Li Xin, Wang Zhongyuan, Chen Qian, Wang Xiaoyun, Qing Zhao, Zhang Wen, Lu Jiaming, Wang Junxia, Zhang Xin, Liu Jiani, Wang Zhengge, Li Baoxin, Zhang Bing
Department of Radiology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China.
Department of Neurology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.
Front Neurosci. 2021 Mar 31;15:640016. doi: 10.3389/fnins.2021.640016. eCollection 2021.
We aimed to determine the alterations in the subcortical structures of patients with idiopathic generalized epilepsy with tonic-clonic seizures (IGE-GTCS) MRI volumetry and vertex-based shape analysis and to evaluate the relationships between MRI measures and drug responses. In a follow-up sample of 48 patients with IGE-GTCS and 48 matched normal controls (NCs), high-resolution 3D TWI was performed at baseline. After 1 year of follow-up, 31 patients were classified as seizure free (SF) and 17 as drug resistant (DR). The volumes of subcortical structures were extracted, and vertex-based shape analysis was performed using FSL-Integrated Registration and Segmentation Toolbox (FSL-FIRST). Comparisons among groups were calculated adjusting for covariates [age, sex, and intracranial volume (ICV)]. Analysis of the relationships among imaging biomarkers along with frequency and duration was assessed using partial correlations. The differential imaging indicators were used as features in a linear support vector machine (LSVM). The DR group displayed significant regional atrophy in the volume of the left amygdala compared with NCs ( = 0.004, false discovery rate corrected) and SF patients ( = 0.029, uncorrected). Meanwhile, vertex-based shape analysis showed focal inward deformation in the basolateral subregion of the left amygdala in DR compared with the results for SF and NC ( < 0.05, FWE corrected). There were significant correlations between the volume changes and seizure frequency ( = -0.324, = 0.030) and between shape ( = -0.438, = 0.003) changes and seizure frequency. Moreover, the volume of the left thalamus in the DR group was significantly correlated with seizure frequency ( = -0.689, = 0.006). The SVM results revealed areas under the receiver operating characteristic curve of 0.82, 0.68, and 0.88 for the classification between SF and DR, between SF and NC, and between DR and NC, respectively. This study indicates the presence of focal atrophy in the basolateral region of the left amygdala in patients with IGE drug resistance; this finding may help predict drug responses and suggests a potential therapeutic target.
我们旨在通过MRI容积测量和基于顶点的形状分析来确定伴有强直阵挛发作的特发性全身性癫痫（IGE-GTCS）患者皮质下结构的改变，并评估MRI测量值与药物反应之间的关系。在一个由48例IGE-GTCS患者和48例匹配的正常对照（NC）组成的随访样本中，在基线时进行了高分辨率3D TWI检查。随访1年后，31例患者被分类为无癫痫发作（SF），17例为耐药（DR）。提取皮质下结构的体积，并使用FSL集成配准和分割工具箱（FSL-FIRST）进行基于顶点的形状分析。计算组间比较时对协变量[年龄、性别和颅内体积（ICV）]进行了校正。使用偏相关分析成像生物标志物之间以及发作频率和持续时间之间的关系。将差异成像指标用作线性支持向量机（LSVM）中的特征。与NC相比，DR组左侧杏仁核体积显示出显著的局部萎缩（ = 0.004，经错误发现率校正），与SF患者相比也有萎缩（ = 0.029，未校正）。同时，基于顶点的形状分析显示，与SF和NC的结果相比，DR组左侧杏仁核基底外侧亚区域有局灶性向内变形（ < 0.05，经FWE校正）。体积变化与发作频率之间存在显著相关性（ = -0.324， = 0.030），形状变化（ = -0.438， = 0.003）与发作频率之间也存在显著相关性。此外，DR组左侧丘脑体积与发作频率显著相关（ = -0.689， = 0.006）。SVM结果显示，SF与DR、SF与NC、DR与NC分类的受试者工作特征曲线下面积分别为0.82、0.68和0.88。本研究表明IGE耐药患者左侧杏仁核基底外侧区域存在局灶性萎缩；这一发现可能有助于预测药物反应，并提示一个潜在的治疗靶点。
