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基于体素和基于表面的皮质形态计量MRI在识别癫痫灶中的应用:一项叙述性综述。

Voxel-based and surface-based cortical morphometric MRI applications for identifying the epileptogenic zone: A narrative review.

作者信息

Bunyamin Jacob, Sinclair Benjamin, Law Meng, Kwan Patrick, O'Brien Terence J, Neal Andrew

机构信息

Department of Neuroscience, The School of Translational Research, Monash University, Melbourne, Victoria, Australia.

Department of Neurology, Alfred Health, Melbourne, Victoria, Australia.

出版信息

Epilepsia Open. 2025 Apr;10(2):380-397. doi: 10.1002/epi4.70012. Epub 2025 Feb 28.

Abstract

Approximately 40% of patients with drug-resistant epilepsy referred for surgical evaluation have no epileptogenic lesion on MRI (MRI-negative). MRI-negative epilepsy is associated with poorer seizure freedom prognosis and has therefore motivated the development of structural post-processing methods to "convert" MRI-negative to MRI-positive cases. In this article, we review the principles, advances, and challenges of voxel- and surface-based cortical morphometric MRI techniques in detecting the epileptogenic zone. The ground truth for the presumed epileptogenic zone in imaging studies can be classified into lesion-based (MRI lesion mask or histopathology) or epileptogenicity-based ground truth (anatomical-electroclinical correlations or resections that lead to seizure freedom). Voxel-based techniques are reported to have a 13%-97% concordance rate, while surface-based techniques have 67%-92% compared to lesion-based ground truths. Epileptogenicity-based ground truth may be more relevant in the case of MRI-negative cases; however, the sensitivity and concordance rate (voxel-based technique 7.1%-66.7%, and surface-based technique 62%) are limited by the reliance on scalp EEG and qualitative analysis of seizure-onset pattern. The use of stereo-EEG and quantitative EEG analysis may fill this gap to evaluate the correlation between cortical morphometry results and electrophysiological epileptogenic biomarkers of the epileptogenic zone and help improve the yield of structural post-processing tools. PLAIN LANGUAGE SUMMARY: Locating the epileptogenic zone (the brain area that is responsible for seizure generation) is important to diagnose and plan epilepsy treatments. An abnormal brain imaging (MRI) result can help clinical decision-making; however, around 40% of patients have normal MRI results (MRI-negative). We are reviewing the potential of two advanced MRI methods (voxel- and surface-based cortical morphometry) to localize the epileptogenic zone in the presence or absence of visible MRI abnormalities. We also describe the current challenge of applying the above methods in daily clinical practice and propose using advanced brain recording analysis to aid this translation process.

摘要

在接受手术评估的耐药性癫痫患者中,约40%在磁共振成像(MRI)上没有致痫性病变(MRI阴性)。MRI阴性癫痫与无癫痫发作的预后较差相关,因此推动了结构后处理方法的发展,以将MRI阴性病例“转化”为MRI阳性病例。在本文中,我们回顾了基于体素和基于表面的皮质形态测量MRI技术在检测致痫区方面的原理、进展和挑战。成像研究中假定致痫区的金标准可分为基于病变的(MRI病变掩码或组织病理学)或基于致痫性的金标准(解剖-电临床相关性或导致无癫痫发作的切除术)。据报道,与基于病变的金标准相比,基于体素的技术一致性率为13%-97%,而基于表面的技术为67%-92%。在MRI阴性病例中,基于致痫性的金标准可能更相关;然而,其敏感性和一致性率(基于体素的技术为7.1%-66.7%,基于表面的技术为62%)受到对头皮脑电图的依赖和癫痫发作起始模式定性分析的限制。使用立体脑电图和定量脑电图分析可能会填补这一空白,以评估皮质形态测量结果与致痫区电生理致痫生物标志物之间的相关性,并有助于提高结构后处理工具的检出率。

通俗易懂的总结

定位致痫区(负责癫痫发作产生的脑区)对于癫痫的诊断和治疗规划很重要。异常的脑成像(MRI)结果有助于临床决策;然而,约40%的患者MRI结果正常(MRI阴性)。我们正在评估两种先进的MRI方法(基于体素和基于表面的皮质形态测量)在有无可见MRI异常情况下定位致痫区的潜力。我们还描述了在日常临床实践中应用上述方法当前面临的挑战,并建议使用先进的脑记录分析来辅助这一转化过程。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d4fd/12014933/7bc8a76728f7/EPI4-10-380-g001.jpg

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