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A Multimodal Imaging- and Stimulation-based Method of Evaluating Connectivity-related Brain Excitability in Patients with Epilepsy
Published on: November 13, 2016
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Voxel-based morphometric MRI post-processing and PET/MRI co-registration reveal subtle abnormalities in cingulate
Ke Sun1, Zhiwei Ren1, Dongju Yang2
1Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
Epilepsy Research
|February 20, 2021
Summary
Advanced MRI post-processing and PET/MRI co-registration effectively identify subtle abnormalities in cingulate epilepsy (CE) patients with negative conventional MRI scans. Combining these techniques significantly improves presurgical evaluation for better surgical targeting.
Area of Science:
- Neurology
- Medical Imaging
- Epilepsy Surgery
Background:
- Cingulate epilepsy (CE) presents diagnostic challenges in presurgical evaluation due to heterogeneous semiology and non-localizing scalp EEG.
- Conventional MRI is often negative in CE, complicating the identification of seizure onset zones.
Purpose of the Study:
- To evaluate advanced neuroimaging techniques, specifically MRI post-processing using morphometric analysis program (MAP) and 18F-fluorodeoxyglucose-positron emission tomography-MRI (PET/MRI) co-registration, for patients with MRI-negative CE.
Main Methods:
- Retrospective analysis of 10 patients with MRI-negative CE who underwent surgical resection and were seizure-free for over 12 months.
- Application and comparison of MAP and PET/MRI co-registration with invasive EEG (iEEG) findings.
- Analysis of scalp EEG, magnetoencephalography (MEG), and pathological findings.
Main Results:
- MAP detected subtle abnormalities in 70% of patients, while PET/MRI co-registration identified focal hypometabolism in 50%.
- Combining MAP and PET/MRI co-registration improved detection rates to 90% for seizure onset zones.
- Pathology revealed various types of focal cortical dysplasia (FCD) in all patients.
Conclusions:
- MAP and PET/MRI co-registration are valuable tools for identifying subtle FCD in MRI-negative CE.
- The combination of these advanced imaging methods significantly enhances the detection of epileptic abnormalities for surgical planning.
- Routine incorporation of MAP and PET/MRI co-registration is recommended for presurgical evaluation in CE.
Keywords:
Cingulate epilepsyFocal cortical dysplasiaInvasive electroencephalographyMagnetic resonance imagingMagnetoencephalographyMorphometric analysis programPET/MRI co-registration
