title: Application of volumetric MR spectroscopic imaging for localization of neocortical epilepsy.
abstract: OBJECTIVE
  The aim of this study was to evaluate volumetric proton magnetic resonance spectroscopic imaging (MRSI) for localization of epileptogenic foci in neocortical epilepsy.
  
  
  METHODS
  Twenty-five subjects reporting seizures considered to be of neocortical origin were recruited to take part in a 3-T MR study that included high-resolution structural MRI and a whole-brain MRSI acquisition. Using a fully automated MRSI processing protocol, maps for signal intensity normalized N-acetylaspartate (NAA), creatine, and choline were created, together with the relative volume fraction of grey-matter, white-matter, and CSF within each MRSI voxel. Analyses were performed using visual observation of the metabolite and metabolite ratio maps; voxel-based calculation of differences in these metabolite maps relative to normal controls; comparison of average grey-matter and white-matter metabolite values over each lobar volume; and examination of relative left-right asymmetry factors by brain region.
  
  
  RESULTS
  Data from 14 subjects were suitable for inclusion in the analysis. Eight subjects had MRI-visible pathologies that were associated with decreases in NAA/creatine, which extended beyond the volume indicated by the MRI. Five subjects demonstrated no significant metabolic alterations using any of the analysis methods, and one subject had no findings on MRI or MRSI.
  
  
  CONCLUSIONS
  This proof of principle study supports previous evidence that alterations of MR-detected brain metabolites can be detected in tissue areas affected by neocortical seizure activity, while additionally demonstrating advantages of the volumetric MRSI approach.
authors.affiliation: Department of Radiology, University of Miami School of Medicine, Miami, FL 33136, USA. AMaudsley@med.miami.edu
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Maudsley
authors.forename: Claudia
authors.initials: C
authors.lastname: Domenig
authors.forename: R Eugene
authors.initials: RE
authors.lastname: Ramsay
authors.forename: Brian C
authors.initials: BC
authors.lastname: Bowen
mesh_terms: D000328:Adult; D001931:Brain Mapping; D002540:Cerebral Cortex / Q000473:pathology / Q000503:physiopathology*; D004828:Epilepsies, Partial / Q000175:diagnosis* / Q000503:physiopathology; D004827:Epilepsy / Q000473:pathology; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012044:Regression Analysis; D012815:Signal Processing, Computer-Assisted