High Field Neuroimaging of Epilepsy

描述(由申请人提供)：本项目的总体目标是确定4T的1H MRI/MRS在部分性癫痫中定位致痫灶的能力，并预测癫痫手术的结果。这项申请提出了一种持续的努力，通过使用最先进的神经成像技术对顽固性部分癫痫进行更好的术前定位，来改善癫痫手术的结果。具体地说，我们将使用4特斯拉扫描仪确定MRI(结构、动脉自旋灌注和扩散张量成像)和MRS(单体素和3D)成像对难治性癫痫诊断评估的预测‘附加值’，该扫描仪将针对神经退行性疾病的研究进行优化。该项目将研究非皮损性、单灶性、难治性、局部性癫痫患者。这些技术将针对两组正在接受癫痫手术的顽固性癫痫患者(为期5年)：1)有或没有MRI证据的内侧颞叶癫痫患者(n=80)，2)非皮损新皮质癫痫患者(可能包括皮质畸形)(n=80)。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)对于内侧颞叶或新皮质区域的难治性复杂部分性癫痫患者，4T的结构、灌注、扩散和MRS成像将比1.5T的常规MRI更敏感地测量癫痫的偏侧化/定位；2)对于这两组患者，4T的MRI和MRS测量与视频/EEG遥测的定侧化一致的术后结果将明显好于不一致的患者。所有研究将以系统的、前瞻性的、盲目的和对照的方式进行，以预测对癫痫手术反应最好的患者。这些研究的意义在于，在高场强下使用新开发的MRI和MRS技术将改善癫痫手术结果，并将减少难治性癫痫患者不必要的手术。

DESCRIPTION (provided by applicant): The overall goal of this project is to determine the ability of 1H MRI/MRS at 4T to localize the epileptogenic focus in partial epilepsy and to predict the outcome of seizure surgery. This application proposes a continuing effort to improve the outcome of seizure surgery by better presurgical localization of intractable partial epilepsy using state of the art neuroimaging techniques. Specifically, we will determine the predictive 'Value added" of MRI (structural, arterial spin perfusion, and diffusion tensor imaging) and MRS (single voxel and 3D) imaging to the diagnostic evaluation of refractory epilepsy using a 4 Tesla scanner that will be optimized for investigation of neurodegenerative disease. This project will study patients with non-lesional, unifocal, medically refractory, localization related epilepsy. These techniques will be directed at two groups of patients with intractable epilepsy who are being evaluated for seizure surgery (numbers for 5 years): 1) patients with medial temporal lobe epilepsy with and without MRI evidence of mesial temporal sclerosis (n=80), 2) patients with non-lesional neocortical epilepsy (may include cortical malformations) (n=80). Post-operative surgical outcome will be analyzed in relation to the pre-operative neuroimaging findings. Hypotheses: 1) for patients with medically refractory complex partial seizures arising from either the medial temporal lobe or from neocortical regions, structural, perfusion, diffusion and MRS imaging at 4T will be a more sensitive measure of seizure lateralization/localization than conventional MRI performed at 1.5T; 2) for these two patient groups, MRI and MRS measures at 4T that are concordant with the lateralization by video/EEG telemetry will have significantly better post surgical outcomes than patients without concordance. All studies will be performed in a systematic, prospective, blinded, and controlled manner to predict the patients that respond best to seizure surgery. The significance of these studies is that the use of newly developed MRI and MRS techniques at high field strength will lead to improved epilepsy surgery outcomes and will reduce unnecessary surgery in patients with intractable epilepsy.