Spectroscopic imaging of human epilepsy

描述（申请人提供）：接受颞叶手术治疗癫痫的患者1 - 2年癫痫发作自由相对较高的成功率（~70%+）表明，准确定位癫痫发作，相应的手术有效。虽然长期的成功存在明显的不确定性，但2年的时间框架清楚地表明，手术成功地切除了癫痫网络的一个关键节点，从而经常使更有效的药物治疗成为可能。然而，对于定位相关的癫痫，其发病不明显为颞叶（或内侧颞叶），1年时间框架内的成功率明显较低，例如，为25%。鉴于对定位相关癫痫的病理生理基础的了解，在这些更困难的病例中，关键步骤仍然是充分的定位和网络表征，磁共振光谱成像（MRSI）被认为具有潜在的敏感性，可以帮助解决这一定位问题。在这个项目中，我们将实施最初在7T开发的关键步骤，使核磁共振成像在临床领域（3特斯拉）用于癫痫发生位点和网络定位。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。目的1将从一大批（每年共n=60例，共240例）接受手术治疗的患者中获得一个强健的术前额-顶叶-颞部和颞-枕部mri数据集。mri异常区域将定义癫痫发作的候选区域，并与当前的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符号学分离的癫痫患者的几个亚组中进行，以评估这种方法在癫痫类型的充分抽样中。与MRI相比，Aim 2将评估全脑T1W和FLAIR MRI的结构成像异常，使用患者和对照组之间皮质厚度、白灰质对比和FLAIR强度的定量图。该目的将评估这些定量成像异常与mri确定的代谢功能障碍同步的程度。最后，在Aim 3中，使用ILAE分类，MRSI和定量成像分析癫痫发作定位的结论将与癫痫发作手术区域和术后2年的预后相关。由于这个项目，我们相信我们将评估大容量脑代谢MRSI评估在癫痫定位中的作用，并将其病理生理应用与结构成像相结合。本研究的健康相关性：核磁共振成像与定量结构成像分析相结合，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，并有望使这种复杂而高效的治疗策略更加现实，并可用于难治性癫痫患者。

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.