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Neuroimaging Technologies

Magnetic Resonance Imaging (MRI) technology continues to evolve at the DMC and Harper University Hospital. In addition to standard MRI images, higher resolution, thin-section images captured with a powerful, state-of-the-art 3-Tesla MRI scanner (using our “epilepsy protocol”) allow exquisite visualization of the medial temporal lobe structures that are often damaged in intractable temporal lobe epilepsy. These images can be transferred to a computer workstation for quantitative volumetric analysis — a powerful tool in detecting hippocampal sclerosis, the most common cause of temporal lobe epilepsy. These high resolution MRI scans also allow visualization of other small structural processes that can cause seizures, such as cryptic vascular malformations, cortical dysplasia or neuronal migration disorders.

Functional MRI
Functional Magnetic Resonance Imaging (fMRI) detects signal changes in the brain that accompany regional changes in cerebral blood flow related to neuronal activity. In normal brain, functional MRI shows these changes in appropriate functional areas of the cerebrum in response to motor, sensory or language tasks that activate these areas. This technique is under study to determine whether it can be used in patients with epilepsy to demonstrate functional areas of the brain, detect abnormalities in cortical function in partial (focal) epilepsy and even capture and map cortical activation during seizures. In this manner, fMRI complements other procedures by demonstrating language and memory lateralization non-invasively.

Magnetic Resonance Spectroscopy (MRS) allows metabolic imaging of brain structures by the detecting biochemical changes in the brain. This technique is becoming a powerful clinical tool in evaluating seizure onset sites, though it remains primarily a research tool at present.

High-field MRI
A powerful 3-Tesla MRI scanner is now available and routinely used for epilepsy patients at Harper University Hospital, providing even more detailed investigation of the brain in patients with epilepsy.

Positron Emission Tomography (PET) scans represent functional images of the brain. Studies performed with radiolabeled glucose assess brain metabolic activity. Epileptogenic cortex correlates with areas of reduced metabolism and relatively decreased glucose uptake on PET scan. New probes such as flumazenil (FMZ) assess the presence of receptors for neurotransmitters such as those associated with GABA in the brain and are proving to be quite helpful in localizing the site of seizure onset. Newer PET probes such as alpha-methyl-tryptophan (AMT) are proving invaluable in understanding epilepsy and brain tumor pathophysiology in various neurological disorders.

Single Photon Emission Computed Tomography (SPECT) scans measure brain blood flow, which is an indirect indicator of cerebral metabolic rate. Interictal SPECT scans tend to show decreased blood flow to the epileptogenic cortex, although this technique has not been sufficiently specific to become a reliable diagnostic tool. However, SPECT scans obtained at the time of a seizure (isotope injected during a seizure, scan obtained later) show excellent sensitivity and specificity for the epileptogenic cortex. Within the Epilepsy Monitoring Unit, highly trained nurses inject the isotope at the time of the seizure. The scan can be obtained within the next several hours in the Nuclear Medicine Department. Interictal SPECT scanning has been incorporated into the protocol for localization of the epileptogenic region. A special technique called SISCOM (subtraction ictal SPECT co-registered to MRI) can provide very powerful visualization of seizure zone by subtracting interictal images from ictal images and co-registering them with anatomical imaging (MRI).
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