Alterations of apparent diffusion coefficient from ultra high b‐values in the bilateral thalamus and striatum in MRI‐negative drug‐resistant epilepsy

• Published in: Epilepsia open Vol. 9; no. 4; pp. 1515 - 1525
• Main Authors: Tang, Guixian, Zhou, Hailing, Zeng, Chunyuan, Jiang, Yuanfang, Li, Ying, Hou, Lu, Liao, Kai, Tan, Zhiqiang, Wu, Huanhua, Tang, Yongjin, Cheng, Yong, Ling, Xueying, Guo, Qiang, Xu, Hao
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01.08.2024; John Wiley and Sons Inc; Wiley
• Subjects: Adolescent; Adult; Blood; Convulsions & seizures; Corpus Striatum - diagnostic imaging; diffusion; Diffusion Magnetic Resonance Imaging; Disease; Drug resistance; Drug Resistant Epilepsy - diagnostic imaging; Epilepsy; Female; Hospitals; Humans; Illnesses; Magnetic resonance imaging; Male; Middle Aged; MRI‐negative drug‐resistant epilepsy; Original; Permeability; Reproducibility of Results; striatum; thalamus; Thalamus - diagnostic imaging; ultra high b‐values; Work stations; Young Adult; China; MRI‐negative drug‐resistant epilepsy; diffusion; striatum; ultra high b‐values; thalamus
• ISSN: 2470-9239; 2470-9239
• DOI: 10.1002/epi4.12990

Objective Subcortical nuclei such as the thalamus and striatum have been shown to be related to seizure modulation and termination, especially in drug‐resistant epilepsy. Enhance diffusion‐weighted imaging (eDWI) technique and tri‐component model have been used in previous studies to calculate apparent diffusion coefficient from ultra high b‐values (ADCuh). This study aimed to explore the alterations of ADCuh in the bilateral thalamus and striatum in MRI‐negative drug‐resistant epilepsy. Methods Twenty‐nine patients with MRI‐negative drug‐resistant epilepsy and 18 healthy controls underwent eDWI scan with 15 b‐values (0–5000 s/mm2). The eDWI parameters including standard ADC (ADCst), pure water diffusion (D), and ADCuh were calculated from the 15 b‐values. Regions‐of‐interest (ROIs) analyses were conducted in the bilateral thalamus, caudate nucleus, putamen, and globus pallidus. ADCst, D, and ADCuh values were compared between the MRI‐negative drug‐resistant epilepsy patients and controls using multivariate generalized linear models. Inter‐rater reliability was assessed using the intra‐class correlation coefficient (ICC) and Bland–Altman (BA) analysis. False discovery rate (FDR) method was applied for multiple comparisons correction. Results ADCuh values in the bilateral thalamus, caudate nucleus, putamen, and globus pallidus in MRI‐negative drug‐resistant epilepsy were significantly higher than those in the healthy control subjects (all p < 0.05, FDR corrected). Significance The alterations of the ADCuh values in the bilateral thalamus and striatum in MRI‐negative drug‐resistant epilepsy might reflect abnormal membrane water permeability in MRI‐negative drug‐resistant epilepsy. ADCuh might be a sensitive measurement for evaluating subcortical nuclei‐related brain damage in epilepsy patients. Plain Language Summary This study aimed to explore the alterations of apparent diffusion coefficient calculated from ultra high b‐values (ADCuh) in the subcortical nuclei such as the bilateral thalamus and striatum in MRI‐negative drug‐resistant epilepsy. The bilateral thalamus and striatum showed higher ADCuh in epilepsy patients than healthy controls. These findings may add new evidences of subcortical nuclei abnormalities related to water and ion hemostasis in epilepsy patients, which might help to elucidate the underlying epileptic neuropathophysiological mechanisms and facilitate the exploration of therapeutic targets.