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Asieh Fatemidokht *1 
, Keyvan Hassanzadeh2 , Mohammad Hossein Harirchian3 , Mohammad Ali Oghabian4 , Abbas Tafakhori3
, Keyvan Hassanzadeh2 , Mohammad Hossein Harirchian3 , Mohammad Ali Oghabian4 , Abbas Tafakhori3
1- Department of Radiology, Faculty of Allied Medical Sciences, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
2- Mojtaba Asadi Non-Profit Institute, Rafsanjan, Iran
3- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
4- Department of Medical Physics and Biomedical Engineering, Tehran University of Medical Sciences, Tehran, Iran.
2- Mojtaba Asadi Non-Profit Institute, Rafsanjan, Iran
3- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
4- Department of Medical Physics and Biomedical Engineering, Tehran University of Medical Sciences, Tehran, Iran.
Abstract:
Background: Approximately 30–40% of drug-resistant epilepsy (DRE) cases are MRI-negative, showing no visible lesions on conventional magnetic resonance imaging. This presents a significant challenge in localizing epileptic foci. However, recent evidence indicates that neuroinflammation plays a crucial role in epileptogenesis, offering potential biomarkers for more precise localization.
Purpose of the study: To evaluate whether multi-parametric quantitative MRI can detect neuroinflammation in the seizure-generating regions of patients with MRI-negative, drug-resistant epilepsy.
Methods: This study included twenty-one MRI-negative, drug-resistant epilepsy patients (mean age: 31.3 years) All participants underwent multi-parametric MRI at 1.5T, which included magnetization transfer imaging (MTI) and magnetic resonance spectroscopy (MRS). Regions of interest in epileptic patients were defined based on long-term video-EEG monitoring. Metabolite values from MRS and magnetization transfer ratios were analyzed using t-tests (p < 0.05) to compare normal and epileptic brain lobes in the patients.
Results: the analysis revealed significant metabolic and physiological alterations in epileptic regions. The magnetization transfer ratio (MTR) was significantly reduced in epileptic white matter (0.5718 ± 0.0141 vs. 0.5943 ± 0.0141, p < 0.05). Additionally, the myo-inositol to creatine ratio (mIns/Cr) was significantly elevated in epileptic areas (2.3581 ± 0.8257 vs. 1.7062 ± 0.4134, p < 0.05).
Conclusions: For patients with MRI-negative, drug-resistant epilepsy, multiparametric quantitative MRI provides a crucial tool for detecting neuroinflammation-related changes. By combining reduced magnetization transfer ratio (MTR) with increased myo-inositol to creatine (mIns/Cr) ratios, could provide helpful methods to localize epileptic focus and improve treatment in MRI-negative DRE.
Purpose of the study: To evaluate whether multi-parametric quantitative MRI can detect neuroinflammation in the seizure-generating regions of patients with MRI-negative, drug-resistant epilepsy.
Methods: This study included twenty-one MRI-negative, drug-resistant epilepsy patients (mean age: 31.3 years) All participants underwent multi-parametric MRI at 1.5T, which included magnetization transfer imaging (MTI) and magnetic resonance spectroscopy (MRS). Regions of interest in epileptic patients were defined based on long-term video-EEG monitoring. Metabolite values from MRS and magnetization transfer ratios were analyzed using t-tests (p < 0.05) to compare normal and epileptic brain lobes in the patients.
Results: the analysis revealed significant metabolic and physiological alterations in epileptic regions. The magnetization transfer ratio (MTR) was significantly reduced in epileptic white matter (0.5718 ± 0.0141 vs. 0.5943 ± 0.0141, p < 0.05). Additionally, the myo-inositol to creatine ratio (mIns/Cr) was significantly elevated in epileptic areas (2.3581 ± 0.8257 vs. 1.7062 ± 0.4134, p < 0.05).
Conclusions: For patients with MRI-negative, drug-resistant epilepsy, multiparametric quantitative MRI provides a crucial tool for detecting neuroinflammation-related changes. By combining reduced magnetization transfer ratio (MTR) with increased myo-inositol to creatine (mIns/Cr) ratios, could provide helpful methods to localize epileptic focus and improve treatment in MRI-negative DRE.
Keywords: Drug-resistant epilepsy, neuroinflammation, magnetization transfer imaging, magnetic resonance spectroscopy, MRI-negative epilepsy
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