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Breath-Hold-Triggered BOLD fMRI in Drug-Resistant Nonlesional Focal Epilepsy—A Pilot Study

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Názov: Breath-Hold-Triggered BOLD fMRI in Drug-Resistant Nonlesional Focal Epilepsy—A Pilot Study
Autori: Christian M. Boßelmann, Josua Kegele, Leonie Zerweck, Uwe Klose, Silke Ethofer, Constantin Roder, Alexander M. Grimm, Till-Karsten Hauser
Zdroj: Clin Neuroradiol
Informácie o vydavateľovi: Springer Science and Business Media LLC, 2023.
Rok vydania: 2023
Predmety: Male, Adult, Drug Resistant Epilepsy, Respiratory-Gated Imaging Techniques, Reproducibility of Results, Pilot Projects, Cerebrovascular reactivity, Breath-hold, Feasibility Studies [MeSH], Original Article, Sensitivity and Specificity [MeSH], Epilepsies, Partial/physiopathology [MeSH], Male [MeSH], Epilepsy surgery, Drug Resistant Epilepsy/diagnostic imaging [MeSH], Female [MeSH], Adult [MeSH], Humans [MeSH], Prospective Studies [MeSH], Epilepsies, Partial/diagnostic imaging [MeSH], Middle Aged [MeSH], Cerebrovascular Circulation/physiology [MeSH], Drug Resistant Epilepsy/physiopathology [MeSH], Neuroimaging, Reproducibility of Results [MeSH], Drug Resistant Epilepsy/surgery [MeSH], Pilot Projects [MeSH], Young Adult [MeSH], Magnetic Resonance Imaging/methods [MeSH], Single-Blind Method [MeSH], Respiratory-Gated Imaging Techniques/methods [MeSH], Epilepsies, Partial/surgery [MeSH], Breath Holding [MeSH], Presurgical evaluation, Middle Aged, Magnetic Resonance Imaging, Sensitivity and Specificity, 3. Good health, Breath Holding, Young Adult, Cerebrovascular Circulation, Humans, Feasibility Studies, Female, Single-Blind Method, Epilepsies, Partial, Prospective Studies
Popis: Purpose Individuals with drug-resistant epilepsy may benefit from epilepsy surgery. In nonlesional cases, where no epileptogenic lesion can be detected on structural magnetic resonance imaging, multimodal neuroimaging studies are required. Breath-hold-triggered BOLD fMRI (bh-fMRI) was developed to measure cerebrovascular reactivity in stroke or angiopathy and highlights regional network dysfunction by visualizing focal impaired flow increase after vasodilatory stimulus. This regional dysfunction may correlate with the epileptogenic zone. In this prospective single-center single-blind pilot study, we aimed to establish the feasibility and safety of bh-fMRI in individuals with drug-resistant non-lesional focal epilepsy undergoing presurgical evaluation. Methods In this prospective study, 10 consecutive individuals undergoing presurgical evaluation for drug-resistant focal epilepsy were recruited after case review at a multidisciplinary patient management conference. Electroclinical findings and results of other neuroimaging were used to establish the epileptogenic zone hypothesis. To calculate significant differences in cerebrovascular reactivity in comparison to the normal population, bh-fMRIs of 16 healthy volunteers were analyzed. The relative flow change of each volume of interest (VOI) of the atlas was then calculated compared to the flow change of the whole brain resulting in an atlas of normal cerebral reactivity. Consequently, the mean flow change of every VOI of each patient was tested against the healthy volunteers group. Areas with significant impairment of cerebrovascular reactivity had decreased flow change and were compared to the epileptogenic zone localization hypothesis in a single-blind design. Results Acquisition of bh-fMRI was feasible in 9/10 cases, with one patient excluded due to noncompliance with breathing maneuvers. No adverse events were observed, and breath-hold for intermittent hypercapnia was well tolerated. On blinded review, we observed full or partial concordance of the local network dysfunction seen on bh-fMRI with the electroclinical hypothesis in 6/9 cases, including cases with extratemporal lobe epilepsy and those with nonlocalizing 18F-fluorodeoxyglucose positron emission tomography (FDG-PET). Conclusion This represents the first report of bh-fMRI in individuals with epilepsy undergoing presurgical evaluation. We found bh-fMRI to be feasible and safe, with a promising agreement to electroclinical findings. Thus, bh-fMRI may represent a potential modality in the presurgical evaluation of epilepsy. Further studies are needed to establish clinical utility.
Druh dokumentu: Article
Other literature type
Jazyk: English
ISSN: 1869-1447
1869-1439
DOI: 10.1007/s00062-023-01363-2
DOI: 10.15496/publikation-104855
Prístupová URL adresa: https://pubmed.ncbi.nlm.nih.gov/38082172
https://repository.publisso.de/resource/frl:6518140
Rights: CC BY
Prístupové číslo: edsair.doi.dedup.....9c7ab4f73d3e3a6ec1e3126da4c344f2
Databáza: OpenAIRE
Popis
Abstrakt:Purpose Individuals with drug-resistant epilepsy may benefit from epilepsy surgery. In nonlesional cases, where no epileptogenic lesion can be detected on structural magnetic resonance imaging, multimodal neuroimaging studies are required. Breath-hold-triggered BOLD fMRI (bh-fMRI) was developed to measure cerebrovascular reactivity in stroke or angiopathy and highlights regional network dysfunction by visualizing focal impaired flow increase after vasodilatory stimulus. This regional dysfunction may correlate with the epileptogenic zone. In this prospective single-center single-blind pilot study, we aimed to establish the feasibility and safety of bh-fMRI in individuals with drug-resistant non-lesional focal epilepsy undergoing presurgical evaluation. Methods In this prospective study, 10 consecutive individuals undergoing presurgical evaluation for drug-resistant focal epilepsy were recruited after case review at a multidisciplinary patient management conference. Electroclinical findings and results of other neuroimaging were used to establish the epileptogenic zone hypothesis. To calculate significant differences in cerebrovascular reactivity in comparison to the normal population, bh-fMRIs of 16 healthy volunteers were analyzed. The relative flow change of each volume of interest (VOI) of the atlas was then calculated compared to the flow change of the whole brain resulting in an atlas of normal cerebral reactivity. Consequently, the mean flow change of every VOI of each patient was tested against the healthy volunteers group. Areas with significant impairment of cerebrovascular reactivity had decreased flow change and were compared to the epileptogenic zone localization hypothesis in a single-blind design. Results Acquisition of bh-fMRI was feasible in 9/10 cases, with one patient excluded due to noncompliance with breathing maneuvers. No adverse events were observed, and breath-hold for intermittent hypercapnia was well tolerated. On blinded review, we observed full or partial concordance of the local network dysfunction seen on bh-fMRI with the electroclinical hypothesis in 6/9 cases, including cases with extratemporal lobe epilepsy and those with nonlocalizing 18F-fluorodeoxyglucose positron emission tomography (FDG-PET). Conclusion This represents the first report of bh-fMRI in individuals with epilepsy undergoing presurgical evaluation. We found bh-fMRI to be feasible and safe, with a promising agreement to electroclinical findings. Thus, bh-fMRI may represent a potential modality in the presurgical evaluation of epilepsy. Further studies are needed to establish clinical utility.
ISSN:18691447
18691439
DOI:10.1007/s00062-023-01363-2