致痫性结核与磁化率值的峰度增加相关：一项联合定量磁化率图和立体脑电图的初步研究。
Epileptogenic Tubers Are Associated with Increased Kurtosis of Susceptibility Values: A Combined Quantitative Susceptibility Mapping and Stereoelectroencephalography Pilot Study.
机构信息
From Developmental Neurosciences (A.C., K. Seunarine, R.J.P., M.M.T., J.H.C.), Great Ormond Street Institute of Child Health
Departments of Neurosurgery (A.C., K. Seunarine, R.J.P. M.M.T.).
出版信息
AJNR Am J Neuroradiol. 2023 Aug;44(8):974-982. doi: 10.3174/ajnr.A7929. Epub 2023 Jul 20.
BACKGROUND AND PURPOSE
Prior studies have found an association between calcification and the epileptogenicity of tubers in tuberous sclerosis complex. Quantitative susceptibility mapping is a novel tool sensitive to magnetic susceptibility alterations due to tissue calcification. We assessed the utility of quantitative susceptibility mapping in identifying putative epileptogenic tubers in tuberous sclerosis complex using stereoelectroencephalography data as ground truth.
MATERIALS AND METHODS
We studied patients with tuberous sclerosis complex undergoing stereoelectroencephalography at a single center who had multiecho gradient-echo sequences available. Quantitative susceptibility mapping and R2* values were extracted for all tubers on the basis of manually drawn 3D ROIs using T1- and T2-FLAIR sequences. Characteristics of quantitative susceptibility mapping and R2* distributions from implanted tubers were compared using binary logistic generalized estimating equation models designed to identify ictal (involved in seizure onset) and interictal (persistent interictal epileptiform activity) tubers. These models were then applied to the unimplanted tubers to identify potential ictal and interictal tubers that were not sampled by stereoelectroencephalography.
RESULTS
A total of 146 tubers were identified in 10 patients, 76 of which were sampled using stereoelectroencephalography. Increased kurtosis of the tuber quantitative susceptibility mapping values was associated with epileptogenicity (= .04 for the ictal group and = .005 for the interictal group) by the generalized estimating equation model. Both groups had poor sensitivity (35.0% and 44.1%, respectively) but high specificity (94.6% and 78.6%, respectively).
CONCLUSIONS
Our finding of increased kurtosis of quantitative susceptibility mapping values (heavy-tailed distribution) was highly specific, suggesting that it may be a useful biomarker to identify putative epileptogenic tubers in tuberous sclerosis complex. This finding motivates the investigation of underlying tuber mineralization and other properties driving kurtosis changes in quantitative susceptibility mapping values.
背景与目的
先前的研究发现结节性硬化症患者的结节内钙化与致痫性之间存在关联。定量磁敏感图是一种新型工具，可敏感地检测到组织钙化引起的磁化率变化。我们使用立体脑电图数据作为金标准，评估定量磁敏感图在识别结节性硬化症患者的潜在致痫性结节中的作用。
材料与方法
我们研究了在单一中心接受立体脑电图检查的结节性硬化症患者，这些患者均具有多回波梯度回波序列。根据 T1 和 T2-FLAIR 序列手动绘制的 3D ROI 提取所有结节的定量磁化率图和 R2* 值。使用设计用于识别癫痫发作（参与癫痫发作起始）和发作间期（持续发作间期癫痫样活动）结节的二项逻辑广义估计方程模型比较植入性结节的定量磁化率图和 R2* 分布特征。然后将这些模型应用于未植入的结节，以识别未通过立体脑电图采样的潜在的癫痫发作和发作间期结节。
结果
在 10 名患者中总共识别出 146 个结节，其中 76 个结节通过立体脑电图进行了采样。广义估计方程模型表明，结节定量磁化率图值的峰度增加与致痫性相关（癫痫发作组为 = .04，发作间期组为 = .005）。两组的敏感性均较差（分别为 35.0%和 44.1%），但特异性均较高（分别为 94.6%和 78.6%）。
结论
我们发现定量磁化率图值的峰度增加（长尾分布）具有高度特异性，表明它可能是识别结节性硬化症患者潜在致痫性结节的有用生物标志物。这一发现促使我们进一步研究潜在的结节性矿物质化和其他导致定量磁化率图值峰度变化的特性。
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