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Research Article
Ivan Rektor
Brno Epilepsy Center, Department of Neurology, St. Anne’s University Hospital and Medical Faculty of Masaryk University
Corresponding Author
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Drug-resistant epilepsy is a diagnostic and therapeutic challenge, mainly in patients with negative MRI findings. State-of-the-art imaging methods complement standard epilepsy protocols with new information and help to epileptologists to increase reliability of their decisions. In this study, we investigate if arterial spin labeling (ASL) perfusion MRI can help localizing the epileptogenic zone (EZ). To that end, we developed an image processing method to detect the EZ as an area with hypoperfusion relative to the contralateral unaffected side, using subject-specific thresholding of the asymmetry index in ASL images. We demonstrated three thresholding criteria (minimal product criterion, minimal distance criterion, and elbow criterion) on 29 patients with MRI-negative epilepsy (age 32.98 ± 10.4 years). The minimal product criterion showed optimal results in terms of positive predictive value (mean 0.12 and 0.22) and true positive rate (mean 0.71 and 1.82). Additionally, we found high accuracy in determining the EZ side (mean 0.86 and 0.73 out of 1.00). In conclusion, the ASL can be easily incorporated to the standard presurgical MR protocol and it provides an additional benefit in EZ localization.
Keywords
Drug-resistant Epilepsy, Hypoperfusion, Minimal Product Criterion, Minimal Distance Criterion, Elbow Criterion
Figure 1
No competing interests reported.
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CURRENT STATUS: Under Review
Version 1
Posted 11 Mar, 2021
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Editorial decision: Major revision
On 23 Mar, 2021
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Received 22 Mar, 2021
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On 07 Mar, 2021
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Editor invited
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A new preprint design is coming!
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This preprint is under consideration at Scientific Reports. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
Ivan Rektor
Brno Epilepsy Center, Department of Neurology, St. Anne’s University Hospital and Medical Faculty of Masaryk University
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 11 Mar, 2021
No community comments so far
Editorial decision: Major revision
On 23 Mar, 2021
Reviews received
Received 22 Mar, 2021
Reviewers agreed
On 07 Mar, 2021
Reviewers invited
Invitations sent on 04 Mar, 2021
Editor assigned
On 03 Mar, 2021
Editor invited
On 03 Mar, 2021
Submission checks complete
On 02 Mar, 2021
First submitted
On 26 Feb, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Drug-resistant epilepsy is a diagnostic and therapeutic challenge, mainly in patients with negative MRI findings. State-of-the-art imaging methods complement standard epilepsy protocols with new information and help to epileptologists to increase reliability of their decisions. In this study, we investigate if arterial spin labeling (ASL) perfusion MRI can help localizing the epileptogenic zone (EZ). To that end, we developed an image processing method to detect the EZ as an area with hypoperfusion relative to the contralateral unaffected side, using subject-specific thresholding of the asymmetry index in ASL images. We demonstrated three thresholding criteria (minimal product criterion, minimal distance criterion, and elbow criterion) on 29 patients with MRI-negative epilepsy (age 32.98 ± 10.4 years). The minimal product criterion showed optimal results in terms of positive predictive value (mean 0.12 and 0.22) and true positive rate (mean 0.71 and 1.82). Additionally, we found high accuracy in determining the EZ side (mean 0.86 and 0.73 out of 1.00). In conclusion, the ASL can be easily incorporated to the standard presurgical MR protocol and it provides an additional benefit in EZ localization.
Figure 1
No competing interests reported.
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