SUrface-PRojected FLuid-Attenuation-Inversion-Recovery Analysis: A Novel Tool for Advanced Imaging of Epilepsy

Area of Science:

• Neuroimaging
• Epilepsy Research
• Medical Diagnostics

Background:

• Subtle cortical signal hyperintensities can indicate the epileptogenic zone (EZ) in epilepsy.
• Accurate localization of the EZ is crucial for successful surgical treatment.
• Conventional MRI may fail to detect subtle abnormalities in some epilepsy cases.

Purpose of the Study:

• To describe and evaluate the Surface-Projected Fluid-Attenuation-Inversion-Recovery (SUPR-FLAIR) analysis.
• To assess the utility of SUPR-FLAIR in identifying subtle cortical signal hyperintensities.
• To determine the accuracy of SUPR-FLAIR in localizing the epileptogenic zone (EZ) in drug-resistant partial epilepsy.

Main Methods:

• Retrospective analysis of MRI scans from 101 healthy controls and 10 epilepsy patients.
• Reconstruction of the brain surface from 3D T1-weighted fast field echo (T1W-FFE) scans.
• Projection of normalized turbo spin echo FLAIR intensity values onto the brain surface for surface-based analysis.

Main Results:

• SUPR-FLAIR analysis successfully localized the first positive lower P value cluster (PLPC) peak within the resection zone (RZ) in all patients.
• All patients achieved seizure freedom post-surgery, suggesting the RZ encompassed the EZ.
• SUPR-FLAIR analysis demonstrated 100% sensitivity in correctly aligning with the EZ.

Conclusions:

• SUPR-FLAIR analysis is a sensitive, noninvasive technique for defining the EZ in epilepsy.
• This method is particularly valuable in cases with negative MRI findings.
• SUPR-FLAIR may reduce the need for invasive electroencephalography and refine surgical planning.