MR spectroscopic imaging at 3 T and outcomes in surgical epilepsy.
MR spectroscopic imaging at 3 T and outcomes in surgical epilepsy.
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3T磁共振波谱成像与外科癫痫的预后
DOI：
10.1002/nbm.4492
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发表时间：
2021-06
影响因子：
2.9
通讯作者：
Hetherington HP
中科院分区：
文献类型：
--
作者：
Pan JW;Antony A;Tal A;Yushmanov V;Fong J;Richardson M;Schirda C;Bagic A;Gonen O;Hetherington HP
对于需要大体积覆盖的脑部疾病的光谱评估，对RF性能和场均匀性的要求很高。对于癫痫，这也是具有挑战性的，因为患者之间在位置、严重程度和解剖识别的细微程度上存在差异，并且倾向于涉及颞区。我们应用一种有针对性的方法来检查手术癫痫患者的大容量MR波谱成像（MRSI）的实用性，实施两步采集，包括覆盖额顶叶区域的3D采集和覆盖颞枕区域的连续平行两层Hadamard编码采集，TR/TE = 2000/40 ms和匹配的采集时间。在其各自区域中使用限制（静态，一阶/二阶）B 0匀场，来自颞叶两层Hadamard和额顶叶3D采集的肌酸的Cramér-Rao下限分别为8.1 ± 2.2%和6.3 ± 1.9%。将数据集合并，以在额叶、顶叶和上级颞叶至中颞枕叶区域上提供总计60 mm的轴向覆盖。我们在n = 27例术前癫痫患者和n = 20例对照中以标称400 mm 3体素分辨率应用这些采集。在对照组中，86.6 ± 3.2%的体素至少有50%的组织（白色+灰质，不包括CSF）符合光谱质量纳入标准。由于所有患者均在术后接受了至少1年的临床随访，因此所有患者的癫痫发作频率结局均可用。与对照组相比，患者的FreeSurfer MRI灰质分段区域中总代谢功能障碍分数（以Cr/NAA度量为特征）的MRSI测量值与术后结局具有显著的斯皮尔曼相关性。这一发现表明，在术后癫痫控制较差的患者中，代谢功能障碍的负担更大。
For the spectroscopic assessment of brain disorders that require large-volume coverage, the requirements of RF performance and field homogeneity are high. For epilepsy, this is also challenging given the inter-patient variation in location, severity and subtlety of anatomical identification and its tendency to involve the temporal region. We apply a targeted method to examine the utility of large-volume MR spectroscopic imaging (MRSI) in surgical epilepsy patients, implementing a two-step acquisition, comprised of a 3D acquisition to cover the fronto-parietal regions, and a contiguous parallel two-slice Hadamard-encoded acquisition to cover the temporal-occipital region, both with TR/TE = 2000/40 ms and matched acquisition times. With restricted (static, first/second-order) B0 shimming in their respective regions, the Cramér-Rao lower bounds for creatine from the temporal lobe two-slice Hadamard and frontal-parietal 3D acquisition are 8.1 ± 2.2% and 6.3 ± 1.9% respectively. The datasets are combined to provide a total 60 mm axial coverage over the frontal, parietal and superior temporal to middle temporal-occipital regions. We applied these acquisitions at a nominal 400 mm3 voxel resolution in n = 27 pre-surgical epilepsy patients and n = 20 controls. In controls, 86.6 ± 3.2% voxels with at least 50% tissue (white + gray matter, excluding CSF) survived spectral quality inclusion criteria. Since all patients were clinically followed for at least 1 year after surgery, seizure frequency outcome was available for all. The MRSI measurements of the total fractional metabolic dysfunction (characterized by the Cr/NAA metric) in FreeSurfer MRI gray matter segmented regions, in the patients compared with the controls, exhibited a significant Spearman correlation with post-surgical outcome. This finding suggests that a larger burden of metabolic dysfunction is seen in patients with poorer post-surgical seizure control.
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