Novel MRI approaches to map focal cortical dysplasia in focal epilepsy (2016–2018)
Focal cortical dysplasia (FCD) is the most common cause of drug-resistant focal epilepsy. Magnetic resonance imaging (MRI) is an essential non-invasive tool for lesion identification in the human brain, yet standard clinical neuroimaging is unable to identify FCD lesions in 20-30% of patients. The likelihood of seizure freedom following epilepsy surgery for FCD is highly dependent on clear lesion identification and delineation, highlighting the need for better methods to detect and delineate FCD. This research aims to significantly enhance the accuracy with which FCD in focal epilepsy is delineated with MRI, by making use of tissue information encoded in the MRI signal and by dissociating the underlying mechanisms responsible for MRI contrast. Specifically, we will examine (i) information from MRI phase images, (ii) multivariate, multi-contrast statistical analysis for tissue classification, and (iii) abnormal cortical boundary and thickness mapping. Using Australia¿¿¿s first ultra-high field 7T human scanner at the Centre for Advanced Imaging, we will combine histological analysis and ultra-high field imaging of surgically removed tissue with in-vivo imaging to develop highly sensitive MRI signatures of FCD. The resulting signatures will then be assessed on standard 3T clinical scanners in patients with focal epilepsy. The outcome of this work will be the creation of an MRI-based tool to aid the detection and delineation of FCD in patients with focal epilepsy who are potential candidates for resective surgery. Improved MRI diagnosis is an important step towards better seizure outcome following surgery, a major determinant of post-surgical quality of life.