Brain, Vol 120, Issue 11 1961-1973, Copyright © 1997 by Oxford University Press
MP Richardson, KJ Friston, SM Sisodiya, MJ Koepp, J Ashburner, SL Free, DJ Brooks and JS Duncan
Using [11C]flumazenil-PET and statistical parametric mapping (SPM), we have
shown recently that regions of increased and decreased benzodiazepine
receptor density may be seen in patients with localization-related epilepsy
due to malformations of cortical development. These abnormalities were seen
both within and beyond lesions visually apparent on high-resolution MRI. We
have also shown, using an interactive anatomical segmentation technique and
volume-of- interest measurements, that subtle and unsuspected abnormalities
of cortical grey matter volume were found in the same group of patients on
high-resolution MRI, beyond the lesions visually apparent. In 10 patients
with localization-related epilepsy and malformations of cortical
development, we have now applied the automated and objective technique of
SPM to the analysis of high-resolution structural MRI. Each individual
patient was compared with 16 normal control subjects. We have then
simultaneously compared the structural and functional data obtained for
each individual patient with normal control high- resolution MRI and
[11C]flumazenil-PET image using a novel technique. This comparison allowed
the detection of functional abnormalities that were not accounted for by
either visible or unsuspected structural abnormalities, in an automated and
statistically rigorous manner. Five patients had abnormalities of cortical
grey matter volume detected using SPM; only these five patients had been
found abnormal using the previous volume-of-interest technique. Six of the
10 patients showed regions of cerebral cortex with disproportionate
flumazenil binding compared with local grey matter volume. This included
regions not found to have abnormal flumazenil binding on analysis of the
PET data alone. Furthermore, regions found to have abnormal binding on
examination of the PET data alone were, in some instances, shown to be
accounted for by abnormalities of cortical grey matter volume. We conclude
that the analysis of ligand PET data should always include a comparison
with structural MRI; such comparisons are greatly facilitated by the novel
approach described.
ARTICLES
Cortical grey matter and benzodiazepine receptors in malformations of cortical development. A voxel-based comparison of structural and functional imaging data
Epilepsy Research Group, Institute of Neurology, London, UK.
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