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Zheng Ding^1,2, Siyuan Hu², Ting-Yu Su^1,2, Joon Yul Choi¹, Xiaofeng Wang³, Ken Sakaie⁴, Hiroatsu Murakami¹, Hans-Juergen Huppertz⁵, Ingmar Blumcke^1,6, Stephen Jones⁴, Imad Najm¹, Dan Ma², and Zhong Irene Wang^1
1Epilepsy Center, Cleveland Clinic, Cleveland, OH, United States, ²Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States, ³Quantitative Health Science, Cleveland Clinic, Cleveland, OH, United States, ⁴Imaging Institute, Cleveland Clinic, Cleveland, OH, United States, ⁵Swiss Epilepsy Clinic - Klinik Lengg AG, Zurich, Switzerland, ⁶University of Erlangen-Nuremberg, Erlangen, Germany

Keywords: Epilepsy, MR Fingerprinting

We sought to improve focal cortical dysplasia (FCD) lesion detection by combining MR fingerprinting (MRF) with voxel-based morphometric MRI analysis. We acquired high-resolution MRF and T1w MPRAGE data from 29 patients and 47 age-and-gender-matched healthy controls. FCD probability maps were generated using the morphometric analysis program (MAP18). MRF T1 and T2 values in white matter were significantly higher in true-positive clusters than false-positive clusters. Using normalized MRF T1, T2, and cluster size as input, an SVM model was able to predict whether each cluster represents a true positive with high accuracy, demonstrating its potential contribution to clinical FCD detection workflow.

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Hui Huang¹, Miao Zhang², Bingyang Cai¹, Siyu Yuan¹, Wen Jin^3,4, Yudu Li^3,5, Yibo Zhao^3,4, Zhi-Pei Liang^3,4, Yao Li¹, Biao Li², and Jie Luo^1
1School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China, ²Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China, ³Beckman Institute for Advanced Sciences and Technology, University of Illinois at Urbana Champaign, Urbana, IL, United States, ⁴Department of Electrical and Computer Engineering, University of Illinois at Urbana Champaign, Urbana, IL, United States, ⁵National Center for Supercomputing Applications, University of Illinois at Urbana Champaign, Urbana, IL, United States

Keywords: Epilepsy, Metabolism

Lateralization of drug refractory mesial temporal lobe epilepsy can be challenging for routine MR scans at 3.0T. Exogenous and radioactive tracer ¹⁸F-FDG has been widely reported to aid the lateralization of MR unidentifiable epileptic hippocampus. ¹H-MRSI holds promise to provide endogenous metabolic information of the epileptogenic zone. This study demonstrated the feasibility of fast high-resolution mapping of NAA/Cr, mIn/Cr and mIn/NAA, and investigated their associations with the FDG uptake. Our experimental results showed that NAA and mIn were independently sensitive to metabolic changes in hippocampal sclerosis, providing complementary information for temporal lobe epilepsy lateralization.

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Stefanie Chambers^1,2, Lukas Haider³, Philipp Lazen¹, Gregor Kasprian³, Johannes Koren⁴, Robert Diehm⁵, Katharina Moser⁵, Matthias Tomschik¹, Jonathan Wais¹, Fabian Winter¹, Vitalij Zeiser¹, Stephan Gruber^2,6, Susanne Aull-Watschinger⁷, Tatjana Traub-Weidinger⁸, Christoph Baumgartner ⁴, Martha Feucht⁵, Christian Dorfer¹, Wolfgang Bogner^2,6, Siegfried Trattnig^2,6, Ekaterina Pataraia⁷, Karl Rössler^1,6, and Gilbert Hangel^1,2,6
1Department of Neurosurgery, Medical University of Vienna, Vienna, Austria, ²High-field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria, ³Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria, ⁴Department of Neurology, Hietzing Hospital, Vienna, Austria, ⁵Center for Rare and Complex Childhood Onset Epilepsies, Member of ERN EpiCARE, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria, ⁶Christian Doppler Laboratory for MR Imaging Biomarkers, Vienna, Austria, ⁷Department of Neurology, Medical University of Vienna, Vienna, Austria, ⁸Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria

Keywords: Epilepsy, High-Field MRI

In this study, structural lesions in 3T and 7T of 12 patients suffering from intractable focal epilepsy were co-registered and manually segmented using ITK-SNAP. The rendered volumes were compared with reference to 3T lesional size in FLAIR, T1 and T2-weighted sequences. Additionally, a WMS sequence was compared to 3T FLAIR as well as 7T FLAIR. Our findings illustrate that on average, 7T showed larger lesion volume in all sequences except WMS.

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Lu Zu^1,2, Peng Zhao², Mengxiao Liu³, Xiaoli Li⁴, Wei Zhang⁵, Yani Cheng^1,2, and Xiangtao Lin^2
1Shandong University, Jinan, China, ²Department of Radiology, Shandong Provincial Hospital, Jinan, China, ³MR scientific Marketing, Diagnostic Imaging, Siemens Healthineers Ltd, Shanghai, China, ⁴Department of Radiology, The Second People’s Hospital of Kunming, Kunming, China, ⁵The People's Hospital of Laoling, Laoling, China

Keywords: Epilepsy, Diffusion/other diffusion imaging techniques, mean apparent propagator (MAP)

For patients with routine MRI-negative epilepsy, noninvasive imaging is important for differential diagnosis. AE might be a subtype of MRI-negative TLE. The aim of this study was to evaluate the diagnostic efficacy of MAP-MRI and traditional DTI between TLE-AE patients and healthy controls. Results showed that MSD, QIV, RTAP, RTOP from MAP-MRI and FA from DTI in amygdala can be used as an imaging indicator to identify TLE-AE(P<0.05). Furthermore, MSD, RTAP, RTOP had a significant correlation with seizure types. MAP-MRI outperformed DTI in the diagnosis of TLE-AE, and MAP-MRI is expected to contribute in probing MRI-negative epileptogenic lesions.   

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Guiqin Chen¹, Jie Hu¹, Haifeng Ran¹, Heng Liu¹, and Tijiang Zhang^1
1Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China

Keywords: Epilepsy, Brain

Large-scale brain network abnormalities and cognitive impairment in patients with benign childhood epilepsy with centrotemporal spikes (BECTS). And cognitive function needs hierarchical interaction support between brain-collateral systems. Whether there are changes in the interaction and functional arrangement between different network systems in patients with BECTS still ambiguous. The purpose of this study is to use the method of gradient connection to investigate the changes of macro-network function hierarchy of BECTS and its potential contribution to cognitive function in BECTS children .

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song cheng ru¹ and cheng jing liang^1
1MRI, the first affiliated hospital of zhengzhou university, zhengzhou, China

Keywords: Epilepsy, fMRI (resting state), intrinsic brain activity, dynamic, cognition

We comprehensively explored the potential intrinsic brain activity (IBA) abnormalities affected by MRI-negative temporal lobe epilepsy (TLE) based on six temporal dynamic indicators (dALFF, dfALFF, dReHo, dDC, dGSCorr, dVMHC) and their corresponding static indicators, the results revealed that the abnormally activated brain regions overlap markedly, including ①decreased fALFF, Reho, DC, VMHC, dfALFF, dReHo in the temporal neocortex with ipsilateral superiority. ②decreased dGSCorr and dVMHC in the occipital lobe. Moreover, many IBA indicators significantly correlated with the epilepsy duration or cognitive scale scores. The dDC, fALFF and DC showed significant discrimination ability. The ReHo and fALFF demonstrated lateralization significance. 

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Kiran K Seunarine¹, Martin M Tisdall², and Enrico De Vita^1
1Physics Group, Department of Radiology, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom, ²Department of Neurosurgery, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom

Keywords: Epilepsy, Precision & Accuracy, Stereotactic

Stereo electroencephalography (sEEG) is a valuable tool for localising seizure-onset zones in focal epilepsy. Pre-surgical planning typically combines CT images, which have little spatial distortion, with MRI images, which have improved cerebral tissue contrast. However, the use of CT results in a potentially unnecessary radiation dose to the patient and additional demand on radiology services. In this work, we assess the additional distortion caused by the stereotactic Leksell G-frame in a single healthy volunteer at both 1.5T and 3T. We show that distortion is <1mm in 99.6% of the brain volume at 3T.

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Shuohua Wu^1,2, Qianqi Wang², Huige Zhai², Yiwen Zhang², Pu-yeh Wu³, Gen Yan², and Renhua Wu^1
1The Second Affiliated Hospital, Medical College of Shantou University, Shantou, China, ²The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China, ³GE Healthcare, Beijing, Beijing, China

Keywords: Epilepsy, Molecular Imaging, therapeutic effect

Current diagnosis of MRI-negative TLE relies on clinical history and EEG or IEEG. However, IEEG is invasive and fails to monitor therapeutic effects dynamically. It is necessary to screen for effective biomarkers. We used MEGA-PRESS technique to investigate role of GABA and other metabolic alterations in TLE. We demonstrated that GABA, NAA, NAA+NAAG, and Glu levels in MTL were significantly different between epileptic and contralateral sides, and increasing index of GABA values is associated with increasing index of seizure frequency. These findings suggested that GABA is an effective biomarker for lateralization and therapeutic effect monitoring in patients with MRI-negative TLE.

jiachen Li¹, jing Zhang¹, wanjun Hu¹, guangyao Liu¹, liang Zhou¹, and kai Ai^2
1Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou, China, ²Philips Healthcare, Xi'an, China

Keywords: Epilepsy, Diffusion/other diffusion imaging techniques

To investigate the relationship between changes in brain networks and changes in emotion and cognition in patients with temporal lobe epilepsy. We used Diffusion spectrum imaging to construct structural brain networks. Then graph-theoretical analysis was applied to estimate structural connectivity and network properties in temporal lobe epilepsy (TLE) patients. Our study found that the brain network connectivity is altered and this alteration is associated with cognitive decline in TLE patients. This result offers a complementary understanding of neuropathology mechanism of TLE and its related cognition alteration, which may be helpful for clinical diagnosis and prognosis evaluation.

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Yuting Li¹, Leiyu Geng², Hong Ge², Wenbo Zhang³, Siyuan Wu³, and Shenghong Ju^2
1Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, China, ²Zhongda Hospital, Medical School of Southeast University, Nanjing, China, ³Medical School of Southeast University, Nanjing, China

Keywords: Epilepsy, MR Fingerprinting

Conventional MRI is limited in diagnosis of subtle epileptic lesions. Therefore, this study aimed to localize epileptic lesions by using MRF technology. Twenty epilepsy patients were included which underwent T1, T2 and MRF examinations. The MRI were spatially normalized to the symmetric ICBM-152 template, followed by transformation of T1 and T2 MRF maps. Absolute asymmetric index (|AI|) analysis was then performed on T1 and T2 MRF maps to detect epileptic lesions. Results showed that the |AI| analysis can detect epileptogenic foci in 75% of patients. In conclusion, the asymmetry analysis could help improve epileptic focus localization in clinical practice.

Yang Fan¹, JIA Wen xiao¹, HANJIAERBIEKE KUKUN¹, WANG Shao yu², and WANG Yun ling^1
1Department of Radiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China, ²MR Scientific Marketing MR Scientific Marketing, Shanghai, China

Keywords: Epilepsy, fMRI (resting state)

Rs-fMRI technology provides a range of analytical approaches that expand the scope of epilepsy research, and these algorithms provide unique views on pathophysiological processes that complement each other in interpreting regional spontaneous brain activity. ALFF, fALFF and ReHo can effectively identify MRI negative TLE (MRIn TLE) patients based on support vector machine algorithm. We hypothesized that there were abnormal changes in DMN-related brain regions in MRIn TLE patients, and the brain function indexes of angular gyrus, precuneus, and inferior parietal angular gyrus could distinguish MRIn TLE patients from HC.

Xuyang Yin¹, Jianhong Wang², Yanwei Zeng¹, Zhenxu Xiao², Junyan Fu¹, Qianhua Zhao², Ding Ding², and Jun Zhang^1
1Radiology Department, Huashan Hospital, Shanghai, China, ²Neurology Department, Huashan Hospital, Shanghai, China

Keywords: Epilepsy, Arterial spin labelling

Older adults with epilepsy accompanied by cognitive impairment represent a huge proportion, which calls for novel clinical techniques for early diagnosis and intervention. By applying pseudo-continuous arterial spin labeling (PCASL), we identified whole-brain voxel-based perfusion pattern of epilepsy associated with cognitive impairment, and explored correlations between cerebral blood flow (CBF) and domain-specific cognitive performance. The enrolled patients exhibited decreased CBF mostly in the bilateral frontal lobes, and there were positive associations between mean CBF and memory as well as executive function. Therefore, CBF measured by PCASL may be a useful indicator for cognitive performance in older adults with MRI-negative epilepsy.

jiachen Li¹, jing Zhang¹, wanjun Hu¹, guangyao Liu¹, liang Zhou¹, and kai Ai^2
1Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou, China, ²Philips Healthcare, Xi'an, China

Keywords: Epilepsy, fMRI (resting state)

To investigate the structural and functional changes of the Temporal Lobe Epilepsy (TLE) patients, voxel-based morphometry (VBM) and resting-state functional MRI (rs-fMRI) methods were used. Our findings showed that thalamus gray matter volume decreased and performed negative correlation with self-rating anxiety scale (SAS) and self-rating depression scale (SDS). Furthermore, in rs-fMRI analysis, we found decreased functional connectivity between bilateral thalamus and right superior frontal gyrus. The results suggested that thalamus plays an important role in emotional change in TLE patients and structural and functional alterations may be related to the pathological mechanism of TLE. 

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Yi-Jing Juan¹, Xiao Zhen¹, Po‑Chun Chu², You-Yin Chen³, Hao-Li Liu², and Jyh-Horng Chen^2
1Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei City, Taiwan, ²Department of Electrical Engineering, National Taiwan University, Taipei City, Taiwan, ³Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Hsinchu City, Taiwan

Keywords: Epilepsy, fMRI (resting state), Focused Ultrasound, Neuromodulation, EEG

A drug-induced epileptic animal model to investigate the feasibility of FUS neuromodulation with rs-fMRI and EEG

Xuyang Yin¹, Jianhong Wang², Yanwei Zeng¹, Zhenxu Xiao², Junyan Fu¹, Qianhua Zhao², Ding Ding², and Jun Zhang^1
1Radiology Department, Huashan Hospital, Shanghai, China, ²Neurology Department, Huashan Hospital, Shanghai, China

Keywords: Epilepsy, Arterial spin labelling

The early identification, evaluation and intervention are important for older people with epilepsy, which calls for techniques of high convenience, repeatability and practicality in clinical application. By applying arterial spin labeling (ASL), we detected perfusion differences between older people with epilepsy and healthy controls on whole-brain voxel-based level, and conducted linear regression between cerebral blood flow (CBF) and duration of epilepsy. Our findings revealed a mixed perfusion pattern for older people with epilepsy, and the significant correlation between CBF and duration of epilepsy. Therefore, ASL has potential value in early diagnosis and evaluation of seizure activity and severity for epilepsy.

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Maria Celeste Bonacci¹, Maria Eugenia Caligiuri¹, Ilaria Sammarra², Tobias Kober³, Domenico Zacà⁴, Francesco Fortunato², and Antonio Gambardella^2
1Neuroscience Research Center, Università degli Studi Magna Graecia di Catanzaro, Catanzaro, Italy, ²Institute of Neurology, Università degli Studi Magna Graecia di Catanzaro, Catanzaro, Italy, ³Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland, ⁴Siemens Healthcare, Milan, Italy

Keywords: Epilepsy, Quantitative Imaging

The use of qMRI techniques in the routine imaging assessment of epilepsy patients may improve sensitivity in detecting subtle MRI abnormalities which can further aid lateralization and localization of the epileptogenic zone. T2 relaxometry might be a promising tool for a better and non-invasive lateralization of the epileptogenic zone, as well as for identifying lesions that are not visible on standard MRI.

Yu Yin¹ and Heng Liu^1
1the Affiliated Hospital of Zunyi Medical University, Zunyi, China

Keywords: Epilepsy, fMRI (resting state)

Combining structural and functional neuroimaging analyses with brain transcriptional data, the present study investigated GMV and fALFF changes in children with RE as well as their underlying gene transcriptional profiles. VBM and fALFF analyses showed altered GMV and fALFF in brain regions associated with behavioral and cognitive regulation. Transcription-neuroimaging spatial correlation analyses further identified genes correlated with GMV and fALFF changes in RE, respectively. Moreover, functional enrichment analysis demonstrated that RE-related genes were enriched for the regulation of biological process. These findings may provide us with important knowledge for understanding the pathophysiological basis of this disease.

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Biao Qu¹, Hejuan Tan², Min Xiao², Dongbao Liu³, Shijin Wang⁴, Yiwen Zhang⁵, Runhan Chen⁶, Gaofeng Zheng¹, Yonggui Yang⁷, Gen Yan⁷, and Xiaobo Qu^3
1Department of Instrumental and Electrical Engineering, Xiamen University, Xiamen, China, ²Institute of Artificial Intelligence, Xiamen University, Xiamen, China, ³Biomedical Intelligent Cloud R&D Center, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, Department of Electronic Science, Xiamen University, Xiamen, China, ⁴Department of Information & Computational Mathematics, Xiamen University, Xiamen, China, ⁵Department of Neurology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China, ⁶National Institute for Data Science in Health and Medicine, Xiamen University, Xiamen, China, ⁷Department of Radiology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China

Keywords: Epilepsy, Brain

The study explored the diagnostic utility of different field strengths for the temporal lobe epilepsy (TLE) with 1H magnetic resonance spectroscopy (1H-MRS) which could be utilized to examine the concentrations of related metabolites. Four ratios of brain metabolites, including NAA/Cr, NAA/Cho, NAA/(Cho+Cr) and Cho/Cr were introduced to four control experiments with the Mann-Whitney U Test, the power analysis and the Paired T-Test adopted. Results suggested that 1.5T and 3.0T scanners might have comparable potential in distinguishing TLEs from HCs when 1H-MRS was used to identify patients with TLE.

Antonio Napolitano¹, Chiara Parrillo¹, Giulia Baldassari¹, Daniela Longo¹, Maria Camilla Rossi Espagnet¹, and Lorenzo Figa' Talamanca^1
1Bambino Gesù Children's Hospital, Rome, Italy

Keywords: Epilepsy, Diffusion/other diffusion imaging techniques, NODDI

Protocadherin 19 (PCDH19)-clustering epilepsy (PCDH19-CE) is a genetic form of epilepsy caused by a mutation of PCDH19-CE gene that begins in the first year of life. Patients with this disorder may present intellectual disability, behavioral problems and motor and language delay. Using advanced Magnetic Resonance Imaging (MRI) methods we were able to highlight microstructural changes of brain in PCDH patients. These results shows that Neurite orientation dispersion and density imaging (NODDI) techniques might be useful tools to investigate PCDH19 anomalous arborization.

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Mark J. Lowe¹, Jian Lin¹, Ajay Nemani¹, Spencer Morris², Balu Krishnan², David Martinez², Juan Bulacio², Stephen Jones¹, Imad Najm², and Irene Wang^2
1Imaging Institute, Cleveland Clinic, Cleveland, OH, United States, ²Neurologic Institute, Cleveland Clinic, Cleveland, OH, United States

Keywords: Epilepsy, fMRI (resting state)

In this study, using a limited sample size, we establish with 95% confidence that epileptogenic and non-epileptogenic periventricular nodular heterotopias can be distinguished based on their relative resting state connectivity