High Field Neuroimaging of Epilepsy

描述（由申请人提供）：该项目的总体目标是确定1H MRI/MRS在4T时定位部分癫痫的致痫灶的能力，并预测癫痫手术的结果。本应用提出了一个持续的努力，通过更好的顽固性部分性癫痫的术前定位，使用最先进的神经成像技术，以提高癫痫手术的结果。具体而言，我们将确定MRI（结构、动脉自旋灌注和弥散张量成像）和MRS（单体素和3D）成像对难治性癫痫诊断评估的预测性“附加价值”，使用4特斯拉扫描仪将优化用于神经退行性疾病的研究。本项目将研究非病灶性、单灶性、医学难治性、局域性癫痫患者。这些技术将针对两组正在评估癫痫发作手术的顽固性癫痫患者（5年）：1)有或没有内侧颞叶硬化MRI证据的内侧颞叶癫痫患者（n=80）， 2)非病变性新皮质癫痫患者（可能包括皮质畸形）（n=80）。术后手术结果将根据术前神经影像学结果进行分析。假设：1)对于由内侧颞叶或新皮质区域引起的难治性复杂部分性癫痫患者，4T时的结构、灌注、扩散和MRS成像将比1.5T时的常规MRI成像更敏感地测量癫痫发作的偏侧/定位；2)对于这两组患者，4T MRI和MRS测量与视频/脑电图遥测侧化一致的患者术后预后明显优于不一致的患者。所有研究将以系统、前瞻性、盲法和控制的方式进行，以预测对癫痫发作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效果，并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.