Qualitative and quantitative imaging of the hippocampus in mesial temporal lobe epilepsy with hippocampal sclerosis

While most patients with focal epilepsy present with clear structural abnormalities on standard, 1.5 or 3 T MRI, some patients are MRI-negative. For those, quantitative MRI techniques, such as volumetry, voxel-based morphometry, and relaxation time measurements can aid in finding the epileptogenic focus. High-field MRI, just recently approved for clinical use by the FDA, increases the resolution and, in several publications, was shown to improve the detection of focal cortical dysplasias and mild cortical malformations. For those cases without any tissue abnormality in neuroimaging, even at 7 T, scalp EEG alone is insufficient to delimitate the epileptogenic zone. They may benefit from the use of high-density EEG, in which the increased number of electrodes helps improve spatial sampling. The spatial resolution of even low-density EEG can benefit from electric source imaging techniques, which map the source of the recorded abnormal activity, such as interictal epileptiform discharges, focal slowing, and ictal rhythm. These EEG techniques help localize the irritative, functional deficit, and seizure-onset zone, to better estimate the epileptogenic zone. Combining those technologies allows several drug-resistant cases to be submitted to surgery, increasing the odds of seizure freedom and providing a must needed hope for patients with epilepsy.

Epileptogenesis refers to the development and extension of tissue capable of generating spontaneous seizures, resulting in the development of an epileptic condition and/or progression of epilepsy after the condition is established. The hippocampus is the seizure-initiating zone in many epilepsy patients as well as in animal models of epilepsy. During epileptogenesis, the hippocampus undergoes structural changes, including mossy fiber sprouting; alterations in dendritic branching, spine density, and shape; and neurogenesis. In vivo magnetic resonance imaging (MRI) techniques provide insights into the microstructural organization of the hippocampus. An assessment of the structural plasticity of the hippocampus may provide parameters that could be used as biomarkers for epileptogenesis. Here we review conventional and more advanced MRI methods for detecting hippocampal tissue changes related to epileptogenesis. In addition, we summarize how diffusion tensor imaging can reveal cellular damage and plasticity, even at the level of hippocampal subfields. Finally, we discuss challenges and future directions for using novel MRI techniques in the search of biomarkers associated with epileptogenesis after brain injury.

Gradient-echo echo-planar imaging (EPI) is the primary method of choice in functional MRI and other methods relying on fast MRI to image brain activation and connectivity. However, the high susceptibility of EPI towards B₀ magnetic field inhomogeneity poses serious challenges. Conventional magnetic field shimming with low-order spherical harmonic (SH) functions is capable of compensating shallow field distortions, but performs poorly for global brain shimming or on specific areas with strong susceptibility-induced B₀ distortions such as the prefrontal cortex (PFC). Excellent B₀ homogeneity has been demonstrated recently in the human brain at 7 Tesla with the DYNAmic Multi-coIl TEchnique (DYNAMITE) for magnetic field shimming (J Magn Reson (2011) 212:280–288). Here, we report the benefits of DYNAMITE shimming for multi-slice EPI and T₂* mapping.

A standard deviation of 13 Hz was achieved for the residual B₀ distribution in the human brain at 7 Tesla with DYNAMITE shimming and was 60% lower compared to conventional shimming that employs static zero through third order SH shapes. The residual field inhomogeneity with SH shimming led to an average 8 mm shift at acquisition parameters commonly used for fMRI and was reduced to 1.5-3 mm with DYNAMITE shimming. T₂* values obtained from the prefrontal and temporal cortices with DYNAMITE shimming were 10-50% longer than those measured with SH shimming. The reduction of the confounding macroscopic B₀ field gradients with DYNAMITE shimming thereby promises improved access to the relevant microscopic T₂* effects.

The combination of high spatial resolution and DYNAMITE shimming allows largely artifact-free EPI and T₂* mapping throughout the brain, including prefrontal and temporal lobe areas. DYNAMITE shimming is expected to critically benefit a wide range of MRI applications that rely on excellent B₀ magnetic field conditions including EPI-based fMRI to study various cognitive processes and assessing large-scale brain connectivity in vivo. As such, DYNAMITE shimming has the potential to replace conventional SH shim systems in human MR scanners.