Quantitative evaluation of multi-parametric MR imaging marker changes post-laser interstitial ablation therapy (LITT) for epilepsy

摘要

Laser-induced interstitial thermal therapy (LITT) has recently emerged as a new, less invasive alternative to craniotomy for treating epilepsy; which allows for focussed delivery of laser energy monitored in real time by MRI, for precise removal of the epileptogenic foci. Despite being minimally invasive, the effects of laser ablation on the epileptogenic foci (reflected by changes in MR imaging markers post-LITT) are currently unknown. In this work, we present a quantitative framework for evaluating LITT-related changes by quantifying per-voxel changes in MR imaging markers which may be more reflective of local treatment related changes (TRC) that occur post-LITT, as compared to the standard volumetric analysis which involves monitoring a more global volume change across pre-, and post-LITT MRI. Our framework focuses on three objectives: (a) development of temporal MRI signatures that characterize TRC corresponding to patients with seizure freedom by comparing differences in MR, imaging markers and monitoring them over time, (b) identification of the optimal time point when early LITT induced effects (such as edema and mass effect) subside by monitoring TRC at subsequent time-points post-LITT, and (c) identification of contributions of individual MRI protocols towards characterizing LITT-TRC for epilepsy by identifying MR markers that change most dramatically over time and employ individual contributions to create a more optimal weighted MP-MRI temporal profile that can better characterize TRC compared to any individual imaging marker. A cohort of patients were monitored at different time points post-LITT via MP-MRI involving Tl-w, T2-w, T2-GRE, T2-FLAIR, and apparent diffusion coefficient (ADC) protocols. Post affine registration of individual MRI protocols to a reference MRI protocol pre-LITT, differences in individual MR markers are computed on a per-voxel basis, at different time-points with respect to baseline (pre-LITT) MRI as well as across subsequent time-points. A time-dependent MRI profile corresponding to successful (seizure-free) is then created that captures changes in individual MR imaging markers over time. Our preliminary analysis on two patient studies suggests that (a) LITT related changes (attributed to swelling and edema) appear to subside within 4-weeks post-LITT, (b) ADC may be more sensitive for evaluating early TRC (upto 3-months), and Tl-w may be more sensitive in evaluating early delayed TRC (1-month, 3-months), while T2-w and T2-FLAIR appeared to be more sensitive in identifying late TRC (around 6-months post-LITT) compared to the other MRI protocols under evaluation. T2-GRE was found to be only nominally sensitive in identifying TRC at any follow-up time-point post-LITT. The framework presented in this work thus serves as an important precursor to a comprehensive treatment evaluation framework that can be used to identify sensitive MR markers corresponding to patient response (seizure-freedom or seizure recurrence), with an ultimate objective of making prognostic predictions about patient outcome post-LITT.