1H MR spectroscopic imaging in patients with MRI-negative extratemporal epilepsy: correlation with ictal onset zone and histopathology

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• 作者：Pavel Krsek ; Milan Hajek ; Monika Dezortova ; Filip Jiru ; Antonin Skoch ; Petr Marusic ; Josef Zamecnik ; Martin Kyncl ; Michal Tichy and Vladimir Komarek
• 关键词：MR spectroscopy ; Focal cortical dysplasia ; MRI ; Epilepsy ; Surgery
• 刊名：European Radiology
• 出版年：2007
• 出版时间：August, 2007
• 年：2007
• 卷：17
• 期：8
• 页码：2126-2135
• 全文大小：313 KB
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Imaging and Radiology
  Diagnostic Radiology
  Interventional Radiology
  Neuroradiology
  Ultrasound
  Internal Medicine
  
• 出版者：Springer Berlin / Heidelberg
• ISSN：1432-1084

文摘

Proton magnetic resonance spectroscopy (1H MRS) is beneficial in the lateralization of the epileptogenic zone in temporal lobe epilepsy; however, its role in extratemporal and, especially, MRI-negative epilepsy has not been established. This study seeks to verify how 1H MRS could help in localizing the epileptogenic zone in patients with MRI-negative extratemporal epilepsy. Seven patients (8–23 years) with MRI-negative refractory focal epilepsy were studied using 1H MRS on a 1.5T MR system. Chemical shift imaging sequence in the transversal plane was directed towards the suspected epileptogenic zone localized by seizure semiology, scalp video/EEG, ictal SPECT and 18FDG-PET. Spectra were evaluated using the program CULICH, and the coefficient of asymmetry was used for quantitative lateralization. MRS detected lateralization in all patients and was able to localize pathology in five. The most frequent findings were decreased ratios of N-acetylaspartate to choline compounds characterized by increasing choline concentration. The localization of the 1H MRS abnormality correlated well with ictal SPECT and subdural mapping. In all cases, histopathological analysis revealed MRI-undetected focal cortical dysplasias. 1H MRS could be more sensitive for the detection of discrete malformations of cortical development than conventional MRI. It is valuable in the presurgical evaluation of patients without MRI-apparent lesions.