NeuroVoices: Irene Wang, PhD, on the Future of MR Fingerprinting and its Impact on Epilepsy Surgery

Irene Wang, PhD

This is a 2-part interview. For part 1, click here.

MRI has been a diagnostic tool that has changed the care for patients with epilepsy through better identification of seizures, assisting in determining proper syndrome, and improving all around safety and efficacy of epilepsy surgery, among others. Although MRI holds an important place in clinical practice, it has limitations. MR fingerprinting, a relatively new approach, has emerged as an alternative imaging method that can successfully address problems associated with conventional and advanced imaging modalities.

This quantitative imaging tool allows for simultaneous measurement of multiple tissue properties in a single, time-efficient acquisition. Clinicians have already begun to expand the capabilities of MR fingerprinting, through new ways of extracting data, and reaching more applicable disease-states. Irene Wang, PhD, the research director and staff scientist at the Comprehensive Epilepsy Center of Cleveland Clinic, has been a leader within the epilepsy community on research for MR fingerprinting.

Most recently, at the 2021 American Epilepsy Society (AES) annual meeting, December 3-7, in Chicago, Illinois, she presented a study that showed high accuracies of MR fingerprinting, using a radiomics extraction model, to classify focal cortical dysplasia from healthy tissue. In part 2 of an interview with NeurologyLive®, Wang provided background on the potential outlets MR fingerprinting has within epilepsy and general neurology, ways it may improve pre-surgical evaluations, and why its noninvasiveness provides a key advantage for clinicians.

NeurologyLive^®: What potential future uses does MR fingerprinting have?

Irene Wang, PhD: This is a big question. Let me first start with my thoughts on the topic in epilepsy. Much of what we’ve talked about is on lesion detection. We use the technology to detect subtle lesions that were not able to be seen before. This already has huge implications for improving the presurgical process. We can also use it to characterize the lesions. There are different kinds of lesions, some that are more epileptic and some that are less epileptic. We’re conducting another study using the MR fingerprinting technique that looks at another type of lesion called nodular heterotopia. These lesions usually occur in a cluster and are not one single lesion. Sometimes they are epileptic, sometimes they are not.

We use this new technology to try to characterize the quantitative tissue properties that may link with the epileptogenicity of these lesions. That is an area that can also have huge clinical implications. Bear in mind, everything is noninvasive. This is a noninvasive MRI technique. Nowadays, a lot of the lesion characterization work can only be done after the electrodes are inserted into the brain for recording or after surgery has been done. With this technique, we’re going to be able to probe the brain earlier, in a noninvasive way.

Other areas that this technique can significantly impact is to characterize the disease progress. As we are more aware, epilepsy is a progressive disorder. There are brain changes that are not just limited to the lesion, but can affect both the sides of the brain, with and without the lesion there. This a whole brain process. How does that process impact the cognitive function of these patients, for example? There remains a great need of well-designed multicenter longitudinal studies, where I can see MR fingerprinting being quantitative and easy to employ in a clinical environment. It has great potential to serve as a basis of such longitudinal imaging studies.

How can we utilize MR fingerprinting to improve the eligibility and success of epilepsy surgery?

Improving the outcome of presurgical evaluation is my own personal passion. It is a passion shared by all the staff members at the Epilepsy Center. The most direct impact of MR fingerprinting in the presurgical evaluation process is in the lesion detection and characterization. For example, we evaluate a patient with non-lesional MRI [non-lesional by the means of all current conventional MRI] and show a new finding that fits with the patient’s clinical profile, it would give us the key to generate a very focal surgical planning strategy. I’m not saying we’re going to take that finding and run with it. We still do a very rigorous process of looking at the concordance of that potential area of abnormality with everything else. But this oftentimes could serve as a piece of extra information that could help us go one level, one step, further with optimizing the pre-surgical evaluation. That makes a huge difference, whether you have this clue in some of these cases.

Every time I speak to a patient who is interested in participating in our research study, we always talk about how epilepsy surgery is a big deal. Any noninvasive information before we open the brain, before we record directly from the brain, is huge to these patients. Doing this noninvasive, informed evaluation in the most complete and technologically informed way, is the key to our success.

Is there anything else you’d like to mention?

Me and my team are greatly appreciative of this opportunity to be able to work with a novel technology and see how it actually impacts a patient’s life. This is huge. This is something that without being immersed in a clinical environment, biomedical engineers like us would not be able to do. There are great opportunities, and we’re just appreciative to be able to serve our patient community better.

Transcript edited for clarity. For more NeuroVoices, click here.

REFERENCE

Choi JY, Su T, Hu S, et al. MR Fingerprinting radiomics for characterization of focal cortical dysplasia. Presented at AES Annual Meeting; December 3-7, 2021. Poster 3.235