1H AND 31P MRSI FOR EPILEPSY LOCALIZATION

该项目的总体长期目标是改善 通过制定癫痫手术的改进方法进行治疗 癫痫灶的定位。已经清楚地证明，当 视频/EEF遥测(VET)与PET或MRI之间存在一致性， 患者通过癫痫手术缓解癫痫的预后有所改善 与不和谐的研究相比。不幸的是，大约50%的 患有颞叶癫痫(TLE)的患者中，70%的患者 新皮质癫痫(NE)的影像研究不一致。 利用MRS进行的初步研究表明，代谢 致痫区域的异常，其病灶由 提高PI和pH，降低NAA和PME。这些初步的 研究还表明，这些变化可以用来 准确预测癫痫发作侧(偏侧化) TLE的敏感性与PET相当或更好。这样做的目的是 应用是开发诊断措施的组合，这些诊断措施 最能预测手术结果。为了实现这一目标，兽医和三个 本研究中使用的成像方式(PET、MRI和MRSI)将 用于提供分类信息。我们将制定决策 确定哪些指标(例如，VET、pH、PI、PME、NAA、萎缩、 信号强度增加、代谢不足)或多种措施的组合 最能预测手术结果。预计：1)MRSI将 与MRI或PET相比，对于TLE，VET的一致性更好，2)最好 手术结果将与以下各项之间的最高一致性相关 所有形式，3)为致痫灶定义的异常 在TLE中也将适用于NE。 总而言之，这些结果将导致更有效的术前治疗。 对癫痫手术的评估，提供了极大改善的诊断 TLE和NE的评价方法

The overall long-term goal of this project is to improve the outcome of seizure surgery by the development of improved methods for the localization of seizure foci. It has clearly been demonstrated that when there is concordance between video/EEF telemetry (VET) and PET, or MRI, patients have an improved prognosis for seizure relief by seizure surgery compared to discordant studies. Unfortunately, approximately 50% of the patients with temporal lobe epilepsy (TLE), and 70% of the patients with neocortical epilepsy (NE) do not have concordant imaging studies. Preliminary studies utilizing MRS have demonstrated metabolic abnormalities in the epileptogenic zone with the focus defined by increased Pi and pH, and decreased NAA and PME. These preliminary studies have also demonstrated that these changes can be used to accurately predict the side of seizure onset (lateralization) with sensitivity in TLE as good as or better than PET. The goal of this application is to develop the combination of diagnostic measures which best predicts surgical outcome. To achieve this goal VET and the three imaging modalities employed in this study (PET, MRI, and MRSI) will be used to provide classification information. We will develop decision rules to determine which measures (e.g. VET, pH, Pi, PME, NAA, atrophy, increased signal intensity, hypometabolism) or combination of measures best predicts surgical outcome. It is expected that: 1) MRSI will provide better concordance with VET than MRI, or PET for TLE, 2) the best surgical outcome will be associated with the highest concordance between all modalities, 3) the abnormalities defined for the epileptogenic focus in TLE will also be true for NE. In conclusion, these results should lead to more effective preoperative evaluation for seizure surgery, providing a greatly improved diagnostic approach for evaluation of TLE & NE.