Spectroscopic imaging of human epilepsy

人类癫痫的光谱成像

• 批准号: 8812313
• 负责人: Jullie W Pan
• 金额: $ 62.03万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-01 至 2018-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8812313
• 关键词: Address; Agreement; Area; Biochemistry; Brain; Brain region; Classification; Clinical; Complex; Data; Data Quality; Data Set; Development; Disease Management; Electrodes; Electroencephalography; Epilepsy; Excision; Freedom; Functional disorder; Goals; Gray unit of radiation dose; Health; Human; Image; Image Analysis; Intractable Epilepsy; Joints; Lesion; Link; Localized Lesion; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Maps; Measures; Medial; Medical; Metabolic; Methods; New York; Occipital lobe; Operative Surgical Procedures; Outcome; Parietal; Partial Epilepsies; Patients; Performance; Refractory; Research Personnel; Resected; Resolution; Role; Sampling; Seizures; Site; Slice; Subgroup; System; Temporal Lobe; Temporal Lobe Epilepsy; Testing; Thick; Time; Tissues; Translations; Uncertainty; Universities; Work; base; brain metabolism; brain volume; cost; effective therapy; experience; gray matter; imaging modality; improved; insight; instrumentation; interest; magnetic field; public health relevance; spectroscopic imaging; success; symposium; treatment strategy

DESCRIPTION (provided by applicant): The relatively high success rates (~70%+) for 1 to 2 year seizure freedom in patients undergoing temporal lobe surgery for epilepsy indicate that with accurate localization of seizure onset, respective surgery works. While there are clearly uncertainties of longer term success, the 2 year timeframe argues clearly that the surgery successfully removed a key node of the seizure network, thus frequently enabling more effective medical therapy. However for localization-related epilepsies which are not clearly temporal lobe (or medial temporal lobe) in onset, the rates of success for the 1 year time frame are substantially less, e.g., at 25%. Given the understanding of the pathophysiological basis of localization related epilepsy, the key step in these more difficult cases remains adequate localization and network characterization MR spectroscopic imaging (MRSI) has been suggested to have the potential sensitivity to assist in this localization problem. In this projectwe will implement key steps originally developed at 7T to make MRSI clinically robust at a clinical field (3 Tesla) for epileptogenic locus and network localization. This will be performed at the University of Pittsburgh and New York University, both sites of which have the needed experience and collaborative interest in epilepsy and imaging. Aim 1 will result in a robust dataset of pre-operative fronto-parietal-temporal and temporal-occipital MRSI from a large group (a total of n=60 each year, 240 total) of surgically treated patients. The MRSI-abnormal regions will define candidate regions of seizure onset, to be compared against the current clinical localization paradigm and clinical outcome of seizure control. This will be done in several subgroups of epilepsy patients segregated based on lesion types and semiology to evaluate this approach in adequate sampling of epilepsy types. In comparison with the MRSI, Aim 2 will evaluate structural imaging abnormalities with whole brain T1W and FLAIR MRI using quantitative maps of cortical thickness, white-gray matter contrast and FLAIR intensities between patients and controls. This Aim will assess the extent to which these quantitative imaging abnormalities will be synchronous with MRSI-determined metabolic dysfunction. Finally in Aim 3, the conclusions of the MRSI and quantitative imaging analysis for localization of seizure onset will be correlated with region of seizure surgery and 2year post-surgical outcomes using ILAE classification. As a result of this project, we believe that we will have evaluated the role of extended volume brain metabolic MRSI evaluation for epilepsy localization and integrated its pathophysiological use with structural imaging. The health relatedness of this study: MRSI integrated with quantitative structural imaging analysis will be able to augment current seizure localization accuracy beyond the temporal lobe group. This may potentially improve outcome, reduce the cost of disease management, and hopefully make this complex yet highly effective treatment strategy more realistic and available to patients with medically refractory epilepsy.

描述（由申请人提供）：接受颞叶癫痫手术的患者1 - 2年无癫痫发作的成功率相对较高（约70%+），表明癫痫发作的准确定位，相应的手术有效。虽然长期成功存在明显的不确定性，但2年的时间框架清楚地表明，手术成功地去除了癫痫发作网络的关键节点，从而通常能够实现更有效的药物治疗。然而，对于发作时不明显位于颞叶（或内侧颞叶）的定位相关癫痫，1年时间范围内的成功率明显较低，例如，25%鉴于对定位相关癫痫的病理生理学基础的理解，在这些更困难的情况下，关键步骤仍然是充分的定位和网络表征MR光谱成像（MRSI）已被建议具有潜在的灵敏度，以帮助在这个定位问题。在这个项目中，我们将实施最初在7 T开发的关键步骤，使MRSI在临床领域（3特斯拉）的致痫位点和网络定位的临床稳健性。这将在匹兹堡大学和纽约大学进行，这两个地点在癫痫和成像方面都有必要的经验和合作兴趣。目标1将从一个大的手术治疗患者组（每年总共n=60，总共240）中获得术前额顶颞和颞枕MRSI的稳健数据集。MRI异常区域将定义癫痫发作的候选区域，与当前临床定位范例和癫痫控制的临床结果进行比较。这将在基于病变类型和症状学分离的癫痫患者的几个亚组中进行，以在癫痫类型的充分采样中评价该方法。与MRSI相比，Aim 2将使用患者和对照组之间的皮质厚度、白质-灰质对比度和FLAIR强度的定量图，评价全脑T1 W和FLAIR MRI的结构成像异常。该目的将评估这些定量成像异常与MRSI确定的代谢功能障碍同步的程度。最后，在目标3中，使用ILAE分类，将MRSI和定量成像分析的癫痫发作定位结论与癫痫发作手术区域和术后2年结局相关。作为这个项目的结果，我们相信，我们将评估的作用，扩大容量脑代谢MRSI评估癫痫定位和整合其病理生理学的使用与结构成像。本研究的健康相关性：MRSI结合定量结构成像分析将能够提高当前癫痫发作定位的准确性，超出颞叶组。这可能会潜在地改善结果，降低疾病管理的成本，并有望使这种复杂但高效的治疗策略更加现实，并可用于难治性癫痫患者。