Značaj postprocesiranja slike magnetske rezonancije mozga u prijeoperacijskoj dijagnostici bolesnika s farmakorezistentnom epilepsijom

doctoral thesis

• Title (english): The importance of postprocessing magnetic resonance imaging of the brain in preoperative diagnosis of patients with pharmacoresistant epilepsy
• Author: Andreja Bujan Kovač
• Mentor: Željka Petelin Gadže (mentor)
• Mentor: Milan Radoš (komentor)
• Committee member: Darko Chudy (predsjednik povjerenstva)
• Committee member: Marko Radoš (član povjerenstva)
• Committee member: Zlatko Trkanjec (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2021-05-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Neurology
• Universal decimal classification (UDC): 616 - Pathology. Clinical medicine

Abstract

Uvod: Epilepsija je kronična bolest središnjeg živčanog sustava koja se javlja u 1% populacije. Kod velikog broja bolesnika se pravilnim odabirom antiepileptičkih lijekova može postići zadovoljavajuća kontrola napadaja, dok preostalih 25-35% ima farmakorezistentnu epilepsiju i smatra se kandidatima za neurokirurško liječenje. Prijeoperacijska obrada bolesnika s farmakorezistentnom epilepsijom obuhvaća različite neinvazivne i invazivne metode. Najznačajniji neuroradiološki postupak u pravilnom odabiru kandidata pogodnih za neurokirurgiju je MR mozga 3T (magnetska rezonancija). Postprocesiranje snimki MR mozga s MAP07 morfometrijskom analizom (Morphometric Analysis Program) je sofisticirani dijagnostički postupak. Program nudi brojne grafičke prikaze kroz tri statističke mape i olakšava detekciju i lokaliziranje skleroze hipokampusa, žarišne kortikalne displazije i drugih vrsta kortikalnih malformacija, koje se ne mogu lako otkriti konvencionalnom vizualnom analizom MR-a. -----
Ispitanici i metode: U istraživanju je sudjelovalo 120 bolesnika s farmakorezistentom epilepsijom, starijih od 16 godina. MR mozga 3T učinjen je u skladu s dizajniranim MR protokolom za obradu epilepsije, nakon čega su prikupljeni podaci i učinjena naknadna obrada MR snimaka u potpuno automatiziranom MATLAB skriptu (engl. MATrix LABoratory), MAP07 morfometrijskoj analizi, primjenom algoritama SPM5 (engl. Statistical Parametric Mapping). -----
Rezultati: Analiza na našim bolesnicima pokazala je visoku osjetljivost MAP07 mofrometrijske analize s niskom specifičnošću i s velikim udjelom lažno pozitivnih bolesnika. Nakon MR analize, 32/120 bolesnika označeno je kao MR negativno. Kod navedenih bolesnika je nakon MAP07 analize utvrđeno 5 strukturnih lezija, kod jednog bolesnika hipokampalna skleroza (HS), kod jednog fokalna kortikalna displazija (FCD), kod dvoje perinatalne vaskularne lezije i u jednog bolesnika hiperintenzitet hipokampusa. Nađena je visoka sveukupna podudarnost nalaza MAP07 morfometrijske analize i MR za otkrivanje FCD, HS, perinatalne ishemije / kronične vaskularne lezije, heterotopije i polimikrogirije (koeficijent kappa iznad 0,700). -----
Zaključak: MAP07 morfometrijska analiza je korisna, automatizirana metoda koja može voditi dodatnu ponovnu re-evaluaciju MR nalaza, isticanjem suspektnih kortikalnih regija, te može poslužiti kao komplementarna metoda konvencionalnim vizualnim MR analizama poboljšavanjem vizualizacije malformacija kortikalnog razvoja.

Abstract (english)

Background: Epilepsy is a chronic disease of the central nervous system that affects 1% of the population. The large number of patients with the proper selection of antiepileptic drugs can achieve satisfactory seizure control, while the remaining 25-35% have pharmacoresistant epilepsy and are considered as candidates for active neurosurgical treatment. Preoperative evaluation of patients with pharmacoresistant epilepsy encompasses non-invasive and invasive methods, were brain MRI (Magnetic resonance imaging) is crucial in delineation of structural lesions. The most significant neuroradiological procedure in proper selection of candidates suitable for neurosurgery is brain MRI 3T. Post-processing of brain MRI with MAP07 (Morphometric Analysis Program) is a sophisticated diagnostic procedure. The program offers a number of graphical post-processing methods (maps) and facilitates the detection and localization of hippocampal sclerosis, focal cortical dysplasias and other types of cortical malformations, which cannot be easily detected by conventional neuroradiological methods. -----
Subjects and methods: 120 patients with epilepsy have been recruited due to pharmacoresistant epilepsy, aged > 16 yrs. MRI 3T was performed according to designes epilepsy imaging protocol followed by data acquisition and postprocessing of MRI data in fully automated MATLAB script (MATrix LABoratory), MAP07, by applying SPM5 algorithms (engl. Statistical Parametric Mapping). -----
Results: Analysis in our patients, showed high sensitivity of MAP07 with low specificity. and with a high proportion of false-positive patients. After MRI analysis, 32/120 patients were labeled as MRI negative, in whom after MAP07 analysis in 5 patients structural lesions were found, in one hippocampal sclerosis (HS), in one focal cortical dysplasia (FCD), in two perinatal vascular lesions and in one hippocampal hyperintensity. There was quite high overall coincidence of the findings of MAP07 and MRI for detection of FCD, HS, perinatal ischaemia/chronic vascular lesions, heterotopia and polymicrogyria (kappa coefficient above 0.700). -----
Conclusions: MAP07 analysis is a useful, automated method that may guide additional re-evaluation of MRI by highlighting suspeciuos cortical regions, as a complementary method to conventional visual MRI analysis by enhancing the visualization of malformation of cortical development.

• Keywords: epilepsija; postprocesiranje MR mozga; hipokampalna skleroza; malformacija kortikalnog razvoja
• Keywords (english): epilepsy; brain MRI postprocessing; hippocampal sclerosis; malformation of cortical development
• Language: croatian
• URN:NBN: urn:nbn:hr:105:574314
• Study programme: Title: Biomedicine and Health Sciences; Study programme type: university; Study level: postgraduate; Academic / professional title: doktor/doktorica znanosti, područje biomedicine i zdravstvo (doktor/doktorica znanosti, područje biomedicine i zdravstvo)
• Type of resource: Text
• Extent: 118 str.
• File origin: Born digital
• Access conditions: Open access
• Created on: 2021-06-25 08:25:46