biology, including experiments in animal and human models. The first publications appeared in 2004, but there is still a lack of studies specifically for one type of FCD. With the advancement of techniques and greater access to molecular and cellular experiments, such as induced pluripotent stem cells (iPSCs) and organoids, it is believed that the trend is increasing the number of publications contributing to the achievement of new discoveries.
Collapse
|
11
|
Osadebey ME, Pedersen M, Arnold DL, Wendel-Mitoraj KE. Blind blur assessment of MRI images using parallel multiscale difference of Gaussian filters. Biomed Eng Online 2018; 17:76. [PMID: 29898715 PMCID: PMC6001176 DOI: 10.1186/s12938-018-0514-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 06/05/2018] [Indexed: 12/02/2022] Open
Abstract
Background Rician noise, bias fields and blur are the common distortions that degrade MRI images during acquisition. Blur is unique in comparison to Rician noise and bias fields because it can be introduced into an image beyond the acquisition stage such as postacquisition processing and the manifestation of pathological conditions. Most current blur assessment algorithms are designed and validated on consumer electronics such as television, video and mobile appliances. The few algorithms dedicated to medical images either requires a reference image or incorporate manual approach. For these reasons it is difficult to compare quality measures from different images and images with different contents. Furthermore, they will not be suitable in environments where large volumes of images are processed. In this report we propose a new blind blur assessment method for different types of MRI images and for different applications including automated environments. Methods Two copies of the test image are generated. Edge map is extracted by separately convolving each copy of the test image with two parallel difference of Gaussian filters. At the start of the multiscale representation, the initial output of the filters are equal. In subsequent scales of the multiscale representation, each filter is tuned to different operating parameters over the same fixed range of Gaussian scales. The filters are termed low and high energy filters based on their characteristics to successively attenuate and highlight edges over the range of multiscale representation. Quality score is predicted from the distance between the normalized mean of the edge maps at the final output of the filters. Results The proposed method was evaluated on cardiac and brain MRI images. Performance evaluation shows that the quality index has very good correlation with human perception and will be suitable for application in routine clinical practice and clinical research.
Collapse
Affiliation(s)
- Michael E Osadebey
- NeuroRx Research Inc, Montreal, 3575 Parc Avenue, Suite # 5322, Montreal, QC, H2X 3P9, Canada
| | - Marius Pedersen
- Department of Computer Science, Norwegian University of Science and Technology, Teknologivegen 22, 2815, Gjovik, Norway.
| | - Douglas L Arnold
- Montreal Neurological Institute and Hospital, McGill University, 3801 University St, Montreal, QC, H3A 2B4, Canada
| | | |
Collapse
|
12
|
Hong SJ, Bernhardt BC, Gill RS, Bernasconi N, Bernasconi A. The spectrum of structural and functional network alterations in malformations of cortical development. Brain 2017; 140:2133-2143. [DOI: 10.1093/brain/awx145] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 05/07/2017] [Indexed: 12/28/2022] Open
Affiliation(s)
- Seok-Jun Hong
- Neuroimaging of Epilepsy Laboratory, Department of Neurology and McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Boris C Bernhardt
- Neuroimaging of Epilepsy Laboratory, Department of Neurology and McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Ravnoor S Gill
- Neuroimaging of Epilepsy Laboratory, Department of Neurology and McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Neda Bernasconi
- Neuroimaging of Epilepsy Laboratory, Department of Neurology and McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Andrea Bernasconi
- Neuroimaging of Epilepsy Laboratory, Department of Neurology and McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
13
|
Bernardo S, Marchionni E, Prudente S, De Liso P, Spalice A, Giancotti A, Manganaro L, Pizzuti A. Unusual association of SCN2A epileptic encephalopathy with severe cortical dysplasia detected by prenatal MRI. Eur J Paediatr Neurol 2017; 21:587-590. [PMID: 28254201 DOI: 10.1016/j.ejpn.2017.01.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 01/23/2017] [Accepted: 01/29/2017] [Indexed: 12/16/2022]
Abstract
We present an atypical association of SCN2A epileptic encephalopathy with severe cortical dysplasia. SCN2A mutations are associated with epileptic syndromes from benign to extremely severe in absence of such macroscopic brain findings. Prenatal MRI (Magnetic Resonance Imaging) in a 32 weeks fetus, with US (Ultrasonography) diagnosis of isolated ventriculomegaly showed CNS (Central Nervous System) dysplasia characterized by lack of differentiation between cortical and subcortical layers, pachygyria and corpus callosum dysgenesis. Postnatal MRI confirmed the prenatal findings. On day 6 the baby presented a focal status epilepticus, partially controlled by phenobarbital, phenytoin, and levetiracetam. After three weeks a moderate improvement in seizure control has been achieved with carbamazepine. Exome sequencing detected a de novo heterozygous mutation in the SCN2A gene, encoding the αII-subunit of a sodium channel. The patient findings expand the phenotype spectrum of SCN2A mutations to epileptic encephalopathies with macroscopic brain developmental features.
Collapse
Affiliation(s)
- Silvia Bernardo
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Policlinico Umberto I Hospital, Viale Regina Elena 324, Rome, Italy; Department of Experimental Medicine, Sapienza University of Rome, Policlinico Umberto I Hospital, Viale Regina Elena 324, Rome, Italy.
| | - Enrica Marchionni
- Department of Experimental Medicine, Sapienza University of Rome, Policlinico Umberto I Hospital, Viale Regina Elena 324, Rome, Italy; IRCCS Casa Sollievo della Sofferenza, Mendel-laboratory, San Giovanni Rotondo, Italy.
| | - Sabrina Prudente
- IRCCS Casa Sollievo della Sofferenza, Mendel-laboratory, San Giovanni Rotondo, Italy.
| | - Paola De Liso
- Department of Pediatrics, Child Neurology and Psychiatry, Sapienza University of Rome, Policlinico Umberto I Hospital, Viale Regina Elena 324, Rome, Italy.
| | - Alberto Spalice
- Department of Pediatrics, Child Neurology and Psychiatry, Sapienza University of Rome, Policlinico Umberto I Hospital, Viale Regina Elena 324, Rome, Italy.
| | - Antonella Giancotti
- Department of Obstetrics, Gynecology and Urologic Sciences, Sapienza University of Rome, Policlinico Umberto I Hospital, Viale Regina Elena 324, Rome, Italy.
| | - Lucia Manganaro
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Policlinico Umberto I Hospital, Viale Regina Elena 324, Rome, Italy.
| | - Antonio Pizzuti
- Department of Experimental Medicine, Sapienza University of Rome, Policlinico Umberto I Hospital, Viale Regina Elena 324, Rome, Italy; IRCCS Casa Sollievo della Sofferenza, Mendel-laboratory, San Giovanni Rotondo, Italy.
| |
Collapse
|
14
|
Martin P, Bender B, Focke NK. Post-processing of structural MRI for individualized diagnostics. Quant Imaging Med Surg 2015; 5:188-203. [PMID: 25853079 DOI: 10.3978/j.issn.2223-4292.2015.01.10] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 01/28/2015] [Indexed: 11/14/2022]
Abstract
Currently, a relevant proportion of all histopathologically proven focal cortical dysplasia (FCD) escape visual detection; this shows the need for additional improvements in analyzing MRI data. A positive MRI is still the strongest prognostic factor for postoperative freedom of seizures. Among several post-processing methods voxel-based morphometry (VBM) of T1- and T2-weighted sequences and T2 relaxometry are routinely applied in pre-surgical diagnostics of cryptogenic epilepsy in epilepsy centers. VBM is superior to conventional visual analysis with 9-15% more identified epileptogenic foci, while T2 relaxometry has its main application in (mesial) temporal lobe epilepsy. Further methods such as surface-based morphometry (SBM) or diffusion tensor imaging are promising but there is a lack of current studies comparing their individual diagnostic value. Post-processing methods represent an important addition to conventional visual analysis but need to be interpreted with expertise and experience so that they should be apprehended as a complementary tool within the context of the multi-modal evaluation of epilepsy patients. This review will give an overview of existing post-processing methods of structural MRI and outline their clinical relevance in detection of epileptogenic structural changes.
Collapse
Affiliation(s)
- Pascal Martin
- 1 Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, 2 Department of Diagnostic and Interventional Neuroradiology, University of Tübingen, 72076 Tübingen, Germany
| | - Benjamin Bender
- 1 Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, 2 Department of Diagnostic and Interventional Neuroradiology, University of Tübingen, 72076 Tübingen, Germany
| | - Niels K Focke
- 1 Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, 2 Department of Diagnostic and Interventional Neuroradiology, University of Tübingen, 72076 Tübingen, Germany
| |
Collapse
|
15
|
Cooper CJ, McConnell F, Walmsley G, Gonçalves R. Focal cortical dysplasia resulting in seizures in an adult dog. VETERINARY RECORD CASE REPORTS 2015. [DOI: 10.1136/vetreccr-2015-000254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | | | - Gemma Walmsley
- Small Animal Teaching HospitalUniversity of LiverpoolNestonUK
| | - Rita Gonçalves
- Small Animal Teaching HospitalUniversity of LiverpoolNestonUK
| |
Collapse
|