Correlating Resting-State Functional Magnetic Resonance Imaging Connectivity by Independent Component Analysis-Based Epileptogenic Zones with Intracranial Electroencephalogram Localized Seizure Onset Zones and Surgical Outcomes in Prospective Pediatric Intractable Epilepsy Study
Correlating Resting-State Functional Magnetic Resonance Imaging Connectivity by Independent Component Analysis-Based Epileptogenic Zones with Intracranial Electroencephalogram Localized Seizure Onset Zones and Surgical Outcomes in Prospective Pediatric Intractable Epilepsy Study
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DOI：
10.1089/brain.2016.0479
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发表时间：
2017-09-01
影响因子：
3.4
通讯作者：
Curry, Daniel J.
中科院分区：
文献类型：
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作者：
Boerwinkle, Varina L.;Mohanty, Deepankar;Curry, Daniel J.
本研究的目的是前瞻性地研究静息态功能磁共振成像（rs-fMRI）定位致痫灶（EZ）与颅内脑电图（ic-EEG）识别癫痫发作灶（SOZ）之间的一致性，并采用新的rs-fMRI异常独立成分（IC）鉴别和分级标准在一个大的连续异质性小儿难治性癫痫人群中，没有先验的替代方式通知EZ定位或总SOZ数量的事先声明。EZ确定标准是通过在rs-fMRI上使用独立成分分析（伊卡）在350名儿科患者的初始队列中进行3年内的癫痫手术评估而制定的。随后，将这些rs-fMRI EZ标准前瞻性应用于40例接受ic-EEG进行SOZ识别的患者的评价队列。其中37例患者对被认为是癫痫发作主要来源的区域进行了手术切除/断开。术后收集1年癫痫发作频率。在评价的40例患者中，rs-fMRI EZ和ic-EEG SOZ之间的一致性为90%（36/40; 95%置信区间[CI]，0.76-0.97）。在37例手术破坏癫痫主要来源区域的患者中，27例（73%）rs-fMRI EZ可归类为真阳性，7例（18%）假阳性，2例（5%）假阴性。rs-fMRI EZ的敏感性为93%（95%CI 78-98%），阳性预测值为79%（95%CI，63-89%）。在隐源性定位相关癫痫患者中，rs-fMRI EZ和ic-EEG SOZ之间的一致性为8/9%（8/9; 95%CI，0.52-99），隐源性和症状性定位相关癫痫亚组之间的一致性无统计学显著差异。2名ic-EEG阴性的儿童移除了rs-fMRI EZ，术后1年无癫痫发作。在33例至少有1个rs-fMRI EZ与ic-EEG SOZ一致的患者中，24%的患者在切除区域外至少有1个额外的rs-fMRI EZ。在这些未切除rs-fMRI EZ的患者中，75%在1年后继续癫痫发作。相反，在rs-fMRI与ic-EEG SOZ一致且没有解剖学上独立的rs-fMRI EZ的75%的患者中，只有24%的患者在1年后继续癫痫发作。外源性rs-fMRI EZ与癫痫发作结局之间的关系具有统计学显著性（p=0.01）。rs-fMRI EZ手术破坏与术后癫痫结局显著相关。前瞻性研究的难治性癫痫儿童人群提供了使用静息状态伊卡分级标准的证据，以确定rs-fMRI EZ，如主要作者（V.L.B.）所开发的。这是该人群中的高产率试验，因为在研究期间不需要发生癫痫发作或特定的发作间期癫痫样活动。因此，通过该技术检测的rs-fMRI EZ可能为该人群的癫痫手术评估和计划提供信息。独立于其他脑功能测试模式，如同步EEG-fMRI或电源成像，rs-fMRI定位EZ的异常IC的上下文排名与SOZ定位的金标准相关，ic-EEG，在广泛的儿科癫痫手术候选人，包括那些隐源性癫痫。
The purpose of this study was to prospectively investigate the agreement between the epileptogenic zone(s) (EZ) localization by resting-state functional magnetic resonance imaging (rs-fMRI) and the seizure onset zone(s) (SOZ) identified by intracranial electroencephalogram (ic-EEG) using novel differentiating and ranking criteria of rs-fMRI abnormal independent components (ICs) in a large consecutive heterogeneous pediatric intractable epilepsy population without an a priori alternate modality informing EZ localization or prior declaration of total SOZ number. The EZ determination criteria were developed by using independent component analysis (ICA) on rs-fMRI in an initial cohort of 350 pediatric patients evaluated for epilepsy surgery over a 3-year period. Subsequently, these rs-fMRI EZ criteria were applied prospectively to an evaluation cohort of 40 patients who underwent ic-EEG for SOZ identification. Thirty-seven of these patients had surgical resection/disconnection of the area believed to be the primary source of seizures. One-year seizure frequency rate was collected postoperatively. Among the total 40 patients evaluated, agreement between rs-fMRI EZ and ic-EEG SOZ was 90% (36/40; 95% confidence interval [CI], 0.76-0.97). Of the 37 patients who had surgical destruction of the area believed to be the primary source of seizures, 27 (73%) rs-fMRI EZ could be classified as true positives, 7 (18%) false positives, and 2 (5%) false negatives. Sensitivity of rs-fMRI EZ was 93% (95% CI 78-98%) with a positive predictive value of 79% (95% CI, 63-89%). In those with cryptogenic localization-related epilepsy, agreement between rs-fMRI EZ and ic-EEG SOZ was 89% (8/9; 95% CI, 0.52-99), with no statistically significant difference between the agreement in the cryptogenic and symptomatic localization-related epilepsy subgroups. Two children with negative ic-EEG had removal of the rs-fMRI EZ and were seizure free 1 year postoperatively. Of the 33 patients where at least 1 rs-fMRI EZ agreed with the ic-EEG SOZ, 24% had at least 1 additional rs-fMRI EZ outside the resection area. Of these patients with un-resected rs-fMRI EZ, 75% continued to have seizures 1 year later. Conversely, among 75% of patients in whom rs-fMRI agreed with ic-EEG SOZ and had no anatomically separate rs-fMRI EZ, only 24% continued to have seizures 1 year later. This relationship between extraneous rs-fMRI EZ and seizure outcome was statistically significant (p=0.01). rs-fMRI EZ surgical destruction showed significant association with postoperative seizure outcome. The pediatric population with intractable epilepsy studied prospectively provides evidence for use of resting-state ICA ranking criteria, to identify rs-fMRI EZ, as developed by the lead author (V.L.B.). This is a high yield test in this population, because no seizure nor particular interictal epilepiform activity needs to occur during the study. Thus, rs-fMRI EZ detected by this technique are potentially informative for epilepsy surgery evaluation and planning in this population. Independent of other brain function testing modalities, such as simultaneous EEG-fMRI or electrical source imaging, contextual ranking of abnormal ICs of rs-fMRI localized EZs correlated with the gold standard of SOZ localization, ic-EEG, across the broad range of pediatric epilepsy surgery candidates, including those with cryptogenic epilepsy.