From the Department of Neurology (H.W.L.), Ewha Womans University School of Medicine and Ewha Medical Research Institute, Seoul, Korea; and Departments of Neurology (H.W.L., P.F., H.B.), Diagnostic Radiology (H.W.L., J.A., X.P., F.T., M.N., R.T.C.), Biomedical Engineering (X.P., D.S., R.T.C.), Neurosurgery (H.B., D.D.S., R.T.C.), and Neurobiology (H.B.), Yale University School of Medicine, New Haven, CT.
Neurology. 2014 Dec 9;83(24):2269-77. doi: 10.1212/WNL.0000000000001068. Epub 2014 Nov 12.
The purpose of this study was to investigate functional connectivity (FC) changes in epileptogenic networks in intractable partial epilepsy obtained from resting-state fMRI by using intrinsic connectivity contrast (ICC), a voxel-based network measure of degree that reflects the number of connections to each voxel.
We measured differences between intrahemispheric- and interhemispheric-ICC (ICCintra-inter) that could reveal localized connectivity abnormalities in epileptogenic zones while more global network changes would be eliminated when subtracting these values. The ICCintra-inter map was compared with the seizure onset zone (SOZ) based on intracranial EEG (icEEG) recordings in 29 patients with at least 1 year of postsurgical follow-up. Two independent reviewers blindly interpreted the icEEG and fMRI data, and the concordance rates were compared for various clinical factors.
Concordance between the icEEG SOZ and ICCintra-inter map was observed in 72.4% (21/29) of the patients, which was higher in patients with good surgical outcome, especially in those patients with temporal lobe epilepsy (TLE) or lateral temporal seizure localization. Concordance was also better in the extratemporal lobe epilepsy than the TLE group. In 85.7% (18/21) of the cases, the ICCintra-inter values were negative in the SOZ, indicating decreased FC within the epileptic hemisphere relative to between hemispheres.
Assessing alterations in FC using fMRI-ICC map can help localize the SOZ, which has potential as a noninvasive presurgical diagnostic tool to improve surgical outcome. In addition, the method reveals that, in focal epilepsy, both intrahemispheric- and interhemispheric-FC may be altered, in the presence of both regional as well as global network abnormalities.
本研究旨在通过使用内在连通性对比（ICC），即一种反映每个体素连接数的基于体素的网络度测量方法，从静息态 fMRI 中研究耐药性部分性癫痫的致痫网络的功能连通性（FC）变化。
我们测量了半球内和半球间 ICC（ICCintra-inter）之间的差异，这可以揭示致痫区的局部连接异常，而当减去这些值时，更多的全局网络变化将被消除。将 ICCintra-inter 图与 29 例至少有 1 年术后随访的患者的颅内 EEG（icEEG）记录的致痫区（SOZ）进行比较。两位独立的审阅者对 icEEG 和 fMRI 数据进行了盲法解释，并比较了各种临床因素的一致性率。
在 72.4%（21/29）的患者中观察到 icEEG SOZ 与 ICCintra-inter 图之间的一致性，在手术效果良好的患者中更高，尤其是在颞叶癫痫（TLE）或外侧颞叶癫痫定位的患者中。在外侧颞叶癫痫患者中，一致性也更好。在 85.7%（18/21）的病例中，SOZ 中的 ICCintra-inter 值为负，表明癫痫半球内的 FC 降低，相对于半球间的 FC 降低。
使用 fMRI-ICC 图评估 FC 的改变有助于定位 SOZ，这可能成为一种非侵入性的术前诊断工具，以提高手术效果。此外，该方法表明，在局灶性癫痫中，无论是半球内还是半球间的 FC 都可能发生改变，存在区域性和全球性网络异常。
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