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Localization of the Epileptogenic Zone by Multimodal Neuroimaging and High-Frequency Oscillation

Accurate localization of the epileptogenic zone (EZ) is a key factor to obtain good surgical outcome for refractory epilepsy patients. However, no technique, so far, can precisely locate the EZ, and there are barely any reports on the combined application of multiple technologies to improve the loca...

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Autores principales: Li, Xiaonan, Yu, Tao, Ren, Zhiwei, Wang, Xueyuan, Yan, Jiaqing, Chen, Xin, Yan, Xiaoming, Wang, Wei, Xing, Yue, Zhang, Xianchang, Zhang, Herui, Loh, Horace H., Zhang, Guojun, Yang, Xiaofeng
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8217465/
https://www.ncbi.nlm.nih.gov/pubmed/34168546
http://dx.doi.org/10.3389/fnhum.2021.677840
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author Li, Xiaonan
Yu, Tao
Ren, Zhiwei
Wang, Xueyuan
Yan, Jiaqing
Chen, Xin
Yan, Xiaoming
Wang, Wei
Xing, Yue
Zhang, Xianchang
Zhang, Herui
Loh, Horace H.
Zhang, Guojun
Yang, Xiaofeng
author_facet Li, Xiaonan
Yu, Tao
Ren, Zhiwei
Wang, Xueyuan
Yan, Jiaqing
Chen, Xin
Yan, Xiaoming
Wang, Wei
Xing, Yue
Zhang, Xianchang
Zhang, Herui
Loh, Horace H.
Zhang, Guojun
Yang, Xiaofeng
author_sort Li, Xiaonan
collection PubMed
description Accurate localization of the epileptogenic zone (EZ) is a key factor to obtain good surgical outcome for refractory epilepsy patients. However, no technique, so far, can precisely locate the EZ, and there are barely any reports on the combined application of multiple technologies to improve the localization accuracy of the EZ. In this study, we aimed to explore the use of a multimodal method combining PET-MRI, fluid and white matter suppression (FLAWS)—a novel MRI sequence, and high-frequency oscillation (HFO) automated analysis to delineate EZ. We retrospectively collected 15 patients with refractory epilepsy who underwent surgery and used the above three methods to detect abnormal brain areas of all patients. We compared the PET-MRI, FLAWS, and HFO results with traditional methods to evaluate their diagnostic value. The sensitivities, specificities of locating the EZ, and marking extent removed versus not removed [RatioChann(ev)] of each method were compared with surgical outcome. We also tested the possibility of using different combinations to locate the EZ. The marked areas in every patient established using each method were also compared to determine the correlations among the three methods. The results showed that PET-MRI, FLAWS, and HFOs can provide more information about potential epileptic areas than traditional methods. When detecting the EZs, the sensitivities of PET-MRI, FLAWS, and HFOs were 68.75, 53.85, and 87.50%, and the specificities were 80.00, 33.33, and 100.00%. The RatioChann(ev) of HFO-marked contacts was significantly higher in patients with good outcome than those with poor outcome (p< 0.05). When intracranial electrodes covered all the abnormal areas indicated by neuroimaging with the overlapping EZs being completely removed referred to HFO analysis, patients could reach seizure-free (p < 0.01). The periphery of the lesion marked by neuroimaging may be epileptic, but not every lesion contributes to seizures. Therefore, approaches in multimodality can detect EZ more accurately, and HFO analysis may help in defining real epileptic areas that may be missed in the neuroimaging results. The implantation of intracranial electrodes guided by non-invasive PET-MRI and FLAWS findings as well as HFO analysis would be an optimized multimodal approach for locating EZ.
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spelling pubmed-82174652021-06-23 Localization of the Epileptogenic Zone by Multimodal Neuroimaging and High-Frequency Oscillation Li, Xiaonan Yu, Tao Ren, Zhiwei Wang, Xueyuan Yan, Jiaqing Chen, Xin Yan, Xiaoming Wang, Wei Xing, Yue Zhang, Xianchang Zhang, Herui Loh, Horace H. Zhang, Guojun Yang, Xiaofeng Front Hum Neurosci Neuroscience Accurate localization of the epileptogenic zone (EZ) is a key factor to obtain good surgical outcome for refractory epilepsy patients. However, no technique, so far, can precisely locate the EZ, and there are barely any reports on the combined application of multiple technologies to improve the localization accuracy of the EZ. In this study, we aimed to explore the use of a multimodal method combining PET-MRI, fluid and white matter suppression (FLAWS)—a novel MRI sequence, and high-frequency oscillation (HFO) automated analysis to delineate EZ. We retrospectively collected 15 patients with refractory epilepsy who underwent surgery and used the above three methods to detect abnormal brain areas of all patients. We compared the PET-MRI, FLAWS, and HFO results with traditional methods to evaluate their diagnostic value. The sensitivities, specificities of locating the EZ, and marking extent removed versus not removed [RatioChann(ev)] of each method were compared with surgical outcome. We also tested the possibility of using different combinations to locate the EZ. The marked areas in every patient established using each method were also compared to determine the correlations among the three methods. The results showed that PET-MRI, FLAWS, and HFOs can provide more information about potential epileptic areas than traditional methods. When detecting the EZs, the sensitivities of PET-MRI, FLAWS, and HFOs were 68.75, 53.85, and 87.50%, and the specificities were 80.00, 33.33, and 100.00%. The RatioChann(ev) of HFO-marked contacts was significantly higher in patients with good outcome than those with poor outcome (p< 0.05). When intracranial electrodes covered all the abnormal areas indicated by neuroimaging with the overlapping EZs being completely removed referred to HFO analysis, patients could reach seizure-free (p < 0.01). The periphery of the lesion marked by neuroimaging may be epileptic, but not every lesion contributes to seizures. Therefore, approaches in multimodality can detect EZ more accurately, and HFO analysis may help in defining real epileptic areas that may be missed in the neuroimaging results. The implantation of intracranial electrodes guided by non-invasive PET-MRI and FLAWS findings as well as HFO analysis would be an optimized multimodal approach for locating EZ. Frontiers Media S.A. 2021-06-08 /pmc/articles/PMC8217465/ /pubmed/34168546 http://dx.doi.org/10.3389/fnhum.2021.677840 Text en Copyright © 2021 Li, Yu, Ren, Wang, Yan, Chen, Yan, Wang, Xing, Zhang, Zhang, Loh, Zhang and Yang. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neuroscience
Li, Xiaonan
Yu, Tao
Ren, Zhiwei
Wang, Xueyuan
Yan, Jiaqing
Chen, Xin
Yan, Xiaoming
Wang, Wei
Xing, Yue
Zhang, Xianchang
Zhang, Herui
Loh, Horace H.
Zhang, Guojun
Yang, Xiaofeng
Localization of the Epileptogenic Zone by Multimodal Neuroimaging and High-Frequency Oscillation
title Localization of the Epileptogenic Zone by Multimodal Neuroimaging and High-Frequency Oscillation
title_full Localization of the Epileptogenic Zone by Multimodal Neuroimaging and High-Frequency Oscillation
title_fullStr Localization of the Epileptogenic Zone by Multimodal Neuroimaging and High-Frequency Oscillation
title_full_unstemmed Localization of the Epileptogenic Zone by Multimodal Neuroimaging and High-Frequency Oscillation
title_short Localization of the Epileptogenic Zone by Multimodal Neuroimaging and High-Frequency Oscillation
title_sort localization of the epileptogenic zone by multimodal neuroimaging and high-frequency oscillation
topic Neuroscience
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8217465/
https://www.ncbi.nlm.nih.gov/pubmed/34168546
http://dx.doi.org/10.3389/fnhum.2021.677840
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