Predicting the laterality of temporal lobe epilepsy from PET, MRI, and DTI: A multimodal study.

Authors

Dorian Pustina, Department of Neurology, University of PennsylvaniaFollow
Brian Avants, Department of Radiology, University of Pennsylvania
Michael R Sperling, Department of Neurology, Thomas Jefferson University, Sidney Kimmel Medical CollegeFollow
Richard Gorniak, Department of Radiology, Thomas Jefferson University, Sidney Kimmel Medical CollegeFollow
Xiaosong He, Department of Neurology, Thomas Jefferson University, Sidney Kimmel Medical CollegeFollow
Gaelle Eve Doucet, Department of Neurology, Thomas Jefferson University, Sidney Kimmel Medical CollegeFollow
Paul Barnett, MS, Department of Neurology, Thomas Jefferson University, Sidney Kimmel Medical CollegeFollow
Scott Mintzer, Department of Neurology, Thomas Jefferson University, Sidney Kimmel Medical CollegeFollow
Ashwini Sharan MD, Department of Neurosurgery, Thomas Jefferson UniversityFollow
Joseph I Tracy, Department of Neurosurgery, Department of Neurology, Thomas Jefferson University, Sidney Kimmel Medical CollegeFollow

Document Type

Article

Publication Date

8-1-2015

Comments

This article has been peer reviewed. It was published in: NeuroImage: Clinical.

Volume 9, 11 August 2015, Pages 20-31.

The published version is available at DOI: 10.1016/j.nicl.2015.07.010

Copyright © 2015 The Authors

Abstract

Pre-surgical evaluation of patients with temporal lobe epilepsy (TLE) relies on information obtained from multiple neuroimaging modalities. The relationship between modalities and their combined power in predicting the seizure focus is currently unknown. We investigated asymmetries from three different modalities, PET (glucose metabolism), MRI (cortical thickness), and diffusion tensor imaging (DTI; white matter anisotropy) in 28 left and 30 right TLE patients (LTLE and RTLE). Stepwise logistic regression models were built from each modality separately and from all three combined, while bootstrapped methods and split-sample validation verified the robustness of predictions. Among all multimodal asymmetries, three PET asymmetries formed the best predictive model (100% success in full sample, >95% success in split-sample validation). The combinations of PET with other modalities did not perform better than PET alone. Probabilistic classifications were obtained for new clinical cases, which showed correct lateralization for 7/7 new TLE patients (100%) and for 4/5 operated patients with discordant or non-informative PET reports (80%). Metabolism showed closer relationship with white matter in LTLE and closer relationship with gray matter in RTLE. Our data suggest that metabolism is a powerful modality that can predict seizure laterality with high accuracy, and offers high value for automated predictive models. The side of epileptogenic focus can affect the relationship of metabolism with brain structure. The data and tools necessary to obtain classifications for new TLE patients are made publicly available.

Recommended Citation

Pustina, Dorian; Avants, Brian; Sperling, Michael R; Gorniak, Richard; He, Xiaosong; Doucet, Gaelle Eve; Barnett, MS, Paul; Mintzer, Scott; Sharan MD, Ashwini; and Tracy, Joseph I, "Predicting the laterality of temporal lobe epilepsy from PET, MRI, and DTI: A multimodal study." (2015). Department of Neurology Faculty Papers. Paper 81.
https://jdc.jefferson.edu/neurologyfp/81

PubMed ID

26288753