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

项目摘要： 概述：神经外科切除、消融和刺激可以治愈医学上 难治性癫痫（MRE），然而，成功的治疗取决于癫痫发作的精确定位 区域（SOZ）。立体脑电图（EEG）是确定SOZ的金标准， 植入许多颅内深度电极以检测癫痫样活动。不幸的是， 脑MRI上可见的病变，只有头皮EEG的粗略空间图来指导立体EEG 植入，导致电极位置不能明确确定SOZ。满足未满足的需求 临床需要一致和准确的立体脑电图指导，我们将开发创新的扩散MRI（dMRI） 编码范式，提供癫痫微结构病理学的特异性敏感性，并通过3D验证 组织学和高密度头皮和立体脑电图。 相关性：美国约有400，000例患者接受了MRE和非病变MRI。 指导和稀疏采样的立体脑电图，确定癫痫发作区的信心是非常 对这些非病变患者具有挑战性。如果我们在拟议的工作中取得成功， 识别大多数MRE患者的可能病变位置。通过这种方式，我们将增加 他们的可能性，一个明确的立体脑电图识别的SOZ，并使潜在的治愈 神经外科治疗选择，否则可能不可能。 方法：我们的方法是：1）开发和验证弥散MRI皮质纤维映射，用于检测 局灶性皮质发育不良内的皮质结构紊乱。2)测试扩散MRI皮质纤维是否 标测可以检测局灶性皮质发育不良; 3）测试弥散纤维束成像和功能性 连接性MRI可以预测癫痫发作的传播。具体来说，我们将使用这些MRI连接来预测 癫痫发作传播网络的可能皮质节点，以及 立体脑电图电极之间的癫痫样活动。 总结：提出的神经成像方法将改善SOZ和传播网络的定位 使更多的MRE患者能够通过神经外科手术得到更有效的治疗。

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.