Functional MRI for Neurosurgical Planning in Epilepsy

描述（由申请人提供）：癫痫患者， 脑损伤的手术切除必须有某种形式的功能映射 以确定是否可以在不产生功能性损伤的情况下切除病变， 赤字目前对这些患者进行语言映射的程序是 空间有限（例如，半球映射与Wada测试）或高度 侵入性（使用硬膜下电极进行皮层刺激）。功能性mr 功能磁共振成像（fMRI）有可能取代或显着增强， 神经外科计划中使用的当前方法。它是非侵入性的， 能够定位大脑皮层的活动然而，标准回声 基于BOLD激活响应的平面成像fMR 1方法， 空间分辨率低，对静态Bo磁场敏感 导致图像失真和低信号强度的不均匀性。这些 这些问题严重限制了功能磁共振成像定位大脑活动的能力， 神经外科计划。这个项目有三个目标。首先，它旨在 改进功能磁共振成像方法。我们早期的工作已经确定了开发 在fMRI研究中最大化统计功效的单次激发方法， 方法学的发展将集中在单次拍摄成像方法上 失真和信号损失，包括非对称自旋回波的研究 EPI和动态匀场。这一创新计划将允许高度强大的 手术计划所需的功能定位，但方法是 可以应用于任何fMRI研究。第二，我们将继续我们的工作， 通过与Wada测试进行比较， 和皮层刺激。一组功能磁共振成像语言范例， 磁外行为研究，旨在解决特定的 在颞叶癫痫患者中获得的缺陷，这些将应用于 对照组和难治性癫痫患者， 手术的候选人。患者将接受成像和行为测试， 手术前后。通过这些研究，功能磁共振成像预测 将评估手术结果。最后，我们将研究 在疾病状态（内侧颞叶硬化、皮质畸形和 肿瘤）和语言重组急性（术前和术后）， 通过将语言组织和表现联系起来， 癫痫的类型、发病部位和发病年龄与手术密切相关。这项研究将 不仅提供了语言重组的证据， 皮质区域的重组，以及这种重组对 性能和手术结果。

Description (provided by applicant): Epilepsy patients who are candidates for surgical resection of a brain lesion must have some form of functional mapping to determine if the lesion can be removed without creating a functional deficit. The current procedures for mapping language in these patients are spatially limited (e.g. hemispheric mapping with Wada testing) or highly invasive (cortical stimulation using subdural electrodes). Functional MR imaging (fMRI) has the potential to replace, or significantly enhance, the current methods used in Neurosurgical planning. It is noninvasive and has been shown to be able to localize cortical activity. However, the standard echo planar imaging fMR1 methods, based on the BOLD activation response, suffer from low spatial resolution, and sensitivity to static Bo magnetic field inhomogeneities which lead to image distortions and low signal intensity. These problems severely limit the ability of fMRI to localize brain activity for Neurosurgical planning. This project has 3 aims. First, it is designed to improve fMRI methodology. Our earlier work has identified the need to develop single shot approaches to maximize statistical power in fMRI studies, and thus the methodology developments will focus on single shot approaches to image distortion and signal loss, including the investigation of asymmetric spin echo EPI and dynamic shimming. This innovative program will allow for highly robust functional localization required for surgical planning, but the methods to be developed may be applied to any fMRI study. Secondly, we will continue our work on validating the fMRI activation detected through comparison with Wada testing and cortical stimulation. A battery of fMRI language paradigms, parallel to out-of-magnet behavioral studies, have been designed to address the specific deficits obtained in temporal lobe epilepsy patients and these will be applied to both control subjects and patients with intractable epilepsy who are candidates for surgery. Patients will be imaged and tested behaviorally both pre and post- surgery. Through such studies the ability of fMRI to predict surgical outcome will be evaluated. Finally, we will examine the relationship between disease states (mesial temporal sclerosis, cortical malformations, and tumors) and language reorganization both acutely (pre- and post- surgery) and chronically by relating the language organization and performance prior to surgery, to the type, location, and age at onset of epilepsy. Such a study will provide evidence not only of language reorganization but also of the specific cortical regions that reorganize, and the impact this reorganization has on performance and surgical outcome.