1
|
Li S, Guo K, Wang Y, Wu D, Wang Y, Feng L, Wang J, Meng X, Ma L, He H, Kang F. Evaluating the Efficacy of CortexID Quantitative Analysis in Localization of the Epileptogenic Zone in Patients with Temporal Lobe Epilepsy. Neurol Ther 2024; 13:1403-1414. [PMID: 39093538 PMCID: PMC11393372 DOI: 10.1007/s40120-024-00646-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 07/02/2024] [Indexed: 08/04/2024] Open
Abstract
INTRODUCTION There remains a critical need for precise localization of the epileptogenic foci in individuals with drug-resistant epilepsy (DRE). 18F-Fluorodeoxyglucose positron emission tomography (FDG-PET) imaging can reveal hypometabolic regions during the interval between seizures in patients with epilepsy. However, visual-based qualitative analysis is time-consuming and strongly influenced by physician experience. CortexID Suite is a quantitative analysis software that helps to evaluate PET imaging of the human brain. Therefore, we aimed to evaluate the efficacy of CortexID quantitative analysis in the localization of the epileptogenic zone in patients with temporal lobe epilepsy (TLE). METHODS A total of 102 patients with epilepsy who underwent 18F-FDG-PET examinations were included in this retrospective study. The PET visual analysis was interpreted by two nuclear medicine physicians, and the quantitative analysis was performed automatically using CortexID analysis software. The assumed epileptogenic zone was evaluated comprehensively by two skilled neurologists in the preoperative assessment of epilepsy. The accuracy of epileptogenic zone localization in PET visual analysis was compared with that in CortexID quantitative analysis. RESULTS The diagnostic threshold for the difference in the metabolic Z-score between the right and left sides of medial temporal lobe epilepsy (MTLE) was calculated as 0.87, and that for lateral temporal lobe epilepsy (LTLE) was 2.175. In patients with MTLE, the area under the curve (AUC) was 0.922 for PET visual analysis, 0.853 for CortexID quantitative analysis, and 0.971 for the combined diagnosis. In patients with LTLE, the AUC was 0.842 for PET visual analysis, 0.831 for CortexID quantitative analysis, and 0.897 for the combined diagnosis. These results indicate that the diagnostic efficacy of CortexID quantitative analysis is not inferior to PET visual analysis (p > 0.05), while combined analysis significantly increases diagnostic efficacy (p < 0.05). Among the 23 patients who underwent surgery, the sensitivity and specificity of PET visual analysis for localization were 95.4% and 66.7%, and the sensitivity and specificity of CortexID quantitative analysis were 100% and 50%. CONCLUSION The diagnostic efficacy of CortexID quantitative analysis is comparable to PET visual analysis in the localization of the epileptogenic zone in patients with TLE. CortexID quantitative analysis combined with visual analysis can further improve the accuracy of epileptogenic zone localization.
Collapse
Affiliation(s)
- Shuangshuang Li
- Department of Neurology, Xijing Hospital of Air Force Military Medical University, Xi'an, 710032, Shaanxi, China
- Medical School, Yan'an University, Yan'an, 716000, Shaanxi, China
| | - Kun Guo
- Department of Nuclear Medicine, Xijing Hospital of Air Force Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Yuanyuan Wang
- Department of Neurology, Xijing Hospital of Air Force Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Dianwei Wu
- Department of Neurology, Xijing Hospital of Air Force Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Yang Wang
- Department of Neurology, Xijing Hospital of Air Force Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Lanlan Feng
- Department of Neurology, Xijing Hospital of Air Force Military Medical University, Xi'an, 710032, Shaanxi, China
- Medical School, Yan'an University, Yan'an, 716000, Shaanxi, China
| | - Junling Wang
- Department of Nuclear Medicine, Xijing Hospital of Air Force Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Xiaoli Meng
- Department of Nuclear Medicine, Xijing Hospital of Air Force Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Lei Ma
- Department of Neurology, Xijing Hospital of Air Force Military Medical University, Xi'an, 710032, Shaanxi, China.
| | - Hua He
- Department of Ultrasound, Xijing 986 Hospital Department, Air Force Military Medical University, Xi'an, 710054, Shaanxi, China.
| | - Fei Kang
- Department of Nuclear Medicine, Xijing Hospital of Air Force Military Medical University, Xi'an, 710032, Shaanxi, China.
| |
Collapse
|
2
|
Cerina V, Crivellaro C, Morzenti S, Pozzi FE, Bigiogera V, Jonghi-Lavarini L, Moresco RM, Basso G, De Bernardi E. A ROI-based quantitative pipeline for 18F-FDG PET metabolism and pCASL perfusion joint analysis: Validation of the 18F-FDG PET line. Heliyon 2024; 10:e23340. [PMID: 38163125 PMCID: PMC10755331 DOI: 10.1016/j.heliyon.2023.e23340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/01/2023] [Indexed: 01/03/2024] Open
Abstract
In Mild Cognitive Impairment (MCI), the study of brain metabolism, provided by 18F-FluoroDeoxyGlucose Positron Emission Tomography (18F-FDG PET) can be integrated with brain perfusion through pseudo-Continuous Arterial Spin Labeling Magnetic Resonance sequences (MR pCASL). Cortical hypometabolism identification generally relies on wide control group datasets; pCASL control groups are instead not publicly available yet, due to lack of standardization in the acquisition parameters. This study presents a quantitative pipeline to be applied to PET and pCASL data to coherently analyze metabolism and perfusion inside 16 matching cortical regions of interest (ROIs) derived from the AAL3 atlas. The PET line is tuned on 36 MCI patients and 107 healthy control subjects, to agree in identifying hypometabolic regions with clinical reference methods (visual analysis supported by a vendor tool and Statistical Parametric Mapping, SPM, with two parametrizations here identified as SPM-A and SPM-B). The analysis was conducted for each ROI separately. The proposed PET analysis pipeline obtained accuracy 78 % and Cohen's к 60 % vs visual analysis, accuracy 79 % and Cohen's к 58 % vs SPM-A, accuracy 77 % and Cohen's к 54 % vs SPM-B. Cohen's к resulted not significantly different from SPM-A and SPM-B Cohen's к when assuming visual analysis as reference method (p-value 0.61 and 0.31 respectively). Considering SPM-A as reference method, Cohen's к is not significantly different from SPM-B Cohen's к as well (p-value = 1.00). The complete PET-pCASL pipeline was then preliminarily applied on 5 MCI patients and metabolism-perfusion regional correlations were assessed. The proposed approach can be considered as a promising tool for PET-pCASL joint analyses in MCI, even in the absence of a pCASL control group, to perform metabolism-perfusion regional correlation studies, and to assess and compare perfusion in hypometabolic or normo-metabolic areas.
Collapse
Affiliation(s)
- Valeria Cerina
- PhD program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Italy
| | - Cinzia Crivellaro
- Nuclear Medicine, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italia
| | - Sabrina Morzenti
- Medical Physics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italia
| | - Federico E. Pozzi
- PhD program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Italy
- Neurology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italia
- Milan center for Neuroscience (NeuroMI), University of Milano-Bicocca, Italy
| | | | | | - Rosa M. Moresco
- School of Medicine and Surgery, University of Milano-Bicocca, Italy
| | - Gianpaolo Basso
- Milan center for Neuroscience (NeuroMI), University of Milano-Bicocca, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Italy
- Neuroradiology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italia
| | | |
Collapse
|
3
|
Bacon EJ, Jin C, He D, Hu S, Wang L, Li H, Qi S. Cortical surface analysis for focal cortical dysplasia diagnosis by using PET images. Heliyon 2024; 10:e23605. [PMID: 38187332 PMCID: PMC10770482 DOI: 10.1016/j.heliyon.2023.e23605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/14/2023] [Accepted: 12/07/2023] [Indexed: 01/09/2024] Open
Abstract
Focal cortical dysplasia (FCD) is a neurological disorder distinguished by faulty brain cell structure and development. Repetitive and uncontrollable seizures may be linked to FCD's aberrant cortical thickness, gyrification, and sulcal depth. Quantitative cortical surface analysis is a crucial alternative to ineffective visual inspection. This study recruited 42 subjects including 22 FCD patients who underwent surgery and 20 healthy controls (HC). For the FCD patients, T1-weighted and PET images were obtained by a PET-MRI scanner, and the confirmed epileptogenic zone (EZ) was collected from postsurgical follow-up. For the HCs, CT and PET images were obtained by a PET-CT scanner. Cortical thickness, gyrification index, and sulcal depth were calculated using a computational anatomical toolbox (CAT12). A cluster-based analysis is carried out to determine each FCD patient's aberrant cortical surface. After parcellating the cerebral cortex into 68 regions by the Desikan-Killiany atlas, a region of interest (ROI) analysis was conducted to know whether the feature in the FCD group is significantly different from that in the HC group. Finally, the features of all ROIs were utilised to train a support vector machine classifier (SVM). The classification performance is evaluated by the leave-one-out cross-validation. The cluster-based analysis can localize the EZ cluster with the highest accuracy of 54.5 % (12/22) for cortical thickness, 40.9 % (9/22) and 13.6 % (3/22) for sulcal depth and gyrification, respectively. Moderate concordance (Kappa, 0.6) is observed between the confirmed EZs and identified clusters by using the cortical thickness. Fair concordance (Kappa, 0.3) and no concordance (Kappa, 0.1) is found by using sulcal depth and gyrification. Significant differences are found in 46 of 68 regions (67.7 %) for the three measures. The trained SVM classifier achieved a prediction accuracy of 95.5 % for the cortical thickness, while the sulcal depth and the gyrification obtained 86.0 % and 81.5 %. Cortical thickness, as determined by quantitative cortical surface analysis of PET data, has a greater ability than sulcal depth and gyrification to locate aberrant EZ clusters in FCD. Surface measures might be different in many regions for FCD and HC. By integrating machine learning and cortical morphologies features, individual prediction of FCD seems to be feasible.
Collapse
Affiliation(s)
- Eric Jacob Bacon
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
- Key Laboratory of Intelligent Computing in Medical Image, Ministry of Education, Northeastern University, Shenyang, China
| | - Chaoyang Jin
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
| | - Dianning He
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
| | - Shuaishuai Hu
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Lanbo Wang
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Han Li
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Shouliang Qi
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
- Key Laboratory of Intelligent Computing in Medical Image, Ministry of Education, Northeastern University, Shenyang, China
| |
Collapse
|
4
|
Flaus A, Jung J, Ostrowky‐Coste K, Rheims S, Guénot M, Bouvard S, Janier M, Yaakub SN, Lartizien C, Costes N, Hammers A. Deep-learning predicted PET can be subtracted from the true clinical fluorodeoxyglucose PET co-registered to MRI to identify the epileptogenic zone in focal epilepsy. Epilepsia Open 2023; 8:1440-1451. [PMID: 37602538 PMCID: PMC10690662 DOI: 10.1002/epi4.12820] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 08/16/2023] [Indexed: 08/22/2023] Open
Abstract
OBJECTIVE Normal interictal [18 F]FDG-PET can be predicted from the corresponding T1w MRI with Generative Adversarial Networks (GANs). A technique we call SIPCOM (Subtraction Interictal PET Co-registered to MRI) can then be used to compare epilepsy patients' predicted and clinical PET. We assessed the ability of SIPCOM to identify the Resection Zone (RZ) in patients with drug-resistant epilepsy (DRE) with reference to visual and statistical parametric mapping (SPM) analysis. METHODS Patients with complete presurgical work-up and subsequent SEEG and cortectomy were included. RZ localisation, the reference region, was assigned to one of eighteen anatomical brain regions. SIPCOM was implemented using healthy controls to train a GAN. To compare, the clinical PET coregistered to MRI was visually assessed by two trained readers, and a standard SPM analysis was performed. RESULTS Twenty patients aged 17-50 (32 ± 7.8) years were included, 14 (70%) with temporal lobe epilepsy (TLE). Eight (40%) were MRI-negative. After surgery, 14 patients (70%) had a good outcome (Engel I-II). RZ localisation rate was 60% with SIPCOM vs 35% using SPM (P = 0.015) and vs 85% using visual analysis (P = 0.54). Results were similar for Engel I-II patients, the RZ localisation rate was 64% with SIPCOM vs 36% with SPM. With SIPCOM localisation was correct in 67% in MRI-positive vs 50% in MRI-negative patients, and 64% in TLE vs 43% in extra-TLE. The average number of false-positive clusters was 2.2 ± 1.3 using SIPCOM vs 2.3 ± 3.1 using SPM. All RZs localized with SPM were correctly localized with SIPCOM. In one case, PET and MRI were visually reported as negative, but both SIPCOM and SPM localized the RZ. SIGNIFICANCE SIPCOM performed better than the reference computer-assisted method (SPM) for RZ detection in a group of operated DRE patients. SIPCOM's impact on epilepsy management needs to be prospectively validated.
Collapse
Affiliation(s)
- Anthime Flaus
- Department of Nuclear MedicineHospices Civils de LyonLyonFrance
- Medical Faculty of Lyon EstUniversity Claude Bernard Lyon 1LyonFrance
- King's College London & Guy's and St Thomas' PET Centre, School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
- Lyon Neuroscience Research CenterINSERM U1028/CNRS UMR5292LyonFrance
| | - Julien Jung
- Lyon Neuroscience Research CenterINSERM U1028/CNRS UMR5292LyonFrance
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, Member of the ERN EpiCARELyon 1 UniversityLyonFrance
| | - Karine Ostrowky‐Coste
- Lyon Neuroscience Research CenterINSERM U1028/CNRS UMR5292LyonFrance
- Department of Pediatric Clinical Epileptology, Sleep Disorders, and Functional NeurologyHospices Civils de Lyon, Member of the ERN EpiCARELyonFrance
| | - Sylvain Rheims
- Lyon Neuroscience Research CenterINSERM U1028/CNRS UMR5292LyonFrance
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, Member of the ERN EpiCARELyon 1 UniversityLyonFrance
| | - Marc Guénot
- Lyon Neuroscience Research CenterINSERM U1028/CNRS UMR5292LyonFrance
- Department of Functional Neurosurgery, Hospices Civils de Lyon, Member of the ERN EpiCARELyon 1 UniversityLyonFrance
| | - Sandrine Bouvard
- Lyon Neuroscience Research CenterINSERM U1028/CNRS UMR5292LyonFrance
| | - Marc Janier
- Department of Nuclear MedicineHospices Civils de LyonLyonFrance
- Medical Faculty of Lyon EstUniversity Claude Bernard Lyon 1LyonFrance
| | - Siti N. Yaakub
- Brain Research & Imaging CentreUniversity of PlymouthPlymouthUK
| | - Carole Lartizien
- INSA‐Lyon, CNRS, Inserm, CREATIS UMR 5220, U1294University Claude Bernard Lyon 1LyonFrance
| | - Nicolas Costes
- Lyon Neuroscience Research CenterINSERM U1028/CNRS UMR5292LyonFrance
- CERMEP‐Life ImagingLyonFrance
| | - Alexander Hammers
- King's College London & Guy's and St Thomas' PET Centre, School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
| |
Collapse
|
5
|
Passaro EA. Neuroimaging in Adults and Children With Epilepsy. Continuum (Minneap Minn) 2023; 29:104-155. [PMID: 36795875 DOI: 10.1212/con.0000000000001242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
OBJECTIVE This article discusses the fundamental importance of optimal epilepsy imaging using the International League Against Epilepsy-endorsed Harmonized Neuroimaging of Epilepsy Structural Sequences (HARNESS) protocol and the use of multimodality imaging in the evaluation of patients with drug-resistant epilepsy. It outlines a methodical approach to evaluating these images, particularly in the context of clinical information. LATEST DEVELOPMENTS Epilepsy imaging is rapidly evolving, and a high-resolution epilepsy protocol MRI is essential in evaluating newly diagnosed, chronic, and drug-resistant epilepsy. The article reviews the spectrum of relevant MRI findings in epilepsy and their clinical significance. Integrating multimodality imaging is a powerful tool in the presurgical evaluation of epilepsy, particularly in "MRI-negative" cases. For example, correlation of clinical phenomenology, video-EEG with positron emission tomography (PET), ictal subtraction single-photon emission computerized tomography (SPECT), magnetoencephalography (MEG), functional MRI, and advanced neuroimaging such as MRI texture analysis and voxel-based morphometry enhances the identification of subtle cortical lesions such as focal cortical dysplasias to optimize epilepsy localization and selection of optimal surgical candidates. ESSENTIAL POINTS The neurologist has a unique role in understanding the clinical history and seizure phenomenology, which are the cornerstones of neuroanatomic localization. When integrated with advanced neuroimaging, the clinical context has a profound impact on identifying subtle MRI lesions or finding the "epileptogenic" lesion when multiple lesions are present. Patients with an identified lesion on MRI have a 2.5-fold improved chance of achieving seizure freedom with epilepsy surgery compared with those without a lesion. This clinical-radiographic integration is essential to accurate classification, localization, determination of long-term prognosis for seizure control, and identification of candidates for epilepsy surgery to reduce seizure burden or attain seizure freedom.
Collapse
|
6
|
Sukprakun C, Tepmongkol S. Nuclear imaging for localization and surgical outcome prediction in epilepsy: A review of latest discoveries and future perspectives. Front Neurol 2022; 13:1083775. [PMID: 36588897 PMCID: PMC9800996 DOI: 10.3389/fneur.2022.1083775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 11/25/2022] [Indexed: 12/23/2022] Open
Abstract
Background Epilepsy is one of the most common neurological disorders. Approximately, one-third of patients with epilepsy have seizures refractory to antiepileptic drugs and further require surgical removal of the epileptogenic region. In the last decade, there have been many recent developments in radiopharmaceuticals, novel image analysis techniques, and new software for an epileptogenic zone (EZ) localization. Objectives Recently, we provided the latest discoveries, current challenges, and future perspectives in the field of positron emission tomography (PET) and single-photon emission computed tomography (SPECT) in epilepsy. Methods We searched for relevant articles published in MEDLINE and CENTRAL from July 2012 to July 2022. A systematic literature review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis was conducted using the keywords "Epilepsy" and "PET or SPECT." We included both prospective and retrospective studies. Studies with preclinical subjects or not focusing on EZ localization or surgical outcome prediction using recently developed PET radiopharmaceuticals, novel image analysis techniques, and new software were excluded from the review. The remaining 162 articles were reviewed. Results We first present recent findings and developments in PET radiopharmaceuticals. Second, we present novel image analysis techniques and new software in the last decade for EZ localization. Finally, we summarize the overall findings and discuss future perspectives in the field of PET and SPECT in epilepsy. Conclusion Combining new radiopharmaceutical development, new indications, new techniques, and software improves EZ localization and provides a better understanding of epilepsy. These have proven not to only predict prognosis but also to improve the outcome of epilepsy surgery.
Collapse
Affiliation(s)
- Chanan Sukprakun
- Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Supatporn Tepmongkol
- Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand,Chulalongkorn University Biomedical Imaging Group (CUBIG), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand,Chula Neuroscience Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand,Cognitive Impairment and Dementia Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand,*Correspondence: Supatporn Tepmongkol ✉
| |
Collapse
|