TY - JOUR
T1 - The role of ultra-high field MRI and image processing in the presurgical workup in MRI-negative focal epilepsy
T2 - A validated 7T MRI case study
AU - Uher, Daniel
AU - Drenthen, Gerhard S.
AU - Hoeberigs, Christianne M.
AU - van Lanen, Rick H. G. J.
AU - Colon, Albert J.
AU - Haast, Roy A. M.
AU - Kranen-Mastenbroek, Vivianne H. J. M. van
AU - Widman, Guido
AU - Hofman, Paul A. M.
AU - Wagner, Louis G.
AU - Beckervordersandforth, Jan C.
AU - Jansen, Jacobus F. A.
AU - Schijns, Olaf E. M. G.
AU - Backes, Walter H.
AU - ACE study group
PY - 2025/6/1
Y1 - 2025/6/1
N2 - This case study demonstrates the value of combined 7 T structural and functional MRI in the presurgical workup of a 24-year-old male with drug-resistant focal epilepsy who was initially considered MRI-negative on clinical 3 T MRI. The patient underwent extensive presurgical workup with 7 T MRI, magnetoencephalography, stereoelectroencephalography, and resection of the suspected right frontal epileptogenic zone. Histopathology showed focal cortical dysplasia (FCD) type IIb. The patient remained 11 months after surgery seizure-free. Retrospective analysis revealed that both structural and functional 7 T MRI showed abnormalities within the resected area. Morphometric Analysis Program (MAP18) detected abnormalities on both 3 T and 7 T images. However, abnormalities were more conspicuous on 7 T. Resting-state functional MRI metrics, particularly regional homogeneity and fractional amplitude of low-frequency fluctuations, demonstrated significantly increased values in both a MAP18-defined region of interest and the entire resected area compared to a healthy control group (p < 0.05). However, extensive unspecific abnormalities were also observed outside the resected region, highlighting the importance of a multimodal approach. This case study illustrates that advanced image processing of ultra-high field structural and resting-state functional MRI scans may enhance the detection of subtle epileptogenic lesions in presurgical evaluation, potentially improving post-operative seizure outcome and associated quality of life.
AB - This case study demonstrates the value of combined 7 T structural and functional MRI in the presurgical workup of a 24-year-old male with drug-resistant focal epilepsy who was initially considered MRI-negative on clinical 3 T MRI. The patient underwent extensive presurgical workup with 7 T MRI, magnetoencephalography, stereoelectroencephalography, and resection of the suspected right frontal epileptogenic zone. Histopathology showed focal cortical dysplasia (FCD) type IIb. The patient remained 11 months after surgery seizure-free. Retrospective analysis revealed that both structural and functional 7 T MRI showed abnormalities within the resected area. Morphometric Analysis Program (MAP18) detected abnormalities on both 3 T and 7 T images. However, abnormalities were more conspicuous on 7 T. Resting-state functional MRI metrics, particularly regional homogeneity and fractional amplitude of low-frequency fluctuations, demonstrated significantly increased values in both a MAP18-defined region of interest and the entire resected area compared to a healthy control group (p < 0.05). However, extensive unspecific abnormalities were also observed outside the resected region, highlighting the importance of a multimodal approach. This case study illustrates that advanced image processing of ultra-high field structural and resting-state functional MRI scans may enhance the detection of subtle epileptogenic lesions in presurgical evaluation, potentially improving post-operative seizure outcome and associated quality of life.
KW - 7T MRI
KW - Focal cortical dysplasia
KW - Resting-state fMRI
KW - Voxel-based morphometry
KW - ReHo
KW - fALFF
KW - MAP18
KW - TASK-FORCE
U2 - 10.1016/j.ebr.2025.100761
DO - 10.1016/j.ebr.2025.100761
M3 - Article
SN - 2589-9864
VL - 30
JO - Epilepsy & Behavior Reports
JF - Epilepsy & Behavior Reports
M1 - 100761
ER -