Integration of Advanced Diffusion MRI and 3D Histology for Improved Neurosurgical Targeting

项目总结： 概述：神经外科手术切除、消融和刺激可以治愈内科患者。 然而，难治性癫痫(MRE)的成功治疗依赖于癫痫发作的准确定位。 区域(SOZ)。立体脑电(EEG)是确定SOZ的金标准，包括 植入多个颅内深部电极以检测癫痫样活动。不幸的是，通常没有 脑MRI上可见的病变和头皮EEG的粗略空间图来指导立体EEG 注入，导致电极位置无法确定SOZ。遇见未被满足的人 临床需要一致和准确的立体脑电引导我们将开发创新的弥散磁共振成像(DMRI) 对癫痫微结构病理提供特异性敏感性并通过3D验证的编码范例 组织学和高密度头皮及立体脑电。 相关性：在美国有大约40万名患有MRE和非病变MRI的患者。 立体脑电的引导和稀疏采样，极大地确定了癫痫发作的起始区 在这些非皮损患者中具有挑战性。如果我们在提议的工作中成功，我们将启用MRI 为大多数MRE患者确定可能的病变位置。通过这种方式，我们将增加 他们对SOZ的最终立体脑电识别的可能性，并使潜在的治愈 神经外科治疗的选择，否则可能是不可能的。 方法：我们的方法是：1)开发和验证弥散磁共振皮质纤维成像用于检测 局灶性皮质发育不良内皮质结构紊乱。2)检测是否有弥散磁共振皮质纤维 标测可以发现局灶性皮质发育不良和3)检测是否有弥漫性纤维束造影和功能性 连通性MRI可以预测癫痫的传播。具体地说，我们将使用这些MRI连接来预测 癫痫传播网络的可能皮层节点，以及潜伏期和空间传播 立体脑电电极之间的癫痫样活动。 摘要：建议的神经成像方法将改善SOZ和传播网络的定位 使更多的MRE患者能够更有效地接受神经外科手术治疗。

Project Summary: Overview: Neurosurgical resection, ablation and stimulation can be curative for patients with medically refractory epilepsy (MRE), however, successful treatment depends on precise localization of the seizure onset zone (SOZ). Stereo-electroencephalography (EEG) is the gold standard for determining the SOZ and involves implanting many intra-cranial depth electrodes to detect epileptiform activity. Unfortunately, there are often no visible lesions on brain MRI and only a crude spatial map from scalp-EEG to guide the stereo-EEG implantation, resulting in electrode positions that fail to definitively determine the SOZ. To meet the unmet clinical need for consistent and accurate stereo-EEG guidance we will develop innovative diffusion MRI (dMRI) encoding paradigms that provide specific sensitivity to epileptic microstructural pathology and validate with 3D histology and high-density scalp- and stereo-EEG. Relevance: There are ~400,000 patients with MRE and non-lesional MRI in the U.S. Given the lack of guidance and sparse sampling of stereo-EEG, identifying the seizure onset zone with confidence is extremely challenging for in these non-lesional patients. If we are successful in the proposed work, we will enable MRI identification of a probable lesion location for the majority of patients with MRE. In this way , we will increase their likelihood of a definitive stereo-EEG identification of the SOZ and enable a potentially curative neurosurgical treatment option that might not have been possible otherwise. Approach: Our approach is to: 1) Develop and validate diffusion MRI cortical fiber mapping for detection of the disrupted cortical architecture within focal cortical dysplasias. 2) Test whether diffusion MRI cortical fiber mapping can detect focal cortical dysplasias and 3) Test whether diffusion tractography and functional connectivity MRI can predict seizure propagation. Specifically, we will use these MRI connectivity to predict probable cortical nodes of the seizure propagation network, as well as, the latency and spatial propagation of epileptiform activity between stereo-EEG electrodes. Summary: The proposed neuroimaging methods will improve localization of the SOZ and propagation network enabling more patients with MRE to be treated more effectively with neurosurgery.