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Park DK, Kim W, Thornburg O, McBrian D, McKhann G, Feldstein N, Maddocks A, Gonzalez E, Shen MY, Akman C, Provenzano F. Convolutional Neural Network-aided Tuber Segmentation in Tuberous Sclerosis Complex Patients Correlates with EEG. Epilepsia 2022; 63:1530-1541. [PMID: 35301716 DOI: 10.1111/epi.17227] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE One of the clinical hallmarks of tuberous sclerosis complex is radiologically-identified cortical tubers present in most patients. Intractable epilepsy may require surgery, often involving invasive diagnostic procedures such as intracranial EEG. Identifying the location of the dominant tuber responsible for generating epileptic activities, is a critical issue. However, the link between cortical tubers and epileptogenesis is poorly understood. Given this, we hypothesized that tuber voxel intensity may be an indicator of the dominant epileptogenic tuber. Also, via tuber segmentation based on deep learning, we explore whether an automatic quantification of the tuber burden is feasible. METHODS We annotated tubers from structural MRIs across 29 TSC subjects, summarized tuber statistics in eight brain lobes, and determined suspected epileptogenic lobes from the same group using EEG monitoring data. Then logistic regression analyses are performed to demonstrate the linkage between the statistics of cortical tuber and the epileptogenic zones. Furthermore, we test the ability of a neural network to identify and quantify tuber burden. RESULTS Logistic regression analyses show that the volume and count of tubers per lobe, not the mean or variance of tuber voxel intensity, are positively correlated with electrophysiological data. In 47.6% of subjects, the lobe with the largest tuber volume concurred with the epileptic brain activity. A neural network model on the test dataset shows a sensitivity of 0.83 for localizing individual tubers. The predicted masks from the model highly correlated with the neurologist labels, thus may be a useful tool for determining tuber burden and searching for epileptogenic zone. SIGNIFICANCE we prove the feasibility of an automatic segmentation of tubers and a derivation of tuber burden across brain lobes. Our method may provide crucial insights in the treatment and outcome of TSC patients.
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Affiliation(s)
- David K Park
- Department of Biomedical Engineering, Columbia University
| | - Woojoong Kim
- Columbia University Irving Medical Center.,Child Neurology, Columbia University Medical Center
| | | | | | - Guy McKhann
- Neurological Surgery, Columbia University Medical Center
| | - Neil Feldstein
- Neurological Surgery, Columbia University Medical Center
| | | | | | - Min Y Shen
- Columbia University Irving Medical Center
| | - Cigdem Akman
- Columbia University Irving Medical Center.,Child Neurology, Columbia University Medical Center
| | - Frank Provenzano
- Columbia University Irving Medical Center.,Department of Neurology, Columbia University
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Use of Innovative SPECT Techniques in the Presurgical Evaluation of Patients with Nonlesional Extratemporal Drug-Resistant Epilepsy. Mol Imaging 2021; 2021:6614356. [PMID: 33746629 PMCID: PMC7953581 DOI: 10.1155/2021/6614356] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 02/04/2021] [Accepted: 02/18/2021] [Indexed: 12/27/2022] Open
Abstract
Up to 30% of patients with epilepsy may not respond to antiepileptic drugs. Patients with drug-resistant epilepsy (DRE) should undergo evaluation for seizure onset zone (SOZ) localization to consider surgical treatment. Cases of drug-resistant nonlesional extratemporal lobe epilepsy (ETLE) pose the biggest challenge in localizing the SOZ and require multiple noninvasive diagnostic investigations before planning the intracranial monitoring (ICM) or direct resection. Ictal Single Photon Emission Computed Tomography (i-SPECT) is a unique functional diagnostic tool that assesses the SOZ using the localized hyperperfusion that occurs early in the seizure. Subtraction ictal SPECT coregistered to MRI (SISCOM), statistical ictal SPECT coregistered to MRI (STATISCOM), and PET interictal subtracted ictal SPECT coregistered with MRI (PISCOM) are innovative SPECT methods for the determination of the SOZ. This article comprehensively reviews SPECT and sheds light on its vital role in the presurgical evaluation of the nonlesional extratemporal DRE.
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Narin A. Detection of Focal and Non-focal Epileptic Seizure Using Continuous Wavelet Transform-Based Scalogram Images and Pre-trained Deep Neural Networks. Ing Rech Biomed 2020. [DOI: 10.1016/j.irbm.2020.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Huaijantug S, Theeraphun W, Suwanna N, Thongpraparn T, Chanachai R, Aumarm W. Localization of cerebral hypoperfusion in dogs with refractory and non-refractory epilepsy using [99mTc] ethyl cysteinate dimer and single photon emission computed tomography. J Vet Med Sci 2020; 82:553-558. [PMID: 32188799 PMCID: PMC7273607 DOI: 10.1292/jvms.19-0372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
To evaluate the localization of functional deficit area in epileptogenic zones of the brain in seven refractory and seven non-refractory epilepsy dogs using technetium 99m labeled with
ethyl cysteinate dimer and interictal single photon emission computed tomography [99mTc-ECD SPECT] co-registration with Magnetic Resonance Imaging (MRI). Regions showing perfusion
deficits in the SPECT images were analyzed by using the standard semiquantitative evaluation method to compare the level of cortical perfusion to the maximum number of counts within the
cerebellum (max C), considered the area of reference. This study showed that SPECT imaging revealed abnormalities in several regions of the brain in both epilepsy groups. The refractory
epilepsy dogs showed more frequency area of hypoperfusion in temporal lobe than non-refractory group with not statistically significance (P=0.28). The result suggests the
lesion in temporal might be relevance with refractory epilepsy in canine patients.
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Affiliation(s)
- Somkiat Huaijantug
- Department of Companion Animals Clinical Sciences, Faculty of Veterinary Medicine, Kasetsart University, Jatujak, Bangkok, 10900, Thailand.,Department of Clinical Sciences and Public Health, Faculty of Veterinary Science, Mahidol University, Nakhon Pathom, 73170, Thailand
| | - Wuttiwong Theeraphun
- Department of Companion Animals Clinical Sciences, Faculty of Veterinary Medicine, Kasetsart University, Jatujak, Bangkok, 10900, Thailand
| | - Nirut Suwanna
- Department of Companion Animals Clinical Sciences, Faculty of Veterinary Medicine, Kasetsart University, Jatujak, Bangkok, 10900, Thailand
| | - Thanapong Thongpraparn
- Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Rujaporn Chanachai
- Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Waraporn Aumarm
- Department of Companion Animals Clinical Sciences, Faculty of Veterinary Medicine, Kasetsart University, Jatujak, Bangkok, 10900, Thailand
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Tsougos I, Kousi E, Georgoulias P, Kapsalaki E, Fountas KN. Neuroimaging methods in Epilepsy of Temporal Origin. Curr Med Imaging 2018; 15:39-51. [DOI: 10.2174/1573405613666170622114920] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 05/04/2017] [Accepted: 05/11/2017] [Indexed: 11/22/2022]
Abstract
Background:
Temporal Lobe Epilepsy (TLE) comprises the most common form of
symptomatic refractory focal epilepsy in adults. Accurate lateralization and localization of the
epileptogenic focus are a significant prerequisite for determining surgical candidacy once the
patient has been deemed medically intractable. Structural MR imaging, clinical,
electrophysiological, and neurophysiological data have an established role in the localization of the
epileptogenic foci. Nevertheless, hippocampal sclerosis cannot be detected on MR images in more
than 30% of patients with TLE, and the presurgical assessment remains controversial.
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Discussion: In the last years, advanced MR imaging techniques, such as 1H-MRS, DWI, DTI,
DSCI, and fMRI, may provide valuable additional information regarding the physiological and
metabolic characterization of brain tissue. MR imaging has shifted towards functional and
molecular imaging, thus, promising to improve the accuracy regarding the lateralization and the
localization of the epileptogenic focus. Additionally, nuclear medicine studies, such as SPECT and
PET imaging modalities, have become an asset for the decoding of brain function and activity, and
can be diagnostically helpful as well, since they provide valuable data regarding the altered
metabolic activity of the seizure foci.
Conclusion:
Overall, advanced MRI, SPECT, and PET imaging techniques are increasingly
becoming an essential part of TLE diagnostics, when the epileptogenic area is not identified on
structural MRI or when structural MRI, clinical, and electrophysiological findings are not in
concordance.
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Affiliation(s)
- Ioannis Tsougos
- Department of Medical Physics, School of Medicine, University of Thessaly, Larisa, Greece
| | - Evanthia Kousi
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Panagiotis Georgoulias
- Department of Medical Physics, School of Medicine, University of Thessaly, Larisa, Greece
| | - Eftychia Kapsalaki
- Department of Medical Physics, School of Medicine, University of Thessaly, Larisa, Greece
| | - Kostas N. Fountas
- Department of Medical Physics, School of Medicine, University of Thessaly, Larisa, Greece
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Fu P, Zhang F, Gao J, Jing J, Pan L, Li D, Wei L. NeuroGam Software Analysis in Epilepsy Diagnosis Using 99mTc-ECD Brain Perfusion SPECT Imaging. Med Sci Monit 2015; 21:2801-8. [PMID: 26386662 PMCID: PMC4581683 DOI: 10.12659/msm.894566] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The aim of this study was to explore the value of NeuroGam software in diagnosis of epilepsy by 99Tcm-ethyl cysteinate dimer (ECD) brain imaging. MATERIAL AND METHODS NeuroGam was used to analyze 52 cases of clinically proven epilepsy by 99Tcm-ECD brain imaging. The results were compared with EEG and MRI, and the positive rates and localization to epileptic foci were analyzed. RESULTS NeuroGam analysis showed that 42 of 52 epilepsy cases were abnormal. 99Tcm-ECD brain imaging revealed a positive rate of 80.8% (42/52), with 36 out of 42 patients (85.7%) clearly showing an abnormal area. Both were higher than that of brain perfusion SPECT, with a consistency of 64.5% (34/52) using these 2 methods. Decreased regional cerebral blood flow (rCBF) was observed in frontal (18), temporal (20), and parietal lobes (2). Decreased rCBF was seen in frontal and temporal lobes in 4 out of 36 patients, and in temporal and parietal lobes of 2 out of 36 patients. NeuroGam further showed that the abnormal area was located in a different functional area of the brain. EEG abnormalities were detected in 29 out of 52 patients (55.8%) with 16 cases (55.2%) clearly showing an abnormal area. MRI abnormalities were detected in 17 out of 43 cases (39.5%), including 9 cases (52.9%) clearly showing an abnormal area. The consistency of NeuroGam software analysis, and EEG and MRI were 48.1% (25/52) and 34.9% (15/43), respectively. CONCLUSIONS NeuroGam software analysis offers a higher sensitivity in detecting epilepsy than EEG or MRI. It is a powerful tool in 99Tcm-ECD brain imaging.
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Affiliation(s)
- Peng Fu
- Department of Nuclear Medicine, 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Fang Zhang
- Department of Nuclear Medicine, 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Jianqing Gao
- Department of Nuclear Medicine, 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Jianmin Jing
- Department of Nuclear Medicine, 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Liping Pan
- Department of Nuclear Medicine, 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Dongxue Li
- Department of Nuclear Medicine, 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Lingge Wei
- Department of Nuclear Medicine, 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
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Obenaus A. Neuroimaging biomarkers for epilepsy: advances and relevance to glial cells. Neurochem Int 2013; 63:712-8. [PMID: 23665337 DOI: 10.1016/j.neuint.2013.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 04/24/2013] [Accepted: 05/01/2013] [Indexed: 12/11/2022]
Abstract
Glial cells play an important role in normal brain function and emerging evidence would suggest that their dysfunction may be responsible for some epileptic disease states. Neuroimaging of glial cells is desirable, but there are no clear methods to assess neither their function nor localization. Magnetic resonance imaging (MRI) is now part of a standardized epilepsy imaging protocol to assess patients. Structural volumetric and T2-weighted imaging changes can assist in making a positive diagnosis in a majority of patients. The alterations reported in structural and T2 imaging is predominantly thought to reflect early neuronal loss followed by glial hypertrophy. MR spectroscopy for myo-inositol is a being pursued to identify glial alterations along with neuronal markers. Diffusion weighted imaging (DWI) is ideal for acute epileptiform events, but is not sensitive to either glial cells or neuronal long-term changes found in epilepsy. However, DWI variants such as diffusion tensor imaging or q-space imaging may shed additional light on aberrant glial function in the future. The sensitivity and specificity of PET radioligands, including those targeting glial cells (translocator protein) hold promise in being able to image glial cells. As the role of glial function/dysfunction in epilepsy becomes more apparent neuroimaging methods will evolve to assist the clinician and researcher in visualizing their location and function.
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Affiliation(s)
- Andre Obenaus
- Department of Pediatrics, School of Medicine, Loma Linda University, Loma Linda, CA, USA; Division of Interdisciplinary Studies, School of Behavioral Health, Loma Linda University, Loma Linda, CA, USA; Cell and Molecular Development and Biology Program, University of California, Riverside, CA, USA; Neuroscience Graduate Program, University of California, Riverside, CA, USA.
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Perfusion network shift during seizures in medial temporal lobe epilepsy. PLoS One 2013; 8:e53204. [PMID: 23341932 PMCID: PMC3544909 DOI: 10.1371/journal.pone.0053204] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 11/26/2012] [Indexed: 11/19/2022] Open
Abstract
Background Medial temporal lobe epilepsy (MTLE) is associated with limbic atrophy involving the hippocampus, peri-hippocampal and extra-temporal structures. While MTLE is related to static structural limbic compromise, it is unknown whether the limbic system undergoes dynamic regional perfusion network alterations during seizures. In this study, we aimed to investigate state specific (i.e. ictal versus interictal) perfusional limbic networks in patients with MTLE. Methods We studied clinical information and single photon emission computed tomography (SPECT) images obtained with intravenous infusion of the radioactive tracer Technetium- Tc 99 m Hexamethylpropyleneamine Oxime (Tc-99 m HMPAO) during ictal and interictal state confirmed by video-electroencephalography (VEEG) in 20 patients with unilateral MTLE (12 left and 8 right MTLE). Pair-wise voxel-based analyses were used to define global changes in tracer between states. Regional tracer uptake was calculated and state specific adjacency matrices were constructed based on regional correlation of uptake across subjects. Graph theoretical measures were applied to investigate global and regional state specific network reconfigurations. Results A significant increase in tracer uptake was observed during the ictal state in the medial temporal region, cerebellum, thalamus, insula and putamen. From network analyses, we observed a relative decreased correlation between the epileptogenic temporal region and remaining cortex during the interictal state, followed by a surge of cross-correlated perfusion in epileptogenic temporal-limbic structures during a seizure, corresponding to local network integration. Conclusions These results suggest that MTLE is associated with a state specific perfusion and possibly functional organization consisting of a surge of limbic cross-correlated tracer uptake during a seizure, with a relative disconnection of the epileptogenic temporal lobe in the interictal period. This pattern of state specific shift in metabolic networks in MTLE may improve the understanding of epileptogenesis and neuropsychological impairments associated with MTLE.
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Lenkov DN, Volnova AB, Pope ARD, Tsytsarev V. Advantages and limitations of brain imaging methods in the research of absence epilepsy in humans and animal models. J Neurosci Methods 2012; 212:195-202. [PMID: 23137652 DOI: 10.1016/j.jneumeth.2012.10.018] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 10/24/2012] [Accepted: 10/25/2012] [Indexed: 12/18/2022]
Abstract
The purpose of this review is to analyze research possibilities and limitations of several methods, technical tools and their combinations for elucidation of absence epilepsy mechanisms, particularly the childhood absences. Despite the notable collection of simultaneous recording of clinical electroencephalography (EEG) and behavioral changes in relation to absence seizures, shortcomings of scalp EEG in both spatial resolution and precise detection of subcortical centers have limited the understanding of the fundamental mechanisms of altered brain function during and after recurrent epileptic paroxysms. Therefore, in the past decade, EEG recordings have often been combined with simultaneous imaging methods in epilepsy studies. Among imaging methods, the following ones are used regularly: functional magnetic resonance imaging (fMRI), positron-emission tomography (PET), low-resolution electromagnetic tomography (LORETA), single photon emission spectroscopy (SPECT), near-infrared spectroscopy (NIRS), and optical imaging of intrinsic signals (IOS). In addition, voltage-sensitive dye optical imaging method and even photoacoustic microscopy can be applied to animal models of epilepsy. Samplings of some of the most relevant data obtained by the above methods are presented. It appears that the elaboration of more adequate animal models of the patterns of absence seizures during the early postnatal period is necessary for better correspondence of human and animal absence phenomena.
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Affiliation(s)
- Dmitry N Lenkov
- Nevsky Center of Scientific Collaboration-Saint Petersburg, Razjezshaya 43/1 Liter A, Suite 8N, Saint Petersburg 192119, Russia
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Hippocampal sclerosis in children younger than 2 years. Pediatr Radiol 2011; 41:1239-45. [PMID: 21735179 DOI: 10.1007/s00247-011-2166-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2011] [Revised: 05/19/2011] [Accepted: 05/25/2011] [Indexed: 01/08/2023]
Abstract
BACKGROUND Hippocampal sclerosis (HS) is rarely considered as a diagnosis in children younger than 2 years. OBJECTIVE To describe imaging features in conjunction with clinical information in patients with hippocampal sclerosis who are younger than 2 years. MATERIALS AND METHODS We retrospectively reviewed MR brain imaging and clinical information in five children in whom the diagnosis of HS was made both clinically and by MRI prior to 2 years of age. RESULTS Imaging features establishing the diagnosis of hippocampal sclerosis were bright T2 signal and volume loss, while the internal architecture of the hippocampal formation was preserved in almost all children. Clinically, all children had an infectious trigger. CONCLUSION It is necessary for radiologists to consider HS in children with certain clinical features to plan an MRI protocol that is appropriate for detection of hippocampal pathology.
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