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Suh PS, Park JE, Roh YH, Kim S, Jung M, Koo YS, Lee SA, Choi Y, Kim HS. Improving Diagnostic Performance of MRI for Temporal Lobe Epilepsy With Deep Learning-Based Image Reconstruction in Patients With Suspected Focal Epilepsy. Korean J Radiol 2024; 25:374-383. [PMID: 38528695 PMCID: PMC10973740 DOI: 10.3348/kjr.2023.0842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/10/2023] [Accepted: 01/07/2024] [Indexed: 03/27/2024] Open
Abstract
OBJECTIVE To evaluate the diagnostic performance and image quality of 1.5-mm slice thickness MRI with deep learning-based image reconstruction (1.5-mm MRI + DLR) compared to routine 3-mm slice thickness MRI (routine MRI) and 1.5-mm slice thickness MRI without DLR (1.5-mm MRI without DLR) for evaluating temporal lobe epilepsy (TLE). MATERIALS AND METHODS This retrospective study included 117 MR image sets comprising 1.5-mm MRI + DLR, 1.5-mm MRI without DLR, and routine MRI from 117 consecutive patients (mean age, 41 years; 61 female; 34 patients with TLE and 83 without TLE). Two neuroradiologists evaluated the presence of hippocampal or temporal lobe lesions, volume loss, signal abnormalities, loss of internal structure of the hippocampus, and lesion conspicuity in the temporal lobe. Reference standards for TLE were independently constructed by neurologists using clinical and radiological findings. Subjective image quality, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were analyzed. Performance in diagnosing TLE, lesion findings, and image quality were compared among the three protocols. RESULTS The pooled sensitivity of 1.5-mm MRI + DLR (91.2%) for diagnosing TLE was higher than that of routine MRI (72.1%, P < 0.001). In the subgroup analysis, 1.5-mm MRI + DLR showed higher sensitivity for hippocampal lesions than routine MRI (92.7% vs. 75.0%, P = 0.001), with improved depiction of hippocampal T2 high signal intensity change (P = 0.016) and loss of internal structure (P < 0.001). However, the pooled specificity of 1.5-mm MRI + DLR (76.5%) was lower than that of routine MRI (89.2%, P = 0.004). Compared with 1.5-mm MRI without DLR, 1.5-mm MRI + DLR resulted in significantly improved pooled accuracy (91.2% vs. 73.1%, P = 0.010), image quality, SNR, and CNR (all, P < 0.001). CONCLUSION The use of 1.5-mm MRI + DLR enhanced the performance of MRI in diagnosing TLE, particularly in hippocampal evaluation, because of improved depiction of hippocampal abnormalities and enhanced image quality.
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Affiliation(s)
- Pae Sun Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Ji Eun Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
| | - Yun Hwa Roh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Seonok Kim
- Department of Clinical Epidemiology and Biostatics, University of Ulsan college of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Mina Jung
- Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Yong Seo Koo
- Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Sang-Ahm Lee
- Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Yangsean Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Ho Sung Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Asadi-Pooya AA, Farazdaghi M. Clinical characteristics of MRI-negative temporal lobe epilepsy. Acta Neurol Belg 2023; 123:1911-1916. [PMID: 36385248 DOI: 10.1007/s13760-022-02145-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/09/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE To investigate the characteristics of patients with MRI-negative temporal lobe epilepsy (TLE) (1.5 T brain MRI) in comparison with: (i) patients with hippocampal sclerosis (HS)-TLE; (ii) persons with non-HS structural TLE; and (iii) patients with dual pathology. METHODS This was a retrospective study. All patients with an electro-clinical diagnosis of TLE were studied at the outpatient epilepsy clinic at Shiraz University of Medical Sciences, Shiraz, Iran, from 2008 until 2020. RESULTS Six hundred and forty-one patients were studied [273 (42.6%) HS, 154 (24.0%) non-HS structural TLE, 174 (27.1%) MRI-negative TLE, and 40 (6.2%) dual pathology]. The groups differed significantly. Important dissimilarities included: (i) compared with HS-TLE group, patients with MRI-negative TLE more often had a family history of epilepsy and less often had a history of febrile convulsion; (ii) compared with non-HS structural TLE group, patients with MRI-negative TLE more often had focal to bilateral tonic-clonic seizures, less often had focal seizures with impaired awareness, and more often had a family history of epilepsy; (iii) compared with the dual pathology group, patients with MRI-negative TLE less often were male and less often had a history of febrile convulsion. CONCLUSION Patients with MRI-negative TLE are not a homogenous group of people and it is not necessarily a distinct entity from other forms of TLE either. With the emergence of advanced imaging technologies, the underlying pathologies of MRI-negative TLE may be revealed.
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Affiliation(s)
- Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
- Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Mohsen Farazdaghi
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Paredes-Aragon E, AlKhaldi NA, Ballesteros-Herrera D, Mirsattari SM. Stereo-Encephalographic Presurgical Evaluation of Temporal Lobe Epilepsy: An Evolving Science. Front Neurol 2022; 13:867458. [PMID: 35720095 PMCID: PMC9197919 DOI: 10.3389/fneur.2022.867458] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/25/2022] [Indexed: 11/15/2022] Open
Abstract
Drug-resistant epilepsy is present in nearly 30% of patients. Resection of the epileptogenic zone has been found to be the most effective in achieving seizure freedom. The study of temporal lobe epilepsy for surgical treatment is extensive and complex. It involves a multidisciplinary team in decision-making with initial non-invasive studies (Phase I), providing 70% of the required information to elaborate a hypothesis and treatment plans. Select cases present more complexity involving bilateral clinical or electrographic manifestations, have contradicting information, or may involve deeper structures as a part of the epileptogenic zone. These cases are discussed by a multidisciplinary team of experts with a hypothesis for invasive methods of study. Subdural electrodes were once the mainstay of invasive presurgical evaluation and in later years most Comprehensive Epilepsy Centers have shifted to intracranial recordings. The intracranial recording follows original concepts since its development by Bancaud and Talairach, but great advances have been made in the field. Stereo-electroencephalography is a growing field of study, treatment, and establishment of seizure pattern complexities. In this comprehensive review, we explore the indications, usefulness, discoveries in interictal and ictal findings, pitfalls, and advances in the science of presurgical stereo-encephalography for temporal lobe epilepsy.
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Affiliation(s)
- Elma Paredes-Aragon
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada
| | - Norah A AlKhaldi
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada.,Neurology Department, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Daniel Ballesteros-Herrera
- Neurosurgery Department, National Institute of Neurology and Neurosurgery "Dr. Manuel Velasco Suárez", Mexico City, Mexico
| | - Seyed M Mirsattari
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada.,Departments of Clinical Neurological Sciences, Diagnostic Imaging, Biomedical Imaging and Psychology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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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.
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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
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Zhu X, He Z, Luo C, Qiu X, He S, Peng A, Zhang L, Chen L. Altered spontaneous brain activity in MRI-negative refractory temporal lobe epilepsy patients with major depressive disorder: A resting-state fMRI study. J Neurol Sci 2018; 386:29-35. [PMID: 29406962 DOI: 10.1016/j.jns.2018.01.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 12/31/2017] [Accepted: 01/09/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate alterations in spontaneous brain activity in MRI-negative refractory temporal lobe epilepsy patients with major depressive disorder using resting-state functional magnetic resonance imaging (RS-fMRI). METHODS Eighteen MRI-negative refractory temporal lobe epilepsy patients with major depressive disorder (PDD), 17 MRI-negative refractory temporal lobe epilepsy patients without major depressive disorder (nPDD), and 21 matched healthy controls (HC) were recruited from West China Hospital of SiChuan University from April 2016 to June 2017. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and 17-item Hamilton Depression Rating Scale were employed to confirm the diagnosis of major depressive disorder and assess the severity of depression. All participants underwent RS-fMRI scans using a 3.0T MRI system. MRI data were compared and analyzed using the amplitude of low-frequency fluctuations (ALFF) and regional homogeneity (ReHo) to measure spontaneous brain activity. These two methods were both used to evaluate spontaneous cerebral activity. RESULTS The PDD group showed significantly altered spontaneous brain activity in the bilateral mesial prefrontal cortex, precuneus, angular gyrus, right parahippocampal gyrus, and right temporal pole. Meanwhile, compared with HC, the nPDD group demonstrated altered spontaneous brain activity in the temporal neocortex but no changes in mesial temporal structures. CONCLUSION The PDD group showed regional brain activity alterations in the prefrontal-limbic system and dysfunction of the default mode network. The underlying pathophysiology of PDD may be provided for further studies.
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Affiliation(s)
- Xi Zhu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Zhongqiong He
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China (UESTC), Chengdu, China
| | - Cheng Luo
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China (UESTC), Chengdu, China
| | - Xiangmiao Qiu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Shixu He
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Anjiao Peng
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Lin Zhang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Lei Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China.
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Muhlhofer W, Tan Y, Mueller SG, Knowlton R. MRI
‐negative temporal lobe epilepsy—What do we know? Epilepsia 2017; 58:727-742. [DOI: 10.1111/epi.13699] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2017] [Indexed: 01/01/2023]
Affiliation(s)
- Wolfgang Muhlhofer
- University of California San Francisco (UCSF) San Francisco California U.S.A
- University of Alabama Birmingham (UAB) Birmingham Alabama U.S.A
| | - Yee‐Leng Tan
- University of California San Francisco (UCSF) San Francisco California U.S.A
- National Neuroscience Institute Singapore Singapore
| | - Susanne G. Mueller
- University of California San Francisco (UCSF) San Francisco California U.S.A
- Center for Imaging of Neurodegenerative Diseases (CIND) San Francisco California U.S.A
- Department of Radiology UCSF San Francisco CaliforniaU.S.A
| | - Robert Knowlton
- University of California San Francisco (UCSF) San Francisco California U.S.A
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Tract-specific atrophy in focal epilepsy: Disease, genetics, or seizures? Ann Neurol 2017; 81:240-250. [DOI: 10.1002/ana.24848] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 11/29/2016] [Accepted: 12/11/2016] [Indexed: 12/13/2022]
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Cho JW, Hong SB, Lee JH, Kang JW, Lee MJ, Lee JY, Park HS, Suh M, Joo EY, Seo DW. Contralateral hyperperfusion and ipsilateral hypoperfusion by ictal SPECT in patients with mesial temporal lobe epilepsy. Epilepsy Res 2010; 88:247-54. [DOI: 10.1016/j.eplepsyres.2009.12.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2009] [Revised: 11/30/2009] [Accepted: 12/10/2009] [Indexed: 11/16/2022]
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