title: 7T MR spectroscopic imaging in the localization of surgical epilepsy.
abstract: OBJECTIVE
  With the success that surgical approaches can provide for localization-related epilepsy, accurate seizure localization remains important. Although magnetic resonance (MR) spectroscopy has had success in earlier studies in medial temporal lobe epilepsy, there have been fewer studies evaluating its use in a broader range of localization-related epilepsy. With improvements in signal-to-noise with ultra-high field MR, we report on the use of high resolution 7T MR spectroscopic imaging (MRSI) in 25 surgically treated patients studied over a 3.5-year period.
  
  
  METHODS
  Patients were included in this analysis if the region of MRSI study included the surgical resection region. Concordance between region of MRSI abnormalities and of surgical resection was classified into three groups (complete, partial, or no agreement) and outcome was dichotomized by International League Against Epilepsy (ILAE) I-III and IV-VI groups. MRSI was performed with repetition time/echo time 1.5 s/40 msec in two-dimensional (2D) or three-dimensional (3D) encoding for robust detection of singlets N-acetyl aspartate (NAA), creatine (Cr), and choline with abnormalities in NAA/Cr determined with correction for tissue content of gray matter.
  
  
  RESULTS
  The concordance between MRSI-determined abnormality and surgical resection region was significantly related to outcome: Outcome was better if the resected tissue was metabolically abnormal. All 14 patients with complete resection of the region with the most severe metabolic abnormality had good outcome, including five requiring intracranial electroencephalography (EEG) analysis, whereas only 3/11 without complete resection of the most severe metabolic abnormality had good outcome (p < 0.001).
  
  
  CONCLUSIONS
  This is consistent with the seizure-onset zone being characterized by metabolic dysfunction and suggests that high resolution MRSI can help define these regions for the purposes of outcome prediction.
authors.affiliation: Department of Neurology and Radiology, University of Pittsburg, Pittsburg, Pennsylvania 15213, USA. panjw@upmc.edu
authors.forename: Jullie W
authors.initials: JW
authors.lastname: Pan
authors.forename: Robert B
authors.initials: RB
authors.lastname: Duckrow
authors.forename: Jason
authors.initials: J
authors.lastname: Gerrard
authors.forename: Caroline
authors.initials: C
authors.lastname: Ong
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Hirsch
authors.forename: Stanley R
authors.initials: SR
authors.lastname: Resor
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhang
authors.forename: Ognen
authors.initials: O
authors.lastname: Petroff
authors.forename: Susan
authors.initials: S
authors.lastname: Spencer
authors.forename: Hoby P
authors.initials: HP
authors.lastname: Hetherington
authors.forename: Dennis D
authors.initials: DD
authors.lastname: Spencer
mesh_terms: D000293:Adolescent; D000328:Adult; D001224:Aspartic Acid / Q000031:analogs & derivatives / Q000032:analysis; D003401:Creatine / Q000032:analysis; D004569:Electroencephalography / Q000379:methods; D004833:Epilepsy, Temporal Lobe / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006801:Humans; D009682:Magnetic Resonance Spectroscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001224:Aspartic Acid; C000179:N-acetylaspartate; D003401:Creatine
keywords: Localization-related epilepsy; Outcomes; Seizure localization; Spectroscopic imaging
references.citation: AJNR Am J Neuroradiol. 2006 Mar;27(3):684-8
references.pmid: 16552016
references.citation: Magn Reson Med. 1999 Jan;41(1):204-7
references.pmid: 10025631
references.citation: Magn Reson Med. 2007 Feb;57(2):308-18
references.pmid: 17260370
references.citation: Magn Reson Med. 2001 Jul;46(1):24-30
references.pmid: 11443707
references.citation: Neurology. 2007 Dec 11;69(24):2256-65
references.pmid: 18071146
references.citation: Epilepsia. 2003 May;44(5):677-87
references.pmid: 12752467
references.citation: NMR Biomed. 2010 Apr;23(3):251-6
references.pmid: 19777506
references.citation: Neurology. 2008 Dec 9;71(24):1993-9
references.pmid: 19064881
references.citation: Neuroradiology. 2001 Jun;43(6):448-52
references.pmid: 11465755
references.citation: Magn Reson Med. 1996 Jul;36(1):21-9
references.pmid: 8795016
references.citation: Cereb Cortex. 2013 Dec;23(12):2944-55
references.pmid: 22952278
references.citation: J Neurol. 2011 Apr;258(4):603-12
references.pmid: 20976465
references.citation: Am J Physiol. 1988 Jun;254(6 Pt 2):R949-59
references.pmid: 2837918
references.citation: Epilepsy Res. 2010 Feb;88(2-3):127-38
references.pmid: 19926450
references.citation: Radiology. 2000 Feb;214(2):403-10
references.pmid: 10671587
references.citation: Magn Reson Med. 2010 Jan;63(1):9-19
references.pmid: 19918903
references.citation: Epilepsia. 2004 Sep;45(9):1100-5
references.pmid: 15329075
references.citation: Eur J Neurol. 2010 Sep;17(9):1193-1202
references.pmid: 20402762
references.citation: MAGMA. 2010 Dec;23(5-6):339-49
references.pmid: 20625794
references.citation: Neuroreport. 1996 May 31;7(8):1397-400
references.pmid: 8856684
references.citation: Neurology. 1994 Aug;44(8):1411-7
references.pmid: 8058140
references.citation: Brain. 2005 Oct;128(Pt 10):2396-407
references.pmid: 15958506
references.citation: Neurology. 1997 Apr;48(4):1018-24
references.pmid: 9109893
references.citation: Acta Neurol Scand. 2012 Dec;126(6):411-20
references.pmid: 22574807
references.citation: Magn Reson Med. 2007 Jul;58(1):167-73
references.pmid: 17659608
references.citation: Pediatr Res. 1999 Oct;46(4):474-85
references.pmid: 10509371
references.citation: Ann Neurol. 2005 Jan;57(1):92-7
references.pmid: 15546136
references.citation: Magn Reson Med. 2005 Dec;54(6):1503-18
references.pmid: 16270333
references.citation: Magn Reson Med. 2009 Jul;62(1):17-25
references.pmid: 19365851
references.citation: Mult Scler. 2000 Jun;6(3):148-55
references.pmid: 10871825
references.citation: Magn Reson Med. 2009 Oct;62(4):868-79
references.pmid: 19591201
references.citation: J Nucl Med. 1999 May;40(5):737-46
references.pmid: 10319744
references.citation: Magn Reson Med. 2012 Oct;68(4):1007-17
references.pmid: 22213108
references.citation: Epilepsia. 2004 Mar;45(3):223-9
references.pmid: 15009223
references.citation: Neuroimage. 2008 Oct 1;42(4):1275-84
references.pmid: 18652902