High Resolution Magnetic Resonance Imaging and Spectroscopy of Epilepsy at 7T

描述（由申请人提供）：神经外科可能是15%-30%的癫痫患者对药物治疗无效的唯一选择。由于良好的软组织对比度和高分辨率的可视化脑解剖结构，磁共振成像（MRI）在术前定位和表征癫痫手术患者的脑异常中起着至关重要的作用。7 T（7 T）MR有可能成为一种强大的无创工具，用于：1）增加致癫痫异常的显著性，从而提高检测效率并减少侵入性电生理评价的使用; 2）提供更准确的病变边界描绘，有助于神经外科计划并改善患者结局。不幸的是，多个技术问题，包括主磁场和施加的RF场的不均匀性以及所选体积中的频率依赖性空间偏移，导致成像和光谱学的伪影，限制了当前高场扫描仪的实用性。我们的目标是设计创新的RF脉冲和脉冲序列，以克服这些限制，以充分利用信噪比和新的对比机制提供的高场MR磁铁成像和光谱癫痫。具体而言，我们的目标是：1）开发用于7 T脑部高分辨率结构MR成像的工具，2）开发用于7 T内侧颞叶高空间分辨率质子光谱成像的工具，3）联合收割机将这些工具组合成一个全面的7 T癫痫成像方案，我们将在一项针对癫痫患者的试点研究中对该方案进行评估，这些患者是手术干预的候选人。 我的职业目标是建立一个独立的研究项目，专注于高场神经成像和光谱学的MR技术开发，以改善神经系统疾病的诊断，治疗和监测，并促进我们对健康大脑的理解。我的职业发展计划包括获得识别临床需求和开发新MR技术以满足这些需求的专业知识。作为培训，我将扩大我的神经科学背景，重点是神经系统疾病的病理生理学，特别是癫痫。此外，我将获得成为一名成功的独立调查员所需的必要科学管理技能。斯坦福大学提供了一套完整的物理和智力资源，以及获得这种培训所需的全面合作的研究环境。在该奖项的独立阶段，我将有机会继续开发创新的MR技术和患者评估，同时建立自己的研究计划。作为一名独立研究者，我将奋进通过在磁共振成像领域进行临床相关研究，对神经系统疾病和障碍患者的护理产生根本性影响。 公共卫生相关性：癫痫对美国近300万人产生不利影响。其中15%-30%的人对药物治疗没有反应，可能需要手术干预。使用超高场MR扫描仪（例如在7特斯拉下操作的扫描仪）对大脑进行高分辨率磁共振成像（MRI）和波谱分析（MRS），有可能显著改善癫痫发作源的术前定位，从而提高患有这种疾病的患者的医疗保健和生活质量。在这项工作中，我们建议开发一些创新的技术，以克服与7特斯拉MRI和MRS和联合收割机这些技术，以创建一个全面的7特斯拉癫痫成像协议相关的技术限制。

DESCRIPTION (provided by applicant): Neurosurgery may be the only option for the 15%-30% of people suffering from epilepsy who are refractory to drug therapy. Due to excellent soft tissue contrast and high-resolution visualization of brain anatomy, magnetic resonance imaging (MRI) plays a vital role in the preoperative localization and characterization of brain abnormalities for patients undergoing epilepsy surgery. 7 Tesla (7T) MR has the potential to be a powerful noninvasive tool to 1) in- crease conspicuity of epileptogenic abnormalities resulting in improved detection efficiency and reduced use of invasive electrophysiological evaluation and 2) provide more accurate delineation of lesion boundaries aiding in neurosurgical planning and leading to better patient outcomes. Unfortunately, multiple technical issues including inhomogeneity of the main magnetic and applied RF fields as well as frequency-dependent spatial shifts in the selected volume, result in artifacts for imaging and spectroscopy, limiting the utility of current high-field scanners. Our objective is to design innovative RF pulses and pulse sequences to overcome these limitations in order to fully utilize the signal-to-noise ratio and novel contrast mechanisms offered by high-field MR magnets for imaging and spectroscopy of epilepsy. Specifically, we aim to 1) develop tools for high-resolution structural MR imaging of the brain at 7T, 2) develop tools for high spatial-resolution proton spectroscopic imaging of the medial temporal lobe at 7T and 3) combine these tools to com- pose a comprehensive 7T epilepsy imaging protocol which we will evaluate in a pilot study of epilepsy patients who are candidates for surgical intervention. My career goal is to establish an independent research program focused on MR technique development for high- field neuroimaging and spectroscopy to improve diagnosis, treatment and monitoring of neurological diseases as well as advance our understanding of the healthy brain. My career development plan includes gaining expertise in identifying clinical needs and developing new MR technologies to meet these needs. As training, I will expand my background in neuroscience, with a focus on pathophysiology of neurological diseases, particularly epilepsy. In addition, I will acquire the necessary scientific management skills required to become a successful independent investigator. Stanford University offers the complete set of physical and intellectual resources as well as a thoroughly collaborative research environment required to obtain this training. During the independent phase of this award, I will have the opportunity to continue development of innovative MR technology and evaluation in patients, while building my own research program. As an independent investigator, I will endeavor to make a fundamental impact on the care of patients with neurological diseases and disorders through the pursuit of clinically relevant research in the field of magnetic resonance imaging. PUBLIC HEALTH RELEVANCE: Epilepsy adversely affects almost 3 million people in the United States. 15%-30% of these individuals do not respond to medication and may be candidates for surgical intervention. High-resolution magnetic resonance imaging (MRI) and spectroscopy (MRS) of the brain using ultrahigh-field MR scanners, such as those operating at 7 Tesla, have the potential to provide significant improvement in the preoperative localization of the source of seizures and, as a result, enhance healthcare and quality of life for those suffering from this disease. In this work, we propose to develop some innovative techniques to overcome the technical limitations associated with 7 Tesla MRI and MRS and combine these techniques to create a comprehensive 7 Tesla epilepsy imaging protocol.