Multimodal MR Imaging: Functional, Diffusion Tensor, and Chemical Shift Imaging in a Patient with Localization‐Related Epilepsy

• Published in: Epilepsia (Copenhagen) 1999-10, Vol.40 (10), p.1459-1462
• Main Authors: Krakow, K., Wieshmann, U. C., Woermann, F. G., Symms, M. R., McLean, M. A., Lemieux, L., Allen, P. J., Barker, G. J., Fish, D. R., Duncan, J. S.
• Format: Article
• Language: English
• Subjects: Adult; Anisotropy; Aspartic Acid - analogs & derivatives; Aspartic Acid - analysis; Biological and medical sciences; Cerebral Cortex - abnormalities; Cerebral Cortex - chemistry; Cerebral Cortex - physiopathology; Chemical shift imaging; Diffusion tensor imaging; EEG; Electroencephalography - statistics & numerical data; Epilepsies, Partial - blood; Epilepsies, Partial - diagnosis; Epilepsies, Partial - physiopathology; Functional MRI; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Humans; Investigative techniques, diagnostic techniques (general aspects); Localization‐related epilepsy; Magnetic Resonance Imaging - methods; Magnetic Resonance Imaging - statistics & numerical data; Male; Malformation of cortical development (MCD); Medical sciences; Nervous system; Nervous system (semeiology, syndromes); Nervous System Malformations - diagnosis; Neurology; Oxygen - blood; Radiodiagnosis. Nmr imagery. Nmr spectrometry
• ISSN: 0013-9580; 1528-1167
• DOI: 10.1111/j.1528-1157.1999.tb02021.x

Purpose: To demonstrate the integration of complementary functional and structural data acquired with magnetic resonance imaging (MRI) in a patient with localization‐related epilepsy. Methods: We studied a patient with partial and secondarily generalized seizures and a hemiparesis due to a malformation of cortical development (MCD) in the right hemisphere by using EEG‐triggered functional MRI (fMRI), diffusion tensor imaging (DTI), and chemical shift imaging (CSI). Results: fMRI revealed significant changes in regional blood oxygenation associated with interictal epileptiform discharges within the MCD. DTI showed a heterogeneous microstructure of the MCD with reduced fractional anisotropy, a high mean diffusivity, and displacement of myelinated tracts. CSI demonstrated low N‐acetyl aspartate (NAA) concentrations in parts of the MCD. Conclusions: The applied MR methods described functional, microstructural, and biochemical characteristics of the epileptogenic tissue that cannot be obtained with other noninvasive means and thus improve the understanding of the pathophysiology of epilepsy.