Ahmad Rida, Maiworm Michelle, Nöth Ulrike, Seiler Alexander, Hattingen Elke, Steinmetz Helmuth, Rosenow Felix, Deichmann Ralf, Wagner Marlies, Gracien René-Maxime
Department of Neurology, Goethe University, Frankfurt/Main, Germany.
Department of Neuroradiology, Goethe University, Frankfurt/Main, Germany.
J Magn Reson Imaging. 2020 Dec;52(6):1783-1789. doi: 10.1002/jmri.27184. Epub 2020 May 7.
In epilepsy patients with focal cortical dysplasia (FCD) as the epileptogenic focus, global cortical signal changes are generally not visible on conventional MRI. However, epileptic seizures or antiepileptic medication might affect normal-appearing cerebral cortex and lead to subtle damage.
To investigate cortical properties outside FCD regions with T -relaxometry.
Prospective study.
Sixteen patients with epilepsy and FCD and 16 age-/sex-matched healthy controls.
FIELD STRENGTH/SEQUENCE: 3T, fast spin-echo T -mapping, fluid-attenuated inversion recovery (FLAIR), and synthetic T -weighted magnetization-prepared rapid acquisition of gradient-echoes (MP-RAGE) datasets derived from T -maps.
Reconstruction of the white matter and cortical surfaces based on MP-RAGE structural images was performed to extract cortical T values, excluding lesion areas. Three independent raters confirmed that morphological cortical/juxtacortical changes in the conventional FLAIR datasets outside the FCD areas were definitely absent for all patients. Averaged global cortical T values were compared between groups. Furthermore, group comparisons of regional cortical T values were performed using a surface-based approach. Tests for correlations with clinical parameters were carried out.
General linear model analysis, permutation simulations, paired and unpaired t-tests, and Pearson correlations.
Cortical T values were increased outside FCD regions in patients (83.4 ± 2.1 msec, control group 81.4 ± 2.1 msec, P = 0.01). T increases were widespread, affecting mainly frontal, but also parietal and temporal regions of both hemispheres. Significant correlations were not observed (P ≥ 0.55) between cortical T values in the patient group and the number of seizures in the last 3 months or the number of anticonvulsive drugs in the medical history.
Widespread increases in cortical T in FCD-associated epilepsy patients were found, suggesting that structural epilepsy in patients with FCD is not only a symptom of a focal cerebral lesion, but also leads to global cortical damage not visible on conventional MRI.
21 TECHNICAL EFFICACY STAGE: 3 J. MAGN. RESON. IMAGING 2020;52:1783-1789.
在以局灶性皮质发育不良（FCD）为致痫灶的癫痫患者中，常规MRI上通常看不到全脑皮质信号变化。然而，癫痫发作或抗癫痫药物可能会影响外观正常的大脑皮质并导致细微损伤。
采用T2弛豫测量法研究FCD区域以外的皮质特性。
前瞻性研究。
16例患有癫痫和FCD的患者以及16例年龄和性别匹配的健康对照者。
场强/序列：3T，快速自旋回波T2映射、液体衰减反转恢复（FLAIR）以及从T2映射导出的合成T1加权磁化准备快速梯度回波采集（MP-RAGE）数据集。
基于MP-RAGE结构图像重建白质和皮质表面，以提取皮质T2值，排除病变区域。三名独立评估者确认，所有患者在FCD区域以外的常规FLAIR数据集中绝对不存在形态学上的皮质/皮质下变化。比较两组之间的平均全脑皮质T2值。此外，使用基于表面的方法对区域皮质T2值进行组间比较。进行与临床参数的相关性测试。
一般线性模型分析、置换模拟、配对和非配对t检验以及Pearson相关性分析。
患者FCD区域以外的皮质T2值升高（83.4±2.1毫秒，对照组81.4±2.1毫秒，P = 0.01）。T2升高广泛存在，主要影响双侧半球的额叶，也影响顶叶和颞叶区域。在患者组的皮质T2值与过去3个月内的癫痫发作次数或病史中的抗惊厥药物数量之间未观察到显著相关性（P≥0.55）。
发现FCD相关癫痫患者的皮质T2广泛升高，这表明FCD患者的结构性癫痫不仅是局灶性脑病变的症状，还会导致常规MRI上不可见的全脑皮质损伤。
21 技术疗效阶段：3 《磁共振成像杂志》2020年；52:1783 - 1789。
