Chen Cong, Xie Juan-Juan, Ding Fang, Jiang Ya-Si, Jin Bo, Wang Shan, Ding Yao, Li Hong, Jiang Biao, Zhu Jun-Ming, Ding Mei-Ping, Chen Zhong, Wu Zhi-Ying, Zhang Bao-Rong, Hsu Yi-Cheng, Lai Hsin-Yi, Wang Shuang
Department of Neurology and Epilepsy Center, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China.
Ther Adv Neurol Disord. 2021 Jun 8;14:17562864211021181. doi: 10.1177/17562864211021181. eCollection 2021.
We aimed to evaluate the diagnostic yield of seven-tesla (7T) magnetic resonance imaging (MRI) with post-processing of three-dimensional (3D) T1-weighted (T1W) images by the morphometric analysis program (MAP) in epilepsy surgical candidates whose 3T MRI results were inconclusive or negative.
We recruited 35 patients with pharmacoresistant focal epilepsy. A multidisciplinary team including an experienced neuroradiologist evaluated their seizure semiology, video-electroencephalography data, 3T MRI and post-processing results, and co-registered FDG-PET. Eleven patients had suspicious lesions on 3T MRI and the other 24 patients were strictly MRI-negative. 7T MRI evaluation was then performed to aid clinical decision. Among patients with pathologically proven focal cortical dysplasia (FCD) type II, signs of FCD were retrospectively evaluated in each MRI sequence (T1W, T2W, and FLAIR), and positive rates were analyzed in each MAP feature map (junction, extension, and thickness).
7T MRI evaluation confirmed the lesion in nine of the 11 (81.8%) patients with suspicious lesions on 3T MRI. It also revealed new lesions in four of the 24 (16.7%) strictly MRI-negative patients. Histopathology showed FCD type II in 11 of the 13 (84.6%) 7T MRI-positive cases. Unexpectedly, three of the four newly identified FCD lesions were located in the posterior quadrant. Blurred gray-white boundary was the most frequently observed sign of FCD, appearing on 7T T1W image in all cases and on T2W and FLAIR images in only about half cases. The 7T junction map successfully detected FCD (10/11) in more cases than the extension (1/11) and thickness (0/11) maps. The 3D T1W images at 7T exhibited superior cerebral gray-white matter contrast, more obviously blurred gray-white boundary of FCD, and larger and brighter positive zones in post-processing than 3T T1W images.
7T MRI with post-processing can enhance the detection of subtle epileptogenic lesions for MRI-negative epilepsy and may optimize surgical strategies for patients with focal epilepsy.
我们旨在评估在3T磁共振成像（MRI）结果不确定或为阴性的癫痫手术候选患者中，采用形态计量分析程序（MAP）对三维（3D）T1加权（T1W）图像进行后处理的7T磁共振成像（MRI）的诊断效能。
我们招募了35例药物难治性局灶性癫痫患者。一个包括经验丰富的神经放射科医生的多学科团队评估了他们的发作症状学、视频脑电图数据、3T MRI及后处理结果，并对FDG-PET进行了联合配准。11例患者在3T MRI上有可疑病变，另外24例患者MRI检查结果严格为阴性。然后进行7T MRI评估以辅助临床决策。在病理证实为II型局灶性皮质发育不良（FCD）的患者中，回顾性评估每个MRI序列（T1W、T2W和FLAIR）中FCD的征象，并分析每个MAP特征图（连接、延伸和厚度）中的阳性率。
7T MRI评估证实了11例3T MRI上有可疑病变的患者中的9例（81.8%）存在病变。它还在24例MRI检查结果严格为阴性的患者中的4例（16.7%）发现了新病变。组织病理学显示，13例7T MRI阳性病例中有11例（84.6%）为II型FCD。出乎意料的是，新发现的4例FCD病变中有3例位于后象限。灰白质边界模糊是FCD最常见的征象，在所有病例的7T T1W图像上均可见，在T2W和FLAIR图像上仅约半数病例可见。7T连接图比延伸图（1/11）和厚度图（0/11）能成功检测出更多例FCD（10/11）。与3T T1W图像相比，7T的3D T1W图像在大脑灰白质对比度方面表现更优，FCD的灰白质边界更明显模糊，后处理中的阳性区域更大且更亮。
采用后处理的7T MRI可提高对MRI阴性癫痫中细微致痫性病变的检测能力，并可能优化局灶性癫痫患者的手术策略。
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