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Ting-Yu Su^1,2, Siyuan Hu², Xiaofeng Wang³, Sophie Adler⁴, Konrad Wagstyl⁵, Zheng Ding^1,2, Joon Yul Choi¹, Ken Sakaie⁶, Ingmar Blümcke^1,7, Hiroatsu Murakami¹, Stephen Jones⁶, Imad Najm¹, Dan Ma², and Zhong Irene Wang^1
1Epilepsy Center, Neurological Institute, 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, ⁴University College London Great Ormond Street Institute for Child Health, London, United Kingdom, ⁵Wellcome Centre for Human Neuroimaging, London, United Kingdom, ⁶Imaging Institute, Cleveland Clinic, Cleveland, OH, United States, ⁷Neuropathology, University Hospitals Erlangen, Erlangen, Germany

Keywords: Epilepsy, MR Fingerprinting

Focal cortical dysplasia (FCD) is a common pathology in medically intractable focal epilepsy and often difficult to detect by visual inspection of conventional MRI. We developed a framework for automatic FCD detection using surface-based processing of conventional MRI and MR fingerprinting data. Thirty-six patients with FCD and 48 healthy controls were included. Improved vertex-wise and cluster-wise performance was seen when MRF and FLAIR features were added to T1w data. A second-stage cluster-wise classifier showed efficacy to reduce false-positive clusters. Interim results of patient-level sensitivity of 76% and low false-positive clusters in controls supported potential clinical applicability of the proposed framework.

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Keywords: Epilepsy, Metabolism, fMRI, Hypoxia

Intractable temporal lobe epilepsy, often acquired after status epilepticus (SE) injury, greatly reduces quality of life.  There is an unmet need for a non-invasive method to track progression from SE to epilepsy, which would allow early intervention to prevent irreversible damage to the brain. Mitochondrial dysfunction is becoming a recognized marker of epileptogenesis. Here, we established a novel functional MRI methodology, the 4D Oxy-wavelet MRI, capable of in vivo detection of mitochondrial dysfunction underlying post-SE epileptogenesis in a spatial specific manner. This non-invasive method may aid early detection of subclinical epileptogenesis and serve as a biomarker for therapeutic efficacy.    

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Gilbert Hangel^1,2,3, Gregor Kasprian⁴, Stefanie Chambers^1,2, Lukas Haider⁴, Philipp Lazen^1,2, Johannes Koren⁵, Robert Diehm⁶, Katharina Moser⁶, Matthias Tomschik¹, Jonathan Wais¹, Fabian Winter¹, Vitalij Zeiser¹, Stephan Gruber², Susanne Aull-Watschinger⁷, Tatjana Traub-Weidinger⁸, Christoph Baumgartner⁵, Martha Feucht⁶, Christian Dorfer¹, Wolfgang Bogner², Siegfried Trattnig², Ekaterina Pataraia⁷, and Karl Rössler^1
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, ³Christian Doppler Laboratory for MR Imaging Biomarkers, Vienna, Austria, ⁴Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria, ⁵Department of Neurology, Klinik Hietzing, Vienna, Austria, ⁶Center for Rare and Complex Childhood Onset Epilepsies, Member of ERN EpiCARE, Department of Pediatrics and, Medical University of Vienna, 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, Wien, Austria

Keywords: Epilepsy, Brain

In a cohort of 38 patients with pharmacoresistant focal epilepsy, our implementation of the 2021 ILAE 7T consensus protocol found lesions in 19% of 3T MR-negative cases and improved delineation of lesions in 88% of 3T MR-positive cases, with statistically significant higher detection confidence at 7T. Our results conform to literature and show the surplus effect of the consensus protocol in addition to clinical standard diagnostics and point at a potential main use of better surgical planning in known lesions.

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Keywords: Epilepsy, Metabolism

We combined quantitative susceptibility mapping (QSM) and single voxel (SV) 1H magnetic resonance spectroscopy (MRS) at 7 tesla (7T) with the aim to characterize mesial temporal lobe epilepsy (mTLE). We discovered in 9 patients that the distribution of quantified susceptibly is negatively skewed in epileptogenic hippocampi compared to contralateral hippocampi, meaning more positive susceptibility values: an indicator for iron deposition. No differences in metabolite ratios could be seen in 7 patients between hippocampi, however our small sample size precludes any final conclusions.

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Jon Orlando Cleary¹, Samuel Rot^2,3, Michael Ayre^4,5,6, Philippa Bridgen⁶, Ayse Sila Dokumaci^5,6, Yasmin Blunck⁷, Warda Syeda⁸, Bhavana S Solanky^2,9, Shaihan J Malik^5,6, Ming Lim⁴, Claudia A.M. Gandini Wheeler-Kingshott^2,10,11, Shan-Shan Tang⁴, and David W Carmichael^5,6
1Department of Radiology, Imperial College Healthcare NHS Trust, London, United Kingdom, ²MR Research Unit, Queen Square MS Centre, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, London, United Kingdom, ³Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom, ⁴Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom, ⁵Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom, ⁶London Collaborative Ultra High Field System (LoCUS), London, United Kingdom, ⁷Melbourne Brain Centre Imaging Unit, The University of Melbourne, Parkville, Melbourne, Australia, ⁸Melbourne Neuropsychiatry Centre, The University of Melbourne, Parkville, Melbourne, Australia, ⁹Quantitative Imaging Group, Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom, ¹⁰Department of Brain & Behavioural Sciences, University of Pavia, Pavia, Italy, ¹¹Brain Connectivity Centre Research Department, IRCCS Mondino Foundation, Pavia, Italy

Keywords: Epilepsy, Non-Proton, brain, sodium MRI, high-field MRI, SCN1A

SCN1A gene mutations disrupt sodium channel (Na_V1.1) function, causing childhood epilepsy which can be severe. Predicting functional consequences in these children is challenging and new prognostic imaging biomarkers are needed. Sodium MRI directly assesses brain sodium and is a potential in vivo imaging biomarker. Using a multiecho sodium sequence, at 7T, we found children with SCN1A mutations had increased relative sodium concentrations across a large number of brain regions compared to controls. The cause of this change is likely complex, and may reflect an interplay between neuronal/axonal/glial dysfunction – with disruptions in microstructure and physiology – and possible medication effects.

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Mackenzie Langan^1,2, Gauarv Verma², Madeline Fields³, Lara Marcuse³, Priti Balchandani^2,4,5, and Rebecca Feldman^2,6
1Icahn School of Medicine at Mount Sinai, New York, NY, United States, ²Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States, ³Department of Neurology, Mount Sinai Hospital, New York, NY, United States, ⁴Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States, ⁵Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, United States, ⁶Computer Science, Math, Physics, and Statistics, University of British Columbia, Kelowna, BC, Canada

Keywords: Epilepsy, Neuroinflammation, High-Field MRI, perivascular spaces

Here we outline a preliminary analysis using a novel method leveraging ultra-high field neuroimaging to measure detectable differences in vasculature within the temporal lobe that may not be detectable at lower field strengths. We provide a tool for detection and quantification of vessels, perivascular spaces, and volumetric changes within the temporal lobe which may be relevant to uncover possible underlying neuroinflammatory processes in mesial temporal lobe epilepsy (MTLE) patients. In our analysis, we found a significant association between volumetric measures of the temporal lobe and vascular and perivascular markers, in patients with lateralized MTLE which may underlie epileptogenic processes. 

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Paulina Jael Villaseñor¹, Ana Aquiles¹, David Cortes-Servín¹, Aylin Perez-Moriel², Hiram Luna-Munguía¹, Alonso Ramirez-Manzanares², Jorge Larriva-Sahd¹, and Luis Concha^1
1Instituto de Neurobiología, Universidad Nacional Autónoma de México, Querétaro, Mexico, ²Centro de Investigación en Matemáticas, Guanajuato, Mexico

Keywords: Epilepsy, Microstructure

Focal cortical dysplasias are characterized by abnormal cyto- and myelo- architecture and represent a frequent cause of epilepsy. In some cases these lesions are macroscopically subtle, often going undetected by several conventional imaging techniques, thus warranting the development of alternative imaging methods for their diagnosis.  Novel methods for the analysis of diffusion-weighted imaging permit the investigation of the complex architecture of the cortex. Through spatial analysis of diffusion metrics using a multi-tensor approach we demonstrate abnormalities in an animal model of cortical dysplasia that reflect myeloarchitecture disarrangement as seen by histology.

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Kang Wang¹, Xiaozhi Cao^2,3, Quan Chen^2,3, Zihan Zhou⁴, Dengchang Wu¹, Yunsong Liu⁵, Hongjian He⁴, Jianhui Zhong^4,6, Kawin Setsompop^2,3, and Congyu Liao^2,3
1Department of Neurology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China, ²Department of Radiology, Stanford University, Stanford, CA, United States, ³Department of Electrical Engineering, Stanford University, Stanford, CA, United States, ⁴Center for Brain Imaging Science and Technology, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China, ⁵Signal and Image Processing Institute, University of Southern California, Los Angeles, CA, United States, ⁶Department of Imaging Sciences, University of Rochester, Rochester, NY, United States

Keywords: Epilepsy, Epilepsy

In this work, we combined a 5-minute whole-brain 0.86mm-iso 3D-MR fingerprinting (MRF) with a 10-minute whole-brain 0.86mm-iso diffusion MRI protocol, to achieve high-fidelity whole-brain T₁/T₂/PD and diffusivity maps at sub-millimeter isotropic resolution. This protocol was applied to medial temporal lobe epilepsy (MTLE) patients to enable accurate detection of the hippocampal sclerosis. A multi-parametric analysis was implemented with whole-brain subcortical segmentation. A multi-component 2D-relaxometry spectra was estimated with non-negative joint sparsity for robust suspicious lesion detection.

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Xu Zhao¹, Zhiqiang Zhou¹, and Wenzhen Zhu^1
1Tongji hospital of Tongji medical college, Huazhong university of science and technology, Wuhan, China

Keywords: Epilepsy, Diffusion Tensor Imaging, glymphatic system, asymmetry

The alterations of glymphatic system function in left hemisphere and right hemisphere and the asymmetric features of glymphatic system were not clear in temporal lobe epilepsy (TLE) patients. We investigated the glymphatic system function in TLE patients and evaluated the asymmetric features of glymphatic system by using DTI-ALPS method. Our findings indicated leftward asymmetric tendency of glymphatic system in adult human brain. The abnormality of glymphatic system asymmetry in LTLE was also found. The glymphatic system function was impaired and more severe alterations of glymphatic system in ipsilateral hemisphere than contralateral hemisphere in TLE patients.

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Chuan Huang^1,2, Tianyun Zhao², Siyu Yuan³, Hui Huang³, Miao Zhang⁴, and Jie Luo^3
1Radiology, Stony Brook Medicine, Stony Brook, NY, United States, ²Biomedical Engineering, Stony Brook University, Stony Brook, NY, United States, ³School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China, ⁴Department of Nuclear Medicine, Ruijin Hospital, Shanghai, China

Keywords: Epilepsy, Epilepsy

Mesial temporal lobe epilepsy is the most common type of drug-resistant epilepsy, with hippocampus sclerosis (HS) being its most common pathology. Anterior temporal lobectomy is the most common surgical strategy for these patients, many still suffer from seizures post-surgery, which may relate to their extensive brain network damage. 18F-FDG-PET is sensitive to metabolic changes in the epileptogenic zone. DTI can assess the integrity of white-matter tracts. In this study, we investigated the changes in glucose uptake, white-matter tracts, and their differences in brain networks of MR-HS versus MR-negative patients using simultaneous PET/MR, and studied if these changes coincide topographically.

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Daniel Uher^1,2,3, Gerhard S. Drenthen^1,2, Tineke van de Weijer², Jochem van der Pol², Rob Rouhl², Olaf E.M.G. Schijns^1,3,4, Albert J. Colon⁴, Walter H. Backes^1,2, and Jacobus F.A. Jansen^1,2,4,5
1School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands, ²Department of Radiology & Nuclear Medicine, Maastricht University Medical Centre, Maastricht, Netherlands, ³Department of Neurosurgery, Maastricht University Medical Centre, Maastricht, Netherlands, ⁴Academic Centre for Epileptology, Kempenhaeghe/Maastricht University Medical Centre, Maastricht, Netherlands, ⁵Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands

Keywords: Epilepsy, PET/MR

Locally reduced glucose metabolism (i.e. hypometabolism) derived from the 18-FDG positron emission tomography (FDG-PET) is considered to be a valuable biomarker for epileptogenic zone localization. Spontaneous fluctuations in blood-oxygen-level-dependent fMRI (BOLD fMRI) can indirectly measure neuronal activity. Studies have suggested that the fMRI-derived metrics may be indicative of the epileptogenic zone localization, however the potential for fMRI to reflect and lateralize the hypometabolic FDG-PET regions remains underdetermined. Here, both static and dynamic fMRI-derived metrics were calculated and we assessed their potential for lateralizing the hypometabolic FDG-PET regions in patients with unilateral focal epilepsy.

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Rosa Sanchez-Panchuelo¹, Nigel Paul Davies¹, Roya Jalali¹, Roman Wesolowski¹, Robert Flintham¹, and Vijay Sawlani^2
1Medical Physics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom, ²Radiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom

Keywords: Epilepsy, fMRI (task based), Memory function; Pre-surgical assessment; Clinical implementation; Clinical reliability

Memory-activated functional MRI (fMRI) is increasingly implemented in the clinic to assess memory function and inform pre-surgical decision making in refractory epilepsy. The Home Town Walking (HTW) fMRI paradigm has been shown to activate the parahippocampal gyri (PHG) and help determine memory lateralization in epilepsy patients. However, limited data are available on the reliability of this technique in clinical practice. This study aims to assess the robustness of the HTW paradigm for localising and lateralising memory function in a consecutive clinical series of 117 Temporal Lobe Epilepsy patients. Memory-related activation patterns were observed in 76% of cases with 94% reproducibility.

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Keywords: Epilepsy, Segmentation, Deep brain stimulation targeting

We present a patient-specific segmentation method for targeting the centromedian nucleus for epilepsy deep brain stimulation and compare it to an atlas-based indirect targeting method in 8 patients.

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David N Vaughan^1,2, Eric Y Pierre¹, Marty Bryant¹, David F Abbott¹, Heath R Pardoe¹, Warda T Syeda³, Bahman Tahayori¹, Chris Tailby^1,4, and Graeme D Jackson^1,2
1Florey Institute of Neuroscience and Mental Health, Melbourne, Australia, ²Department of Neurology, Austin Health, Melbourne, Australia, ³Division of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia, ⁴Department of Neuropsychology, Austin Health, Melbourne, Australia

Keywords: Epilepsy, Quantitative Susceptibility mapping

Magnetic susceptibility of subcortical grey matter regions was assessed in participants of the Australian Epilepsy Project pilot study. Adults with medication-resistant focal epilepsy were compared to those with newly-diagnosed focal epilepsy, and to people with a single seizure but no epilepsy diagnosis.  Basal ganglia, thalamus, hippocampi and amygdala showed susceptibility values consistent with published values, with a positive correlation to age seen at the basal ganglia. There was no significant difference in subcortical susceptibility between the groups. Although other brain network changes may progress with refractory seizures, mineralisation of subcortical regions appears generally stable over the course of focal epilepsy.

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Jiwei Li¹, Hui Huang¹, Bingyang Cai¹, Siyu Yuan¹, and Jie Luo^1
1School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China

Keywords: Epilepsy, Tissue Characterization

Imaging transcriptomics could bridge the gap between connectome and transcriptome. In this study, we selected brain regions that were vulnerable to hypometabolism, and those vulnerable to atrophy, then investigated transcriptional signatures and cell-type composition differences that may contribute to TLE-related brain structural and metabolic changes. We found hippocampus and entorhinal were found to be most vulnerable brain regions in both anatomical and metabolic changes in TLE patients. Enrichment analysis found that differential expression genes most significantly enriched in neuroactive ligand-receptor interaction pathway. Inhibitory neuron, microglia and oligodendrocyte precursor cells showed significant difference between vulnerable regions and relatively healthy regions.