1H AND 31P MRSI FOR EPILEPSY LOCALIZATION

这一应用的长期目标是通过使用包括磁共振成像(MRI)、1H和31P磁共振波谱成像(MRSI)和18F-PET在内的神经成像技术的组合，对难治性癫痫进行更好的术前定位，从而改善癫痫手术的结果。这些技术将针对三组难治性癫痫患者，他们正在接受癫痫手术评估(为期5年)：1)MRI不一致的内侧颞叶癫痫患者，即MRI未显示异常或EEG定义的癫痫灶对侧异常(NC-MTLE，n=75)；2)非皮质区新皮质癫痫患者(NE，n=100)；以及3)婴儿痉挛儿童(IS，n=100)。NC-MTLE和NE患者经常需要有创性脑电记录，手术后癫痫消失的概率不到50%，而且通常不考虑手术。手术后的结果将与手术前的神经影像检查结果进行对比分析。假设：1)NC-MTLE--患有难治性MTLE但MRI无一致性的患者，其1H和31P MRSI测量结果与EEG定位(即脑叶和侧部)一致的患者，术后预后明显好于无MRSI一致性的患者。(2)在MRI上无病变的NE-NE患者的1H和31P MRSI与EEG定位(即脑叶和脑侧)一致，且这种一致性大于18FDG-PET。2b)1H和31P MRSI测量与EEG定位一致的NE-NE患者术后预后明显好于MRSI不一致的患者。3A)IS-患有难治性婴儿痉挛的儿童的1H和31P磁共振成像与两项或两项以上检查(VET、18FDG-PET和/或MRI)确定的癫痫灶一致，这种一致性将大于MRI或18FDG-PET所提供的结果。3B)IS-IS患儿的1H和31P MRSI与其他临床和影像研究提供的定位相一致的患者的术后预后明显好于不符合的患者。这些研究有望改善顽固性癫痫患者的手术结果，减少不必要的手术。

The long term goal of this application is to improve the outcome of seizure surgery by better presurgical localization of medically refractory epilepsy using a combination of neuroimaging techniques including magnetic resonance imaging (MRI), 1H and 31P MR spectroscopic imaging (MRSI), and 18F-PET. These techniques will be directed at three groups with medically refractory epilepsy who are being evaluated for seizure surgery (numbers for 5 years): 1)patients with medial temporal lobe epilepsy in whom MRI is non-concordant i.e., MRI shows no abnormality, or an abnormality contralateral to the EEG-defined seizure focus (NC-mTLE, n=75), 2) patients with non-lesional neocortical epilepsy (NE, n=100), and 3) children with Infantile Spasms (IS, n=100). NC-mTLE and NE patients frequently require invasive EEG recording, have less than a 50 percent probability of becoming seizure free with surgery, and are often not considered for surgery. Post-operative surgical outcome will be analyzed in relation to the pre-operative neuroimaging findings. Hypotheses: 1) NC-mTLE -Patients with medically refractory mTLE without MRI concordance, who have 1H and 31P MRSI measures concordant with the EEG localization (i.e., lobe and side), will have a significantly better post surgical outcome than patients without MRSI concordance. 2a) NE - NE patients without lesions on MRI, will have 1H and 31P MRSI concordant with the EEG localization (i.e., lobe and side), and this concordance will be greater than that provided by 18FDG-PET. 2b) NE - NE patients, who have 1H and 31P MRSI measures concordant with the EEG localization will have a significantly better post surgical outcome than patients without MRSI concordance. 3a) IS - Children with medically refractory Infantile Spasms will have 1H and 31P MRSI concordant with the seizure focus determined by a combination of two or more studies (VET, 18FDG-PET, and/or MRI) and this concordance will be greater than that provided by MRI or 18FDG-PET. 3b) IS - IS children, who have 1H and 31P MRSI concordant with the localization provided by the other clinical and imaging studies will have a significantly better post surgical outcome than patients without such concordance. These studies are expected to lead to improved surgical outcome, and to reduce unnecessary surgery, in patients with intractable epilepsy.