Objective

To develop a decision-making tool to evaluate and compare the performance of neuroimaging markers with clinical findings and the significance of attributes for presurgical lateralization of mesial temporal lobe epilepsy (mTLE).

Methods

Thirty-five unilateral mTLE patients who qualified as candidates for surgical resection were studied. Seizure semiology, ictal EEG, ictal epileptogenic zone, interictal–irritative zone, and MRI findings were used as clinical markers. Hippocampal T1 volumetry and FLAIR intensity, DTI estimated; mean diffusivity (MD) in the hippocampus and fractional anisotropy (FA) in posteroinferior cingulum and crus of fornix, and the output of logistic regression method on volumetrics of the hippocampus, amygdala, and thalamus were adopted as neuroimaging markers. The self-organizing map (SOM) method was applied to markers to provide predictive methods for mTLE lateralization.

Results

The SOM clustered all clinical attributes correctly with 100% accuracy and sensitivity for both the left and right mTLE. Among the clinical markers, seizure semiology and interictal-irrelative zone are the most sensitive attribute for the left-mTLE group lateralization. The accuracy achieved by applying the SOM method to the neuroimaging attributes was 94%, while the sensitivity was achieved 90% for left and 100% for right mTLE. SOM evidence indicated that the hippocampal volume is the most sensitive attribute for the prediction of the laterality in left-mTLE groups.

Conclusion

The proposed SOM method showed that neuroimaging markers may not replace with clinical findings. Nevertheless, multimodal neuroimaging can play an effective role in preoperative lateralization to reduce the costs and risks of surgical resection.

中文翻译：

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使用自组织图比较颞叶癫痫致痫侧的多模态发现

客观的

开发一种决策工具，以评估和比较神经影像标志物的性能与临床发现以及内侧颞叶癫痫 (mTLE) 术前侧化属性的重要性。

方法

研究了 35 名符合手术切除条件的单侧 mTLE 患者。癫痫发作症状学、发作期脑电图、发作期致癫痫区、发作间刺激区和 MRI 结果被用作临床标志物。海马 T1 体积和 FLAIR 强度，DTI 估计；采用海马平均扩散率（MD）和后下扣带回和穹窿脚的分数各向异性（FA），以及海马、杏仁核和丘脑体积的逻辑回归方法的输出作为神经影像学标志物。将自组织图 (SOM) 方法应用于标记，为 mTLE 侧化提供预测方法。

结果

SOM 以 100% 的准确度和灵敏度对左右 mTLE 正确聚类了所有临床属性。在临床标志物中，癫痫发作症状学和发作间无关区是左侧 mTLE 组偏侧化最敏感的属性。将 SOM 方法应用于神经影像属性所获得的准确度为 94%，而左侧 mTLE 和右侧 mTLE 的灵敏度分别达到 90% 和 100%。SOM 证据表明，海马体积是预测左侧 mTLE 组偏侧性的最敏感属性。

结论

所提出的 SOM 方法表明，神经影像学标志物可能不会被临床发现所取代。尽管如此，多模式神经影像学可以在术前侧化中发挥有效作用，以降低手术切除的成本和风险。