机构：[1]Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA[2]Division of Biomedical Engineering, Hankuk University of Foreign Studies, Yongin, Korea[3]Imaging Institute, Cleveland Clinic, Cleveland, OH, USA[4]Institute of Neuropathology, University Hospitals Erlangen, Erlangen, Germany[5]Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, USA[6]Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China[7]Department of Neurology, Helsinki University Hospital, Helsinki, Finland[8]Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, USA
Objective Ultra-high-field 7-Tesla (7T) magnetic resonance imaging (MRI) offers increased signal-to-noise and contrast-to-noise ratios, which may improve visualization of cortical malformations. We aim to assess the clinical value of in vivo structural 7T MRI and its post-processing for the noninvasive identification of epileptic brain lesions in patients with pharmacoresistant epilepsy and nonlesional 3T MRI who are undergoing presurgical evaluation. Methods Sixty-seven patients were included who had nonlesional 3T MRI by official radiology report. Epilepsy protocols were used for the 3T and 7T acquisitions. Post-processing of the 7T T1-weighted magnetization-prepared two rapid acquisition gradient echoes sequence was performed using the morphometric analysis program (MAP) with comparison to a normal database consisting of 50 healthy controls. Review of 7T was performed by an experienced board-certified neuroradiologist and at the multimodal patient management conference. The clinical significance of 7T findings was assessed based on intracranial electroencephalography (ICEEG) ictal onset, surgery, postoperative seizure outcomes, and histopathology. Results Unaided visual review of 7T detected previously unappreciated subtle lesions in 22% (15/67). When aided by 7T MAP, the total yield increased to 43% (29/67). The location of the 7T-identified lesion was identical to or contained within the ICEEG ictal onset in 13 of 16 (81%). Complete resection of the 7T-identified lesion was associated with seizure freedom (P = .03). Histopathology of the 7T-identified lesions encountered mainly focal cortical dysplasia (FCD). 7T MAP yielded 25% more lesions (6/24) than 3T MAP, and showed improved conspicuity in 46% (11/24). Significance Our data suggest a major benefit of 7T with post-processing for detecting subtle FCD lesions for patients with pharmacoresistant epilepsy and nonlesional 3T MRI.
基金：
National Institute of Neurological Disorders
and Stroke, Grant/Award Number: R01
NS109439 ; JoshProvides Epilepsy
Assistance Foundation Research Grant
第一作者机构：[1]Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA[*1]Cleveland Clinic, Epilepsy Center, Desk S-51, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
通讯作者：
通讯机构：[*1]Cleveland Clinic, Epilepsy Center, Desk S-51, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
推荐引用方式(GB/T 7714)：
Irene Wang,Sehong Oh,Ingmar Blümcke,et al.Value of 7T MRI and post-processing in patients with nonlesional 3T MRI undergoing epilepsy presurgical evaluation[J].EPILEPSIA.2020,61(11):2509-2520.doi:10.1111/epi.16682.
APA：
Irene Wang,Sehong Oh,Ingmar Blümcke,Roland Coras,Balu Krishnan...&Stephen E. Jones.(2020).Value of 7T MRI and post-processing in patients with nonlesional 3T MRI undergoing epilepsy presurgical evaluation.EPILEPSIA,61,(11)
MLA：
Irene Wang,et al."Value of 7T MRI and post-processing in patients with nonlesional 3T MRI undergoing epilepsy presurgical evaluation".EPILEPSIA 61..11(2020):2509-2520
医学