Abstract
Proton magnetic resonance spectroscopy (1H MRS) is beneficial in the lateralization of the epileptogenic zone in temporal lobe epilepsy; however, its role in extratemporal and, especially, MRI-negative epilepsy has not been established. This study seeks to verify how 1H MRS could help in localizing the epileptogenic zone in patients with MRI-negative extratemporal epilepsy. Seven patients (8–23 years) with MRI-negative refractory focal epilepsy were studied using 1H MRS on a 1.5T MR system. Chemical shift imaging sequence in the transversal plane was directed towards the suspected epileptogenic zone localized by seizure semiology, scalp video/EEG, ictal SPECT and 18FDG-PET. Spectra were evaluated using the program CULICH, and the coefficient of asymmetry was used for quantitative lateralization. MRS detected lateralization in all patients and was able to localize pathology in five. The most frequent findings were decreased ratios of N-acetylaspartate to choline compounds characterized by increasing choline concentration. The localization of the 1H MRS abnormality correlated well with ictal SPECT and subdural mapping. In all cases, histopathological analysis revealed MRI-undetected focal cortical dysplasias. 1H MRS could be more sensitive for the detection of discrete malformations of cortical development than conventional MRI. It is valuable in the presurgical evaluation of patients without MRI-apparent lesions.
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Acknowledgements
Supported by grants from the Grant Agency of Czech Republic, no. 309/02/D076, Internal Grant Agency of Ministry of Health, Czech Republic, no. NF/7411-3 and NR/8843-4, Ministry of Education, Youth and Sport, Czech Republic LC554, and research projects no. 00000064203-4, 111300003, 111300004 and MZO 00023001.
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Pavel Krsek and Milan Hajek contributed equally to this work.
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Krsek, P., Hajek, M., Dezortova, M. et al. 1H MR spectroscopic imaging in patients with MRI-negative extratemporal epilepsy: correlation with ictal onset zone and histopathology. Eur Radiol 17, 2126–2135 (2007). https://doi.org/10.1007/s00330-007-0594-1
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DOI: https://doi.org/10.1007/s00330-007-0594-1