Manish N Shah1, Anish Mitra2, Manu S Goyal2, Abraham Z Snyder2,3, Jing Zhang4, Joshua S Shimony2, David D Limbrick5, Marcus E Raichle2,3,6,7, Matthew D Smyth5. 1. Departments of Pediatric Surgery and Neurosurgery, McGovern Medical School at UTHealth, 6431 Fannin St, MSB 5.144, Houston, TX, 77030, USA. manish.n.shah@uth.tmc.edu. 2. Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, 63110, USA. 3. Department of Neurology, Washington University School of Medicine, St. Louis, MO, 63110, USA. 4. Departments of Pediatric Surgery and Neurosurgery, McGovern Medical School at UTHealth, 6431 Fannin St, MSB 5.144, Houston, TX, 77030, USA. 5. Department of Neurological Surgery, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO, 63110, USA. 6. Department of Biomedical Engineering, Washington University School of Medicine, St. Louis, MO, 63110, USA. 7. Department of Anatomy and Neurobiology, Washington University School of Medicine, St. Louis, MO, 63110, USA.
Abstract
PURPOSE: Temporal lobe epilepsy (TLE) affects resting state brain networks in adults. This study aims to correlate resting state functional MRI (rsMRI) signal latency in pediatric TLE patients with their laterality. METHODS: From 2006 to 2016, 26 surgical TLE patients (12 left, 14 right) with a mean age of 10.7 years (range 0.9-18) were prospectively studied. Preoperative rsMRI was obtained in patients with concordant lateralizing structural MRI, EEG, and PET studies. Standard preprocessing techniques and seed-based rsMRI analyses were performed. Additionally, the latency in rsMRI signal between each 6 mm voxel sampled was examined, compared to the global mean signal, and projected onto standard atlas space for individuals and the cohort. RESULTS: All but one of the 26 patients improved seizure frequency postoperatively with a mean follow-up of 2.9 years (range 0-7.7), with 21 patients seizure-free. When grouped for epileptogenic laterality, the latency map qualitatively demonstrated that the right TLE patients had a relatively early signal pattern, whereas the left TLE patients had a relatively late signal pattern compared to the global mean signal in the right temporal lobe. Quantitatively, the two groups had significantly different signal latency clusters in the bilateral temporal lobes (p < 0.001). CONCLUSION: There are functional MR signal latency changes in medical refractory pediatric TLE patients. Qualitatively, signal latency in the right temporal lobe precedes the mean signal in right TLE patients and is delayed in left TLE patients. With larger confirmatory studies, preoperative rsMRI latency analysis may offer an inexpensive, noninvasive adjunct modality to lateralize pediatric TLE.
PURPOSE:Temporal lobe epilepsy (TLE) affects resting state brain networks in adults. This study aims to correlate resting state functional MRI (rsMRI) signal latency in pediatric TLEpatients with their laterality. METHODS: From 2006 to 2016, 26 surgical TLEpatients (12 left, 14 right) with a mean age of 10.7 years (range 0.9-18) were prospectively studied. Preoperative rsMRI was obtained in patients with concordant lateralizing structural MRI, EEG, and PET studies. Standard preprocessing techniques and seed-based rsMRI analyses were performed. Additionally, the latency in rsMRI signal between each 6 mm voxel sampled was examined, compared to the global mean signal, and projected onto standard atlas space for individuals and the cohort. RESULTS: All but one of the 26 patients improved seizure frequency postoperatively with a mean follow-up of 2.9 years (range 0-7.7), with 21 patientsseizure-free. When grouped for epileptogenic laterality, the latency map qualitatively demonstrated that the right TLEpatients had a relatively early signal pattern, whereas the left TLEpatients had a relatively late signal pattern compared to the global mean signal in the right temporal lobe. Quantitatively, the two groups had significantly different signal latency clusters in the bilateral temporal lobes (p < 0.001). CONCLUSION: There are functional MR signal latency changes in medical refractory pediatric TLEpatients. Qualitatively, signal latency in the right temporal lobe precedes the mean signal in right TLEpatients and is delayed in left TLEpatients. With larger confirmatory studies, preoperative rsMRI latency analysis may offer an inexpensive, noninvasive adjunct modality to lateralize pediatric TLE.
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