Search

7T ultra-high field MRI (7T MRI), with its high resolution, high signal-to-noise ratio (SNR) and high contrast, is superior to conventional field intensity MRI in clinical applications such as diagnosis of hippocampal sclerosis (HS) and focal cortical dysplasia (FCD), assisting in the identification of pathological subtypes of the both, locating the scope of surgical excision, and has made progress in the diagnosis and treatment of drug-resistant epilepsy (DRE). This paper aims to review the clinical application value and research progress of 7T MRI in order to promote its application in the field of diagnosis and treatment of epilepsy. [ABSTRACT FROM AUTHOR]

Objective To explore the clinical value of a new artificial intelligence MR brain segmentation method for quantitat鄄 ing the bilateral hippocampus volume in temporal lobe epilepsy (TLE) and hippocampal sclerosis (HS). Methods 50 patients with unilateral TLE were categorized as 20 L-HS (+), 17 R-HS (+), and 13 HS (-) groups according to the epilepsy lateralization and HS. 30 healthy volunteers were recruited as control. MR brain segmentation was performed to measure the volume of hippocampus and the volume asymmetry index (AI) automatically. The feasibility analysis of the measurement error of this segmentation technology was performed with manual measurement as the gold standard. The affected versus contralateral intra-group comparisons and the inter-group comparisons among 4 subgroups were made for the hippocampus volume and AI values. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic performance of these two indicators. Results Compared to the manually measured volumes of left (4.08依0.56) cm3 and right (4.21依0.63) cm3 hippocampi, the automated measurement volumes of (4.25依0.53) cm3 and (4.32依0.66) cm3 had a measurement error of 4%. Therefore, the number of samples outside the 95%limits of agreement was less than 5%. The values of AI, left and right hippocampus volume were -0.17依0.11, (3.88依0.42) cm3, and (4.60依0.46) cm3 in L-HS (+) group; 0.18依0.14, (4.57依0.41) cm3, and (3.86依0.66) cm3 in the R-HS (+) group; -0.01依0.06, (4.39依0.50) cm3, and (4.47依0.62) cm3 in the HS (-) group; -0.02依0.04, (4.48依 0.32) cm3, and (4.56依0.36) cm3 in the control group. The volumes of hippocampi on the affected side of HS (+) patients were significantly reduced in both intra-group and inter-group comparisons (P<0.05) whereas there was no significant difference (P>0.05) in TLE-HS (-) and the control groups. The overall difference in both AI and hippocampus volumes was significant in L-HS (+), R-HS (+), HS (-), and control groups (P<0.05). The area under the ROC curve (AUC) of AI was significantly greater (P<0.05) at 0.88 in L-HS (+) and 0.90 in R-HS (+) than that of volume at 0.87 in L-HS (+) and 0.83 in R-HS (+). Conclusion The measurement error of this new artificial intelligence MR brain segmentation technology is within the acceptable range, which can be used to measure the volume of hippocampus. The AI values are the most significant in the diagnosis of TLE combined with HS. [ABSTRACT FROM AUTHOR]

Objective To explore the subtle structural damage pattern of MRI negative temporal lobe epilepsy (TLE) by com paring MRI negative TLE models. Methods Patients with MRI negative TLE have typical electroclinical physiological manifestations of TLE. but no epileptogenic lesions are visible to the naked eye on conventional structural MRI. In this study. 21 patients with MRI negative TLE and 20 patients with mesial temporal lobe epilepsy caused by hippocampal sclerosis (MTLE-HS) as well as 25 healthy controls were enrolled. Voxel-based morphometry (VBM) measurement method was used to compare the gray matter volume and Spearman correlation was used to analyze the correlation between the mean gray matter volume and the course of disease and age of onset. Results Compared with the control group, the areas of gray matter volume reduction in patients with MRI negative TLE were located in the bilateral fusiform gyrus, left superior temporal gyrus, right middle temporal gyrus, right cuneus, left superior occipital gyrus, right superior gyrus, and right paracentral lobule (FDR correction. P<0.05, cluster value>50) whereas the areas of gray matter volume reduction in patients with MTLE-HS were distributed in the bilateral amygdala, hippocampus, parahippocampal gyrus, superior temporal gyrus, precuneus, middle temporal gyrus, left fusiform gyrus, left angular gyrus, right orbital superior frontal gyrus, right anterior cingulate gyrus, tight supplementary brain region, right cerebellum and other brain regions (FDR correction. P<0.05, cluster value>50). The brain injury in MTLE-HS patients was diffuse and mainly bilateral without correlation to the course of disease and age of onset (P>0.05). Conclusion MTLE-HS patients show extensive bilateral gray matter damage, mainly in the limbic system. MRI negative TLE patients also show diffuse gray matter atrophy of different distribution suggesting different pathologic mechanism [ABSTRACT FROM AUTHOR]

Objective To explore the clinical characteristics, preoperative evaluation, surgical treatment and its effect of intractable temporal lobe epilepsy. Methods CT and MRI were performed in 105 patients with intractable temporal lobe epilepsy before operation, and MR spectroscopy (MRS) of bilateral hippocampus was also performed. All of them were examined by video EEG. According to the characteristics of the patients' pre-operative clinical attack, imaging and long-term video EEG, the patients were monitored by the cortical EEG during the operation. The patients were followed up for more than 1 year after operation, and the curative effect of the operation was observed. Results In this group, 48 patients with hippocampal sclerosis underwent anterior temporal lobectomy (including most of the hippocampus and amygdala) ; In addition, 57 patients with other lesions were resected first. 23 patients were still abnormal discharge after reexamination of the EEG. The 23 patients were treated with anterior temporal lobectomy (including most of the hippocampus and amygdala) . After anterior temporal lobectomy, 5 patients still had abnormal discharge and were scorched. The results showed that the epilepsy of 80 patients disappeared completely, 13 patients were relieved significantly than before operation, and 12 patients had no obvious change; The total effective rate was 88. 6%, and the excellent rate was 76. 2%. Conclusions If the results of neuroimaging and video EEG are consistent, surgical treatment is strongly recommended. The operation must be carried out under the monitoring of cortical electroencephalogram. At the same time, after resection of temporal lobe lesions, anterior temporal lobectomy should be added according to the monitoring results of cortical EEG, and cortical cauterization should be added if necessary to solve the double pathological phenomenon. [ABSTRACT FROM AUTHOR]

ObjectiveTo study the prognostic factors of surgical operation in patients with refractory temporal lobe epilepsy(TLE) induced by dual pathology of hippocampal sclerosis(HS) with focal cortical dysplasia(FCD). MethodsThe clinical data of 45 patients with refractory TLE induced by pathological proved dual pathology(HS with FCD) were analyzed retrospectively. The postoperative follow-up ranged from 1 to 5years, according to the follow-up results. Engel classI-IIwere taken as the effective treatment group and Engel class III-IV were taken as the ineffective treatment group. The binary logistic regression analysis was used to investigate the factors influencing the prognosis of surgery. Results29 (29/45) patients were in the effective treatment group. Among them, 27 were Engel class Iand 2 were Engel class II. 16(16/45) patients were in the ineffective treatment group. Among them, 9 were Engel class III and 7 were Engel class IV. Binary logistic regression analysis showed that histopathological subtypes were FCDIIIa or not (χ2=4.593, P=0.032, OR=6.098, 95% CI=1.167-31.863) and complete resection of epileptogenic area or not(χ2=9.477, P=0.002, OR=13.487, 95% CI=2.574-70.679) were statistically significant. Onset age, preoperative seizure frequency, course of onset, age at operation, having a history of febrile seizure or not and positive or not on MRI were not statistically significant(P＞0.05). ConclusionThe operative prognoses of the patients with TLE induced by dual pathology(HS with FCD) are associated with histopathological subtypes, complete resection of epileptogenic area. [ABSTRACT FROM AUTHOR]

Objective To investigate the alterations of interictal cerebral blood flow(CBF) and asymmetrical CBF of bilateral temporal lobes, insula, and limbic systems in mesial temporal lobe epilepsy with hippocampal sclerosis(MTLE-HS) by arterial spin labeling. Methods CBF values in 28 regions of interest( ROIs) in the bilateral temporal lobes, insula and limbic systems were compared between the left MTLE-HS(11 patients), right MTLE-HS(10), and healthy control(25) groups. The asymmetry index of each pair of ROIs was calculated. Results Compared with the HC group, the CBF values of the left MTLE-HS group were significantly lower than the control group in the left insula(P=0.045), left hippocampus(P=0.006), left parahippocampus(P=0.033),left amygdala(P=0.033), left thalamus(P=0.020), left Heschl’s gyrus(P=0.034), and right thalamus(P=0.045). The CBF values of the right MTLE-HS group were significantly lower than the control group in the right anterior cingulum( P =0.020), right superior temporal gyrus(P =0.036), right superior temporal pole(P =0.008), and left insula(P =0.035). The left hippocampal CBF of the left and right MTLE-HS groups was significantly different(P=0.015). The asymmetry indices were significantly different from the control group in the bilateral insula( P =0.034) and bilateral hippocampi( P =0.040) of left MTLE-HS group and in the bilateral superior temporal gyri(P=0.031) of right MTLE-HS group. There was significant difference in the asymmetry indices of the bilateral insula(P =0.040), hippocampi(P=0.001), parahippocampi(P =0.037), amygdala(P =0.020), superior temporal gyri(P =0.002), and middle temporal gyri(P=0.012) between the left and right MTLE-HS groups. Conclusion CBF of ipsilateral and some contralateral brain regions of MTLE-HS is decreased. Hemispheric CBF asymmetry may be helpful for the diagnosis of MTLE and differentiating left from right MTLE-HS. [ABSTRACT FROM AUTHOR]

Objective To analyze the gray matter (GM) of temporal lobe epilepsy (TLE) caused by double pathology using voxel-based morphometry and surface-based morphology methods. Methods The GM volume, cortical thickness, and cortical surface area on three-dimensional T1-weighted BRAVO sequence of 36 patients with left (20) and 16 right (16) TLE from hippocampal sclerosis (HS) and focal cortical dysplasia (FCD) were compared with that of 30 healthy subjects. Results In patients with TLE, GM volume was reduced in the ipsilateral epileptogenic temporal lobe gyrus including hippocampus. In addition, the left thalamus and amygdala volume was significantly decreased in left TLE (P＜0.001). The temporal and extra-temporal lobe cortical thickness was increased in some of the patients whereas the surface area of the ipsilateral temporal lobe was significantly reduced in TLE (P＜ 0.01). Conclusion In TLE caused by HS and FCD, the ipsilateral epileptogenic temporal lobe regions including hippocampus showed reduction in GM volume and cortical surface area. [ABSTRACT FROM AUTHOR]

Objective: To analyze whole brain structural volume asymmetry in temporal lobe epilepsy with hippocampal sclerosis (TLE-HS) using automated brain segmentation technology, and to investigate the application value of this technology in the diagnosis of TLE-HS and the performance in determining the location the lateralization of epileptogenic focus. Methods: Twenty-eight patients with TLE-HS were enrolled in the First Affiliated Hospital of Zhengzhou University from April 2019 to October 2020, including 13 females and 15 males, aged ranged from 18 to 63 (30±12) years, and these patients were divided two group according to the epilepsy lateralization, left TLE-HS(LTLE-HS) group ( n =11), right TLE-HS(RTLE-HS) group ( n =17) and 28 normal controls [aged ranged from 18 to 49 (29±10) years]. All of these subjects underwent three-dimensional T 1 weighted image (3D T 1 WI). The differences of brain structure and volumes in LTLE-HS, RTLE-HS and normal controls group were retrospectively analyzed, and Pearson's correlation coefficient was used to evaluate the left and right volume correlations, and effect size was used for evaluating the differences in left and right volume averages. The asymmetry index (AI) of the left and right lateral volumes in each group was also calculated and compared among the three groups. Results: Standard volumes of all structures within the brain were asymmetric in the normal controls, LTLE-HS, and RTLE-HS groups, with smaller volumes of ipsilateral hippocampus than contralateral hippocampus in both the LTLE-HS and RTLE-HS groups(0.20%±0.03% vs 0.24%±0.02%,0.21%±0.03% vs 0.25%±0.02% respectively;both P <0.001), and smaller volumes of gray and white matter of the ipsilateral temporal lobe than contralateral in the LTLE-HS group(4.41%±0.38% vs 5.01%±0.43%,1.83%±0.22 % vs 2.22%±0.14%;both P <0.001). There was a moderate to strong linear correlation (0.553< r <0. 964,all P <0.05) between left and right lateral volumes in the normal controls, LTLE-HS, and RTLE-HS groups. All three groups showed the largest effect sizes in the cingulate gyrus (The effect sizes were 3.07, 4.85 and 4.22 in control, LTLE-HS and RTLE-HS, respectively.). The AI values of the hippocampus, temporal lobe gray matter, and temporal lobe white matter were statistically different among the three groups (-1.48±8.64 vs 15.91±10.15 vs -17.59±10.00, 7.46±2.67 vs 12.67±6.67 vs 3.67±6.15, 6.53±3.71 vs 19.91±9.85 vs 1.57±8.38;all P <0.001). Conclusion: Volumetric measurements by automated brain segmentation techniques can play an important role in preoperative assessment of TLE, and the asymmetry of brain volume may be of value in determining the localization and extent of the epileptogenic focus.

Objective To discuss the clinical features and surgical effects of mesial temporal lobe epilepsy (MTLE) patients with hippocampal sclerosis. Methods The clinical data of 47 MTLE patients with hippocampal sclerosis diagnosed and treated in our hospital from May 2010 to July 2014 were analyzed retrospectively. The clinical manifestations included generalized tonoclonic seizure in 17 cases, generalized seizure secondary to partial seizure in 8 and complex partial seizure in 22. After the examination of Video EEG (V-EEG) and MRI, we performed the standard anterior temporal lobe resection treatment in the 47 cases. Results The hippocampal sclerosis was confirmed by the postoperative pathological examination. All patients had no permanent neurological deficits and significant postoperative complications. Engel classification results after operation was grade I 76. 6%, grade II 10. 6%, grade III 8. 5%, grade IV 4. 3%. Conclusions The operative efficacy of temporal lobe epilepsy with hippocampal sclerosis is satisfied. The standard anterior temporal lobe resection treatment is worthy of promotion and application for the future on the basis of the standardized operation. [ABSTRACT FROM AUTHOR]

Objective To investigate long term surgical outcome of temporal lobe epilepsy with unilateral hippocampal sclerosis on MRI. Methods 25 refractory temporal lobe epilepsy patients with MRI demonstrating unilateral hippocampal sclerosis were included. All the patients were processed anterior temporal lobectomy under intraoperative electrocorticogram (ECoG) monitoring. The seizure outcome were analyzed after long-term follow-up. Results The outcome was favorable. With ILAE classification, 1 year postoperatively 76% belonged in class 1, 4% in class 2, 16% in class 3 and 4% in class 5.3 years postoperatively, 68% belonged in class 1,4% in class 2, 24% in class 3, and 4% in class 5, 5 years postoperatively, 65% belonged in class 1, 29% in class 3 and 6% in class 5. Conclusion The long-term surgical outcome of temporal lobe eiplepsy with unilateral hippcampal sclerosis on MRI is favorlable, the quality of life for patients was improved. [ABSTRACT FROM AUTHOR]