Article
7 Tesla high resolution spectroscopic imaging (MRSI) may detect focal cortical dysplasia in intractable epilepsy patients as neuronavigation targets for epilepsy surgery
7 Tesla Multi-Voxel Spektroskopie in der Detektion von fokalen kortikalen Dysplasien in therapieresistenter Epilepsie als Hilfestellung für die navigationsgeführte Resektion
Search Medline for
Authors
Published: | June 4, 2021 |
---|
Outline
Text
Objective: Structural 7 Tesla MRI has proven to enhance the diagnostic yield of detecting focal cortical dysplasia in refractory epilepsy patients. The aim of our study was to investigate if high resolution MR spectroscopic imaging (MRSI) using 7 Tesla may improve the detection rate even further.
Methods: We measured 10 patients suffering from medically refractory epilepsy using MRSI covering the whole brain with 3.4mm isotropic resolution in 15 min. Quantification used a basis set of neurochemical components including Choline, Creatine, NAA, myo-Inositol, Glutamate and Glutamine.
Results: Different patient specific patterns of investigated metabolites were detected. Increased focal total choline and creatine activity was found in 3 patients, corresponding to suspected areas of focal cortical dysplasia in the structural images as well as being in accord with previous MRS studies. These findings correlated strongly to the suspected epileptogenic zone defined by electro-clinical investigations and PET imaging. Other metabolite findings differed between these three patients. Intraoperatively, a tailored resection of these MRSI choline areas using neuronavigation and electro-corticography (ECoG) in these 3 patients was successfully performed and FCD I and IIb histology verified. Patients are seizure free so far.
Conclusion: Choline mapping using 7 Tesla MRSI may contribute to identify FCDs in patients with intractable epilepsy and guide the resection when included in the intraoperative neuronavigation. The observed different metabolic patterns could lead to improved preoperative classification during further investigation.