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Detection of regional metabolic alteration using 7T deuterium metabolic imaging in MRI-negative, 18FDG-PET-positive
Narjes Ahmadian1, Romy Buijs2, Mark Gosselink2
1Center for Image Sciences, University Medical Center Utrecht, Utrecht, Netherlands. n.ahmadian786@gmail.com.
Objective:
Identifying presumed epileptogenic region (PER) in MRI-negative epilepsy patients is crucial for successful surgical outcomes. This study aims to determine whether dynamic deuterium metabolic imaging (DMI) at 7Tesla can detect region-specific metabolic alterations in MRI-negative, 18FDG-PET-positive temporal-lobe epilepsy.
Methods:
Five drug-resistant MRI-negative, 18FDG-PET-positive epilepsy patients underwent dynamic DMI. 3D 2H FID-MRSI scans (11:44 min each) were acquired at 7T over ~ 100 min following oral [6,6'-2H2]glucose intake. Venous plasma glucose and 2H glucose atom percent enrichment (APE) were measured in blood samples taken during scanning. Plasma glucose and 2H-glucose APE were analyzed using a General Linear Model with Repeated measures. From DMI, brain 2H-glucose and 2H glutamate/glutamine levels were analyzed using a two-level linear mixed model (factors: time and tissue type) comparing the PER and contralateral (contra-PER), hippocampus and temporal pole regions.
Results:
Plasma glucose and 2H-Glucose (Glc) atom-percent excess rose within 40 min post ingestion and then stabilized. Brain 2H-Glc and 2H-glutamate/glutamine (Glx) increased over time (p < 0.001). For 2H-Glc, regional differences were small, with only a modest elevation in hippocampus-PER relative to temporal-contra (p = 0.04). In contrast, 2H-Glx showed clear regional variation (p < 0.001), with the highest levels in hippocampus-PER, significantly exceeding PER, Temporal-PER, and Temporal-Contra (p ≤ 0.01). These findings remained consistent when averaging the final four time points.
Conclusions:
Ultra-high-field DMI revealed elevated hippocampal glutamatergic turnover in MRI negative epilepsy patients, with the highest levels in the epileptogenic hippocampus. These findings indicate the presence of subtle metabolic alterations in hippocampal tissue, supporting the potential of DMI to capture pathophysiological changes that remain invisible to conventional imaging.
Insights
Dynamic deuterium metabolic imaging (DMI) detects metabolic changes in MRI-negative epilepsy. Elevated glutamatergic turnover in the epileptogenic hippocampus was observed, aiding in identifying the presumed epileptogenic region (PER).
Area of Science:
- Neuroimaging
- Metabolic Imaging
- Epilepsy Research
Background:
- Identifying the presumed epileptogenic region (PER) is critical for surgical success in MRI-negative epilepsy.
- Conventional imaging often fails to detect subtle metabolic alterations in these patients.
- Dynamic deuterium metabolic imaging (DMI) offers a novel approach to visualize brain metabolism.
Purpose of the Study:
- To evaluate the capability of 7Tesla dynamic deuterium metabolic imaging (DMI) in detecting metabolic alterations.
- To assess region-specific metabolic changes in MRI-negative, 18FDG-PET-positive temporal lobe epilepsy patients.
- To correlate DMI findings with the presumed epileptogenic region (PER).
Main Methods:
- Five drug-resistant, MRI-negative, 18FDG-PET-positive epilepsy patients underwent dynamic DMI at 7 Tesla.
- 3D 2H FID-MRSI scans were acquired over 100 minutes after oral [6,6'-2H2]glucose intake.
- Brain 2H-glucose and 2H-glutamate/glutamine levels were analyzed comparing the PER and contralateral regions.
Main Results:
- Brain 2H-glucose and 2H-glutamate/glutamine levels increased over time.
- 2H-glucose showed only modest regional differences, with slight elevation in the hippocampus-PER.
- 2H-glutamate/glutamine demonstrated significant regional variation, with highest levels in the hippocampus-PER.
Conclusions:
- Ultra-high-field DMI revealed elevated hippocampal glutamatergic turnover in MRI-negative epilepsy.
- The epileptogenic hippocampus showed the highest levels of 2H-glutamate/glutamine.
- DMI can detect subtle metabolic alterations in epilepsy, potentially aiding in identifying the PER.
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