What question did this study set out to answer?

This study aims to identify metabolic changes in presumed epileptogenic regions of MRI-negative epilepsy patients using deuterium metabolic imaging.

February 21, 2026Open Access

Detection of regional metabolic alteration using 7T deuterium metabolic imaging in MRI-negative, 18FDG-PET-positive epilepsy patients

Puntos clave

This study aims to identify metabolic changes in presumed epileptogenic regions of MRI-negative epilepsy patients using deuterium metabolic imaging.
Five epilepsy patients with MRI-negative but FDG-PET-positive underwent dynamic deuterium metabolic imaging.
3D 2H FID-MRSI scans were performed at 7T following oral deuterated glucose intake.
Glucose levels and 2H glucose enrichment were measured in plasma samples during scanning.
Data was analyzed through General Linear Models and two-level linear mixed models for regional comparisons.
Plasma glucose and 2H glucose levels increased after glucose ingestion, stabilizing within 40 minutes.
Brain 2H glucose and glutamate/glutamine levels rose significantly over time.
Only modest regional differences in 2H glucose were observed, while 2H glutamate/glutamine indicated significant variation with the highest levels in hippocampus-PER.

Resumen

Abstract Objective Identifying presumed epileptogenic region (PER) in MRI-negative epilepsy patients is crucial for successful surgical outcomes. This study aims to determine whether dynamic deuterium metabolic imaging (DMI) at 7Tesla can detect region-specific metabolic alterations in MRI-negative, 18 FDG-PET-positive temporal-lobe epilepsy. Methods Five drug-resistant MRI-negative, 18 FDG-PET-positive epilepsy patients underwent dynamic DMI. 3D 2H FID-MRSI scans (11:44 min each) were acquired at 7T over ~ 100 min following oral 6,6′-2H2glucose intake. Venous plasma glucose and 2H glucose atom percent enrichment (APE) were measured in blood samples taken during scanning. Plasma glucose and 2H-glucose APE were analyzed using a General Linear Model with Repeated measures. From DMI, brain 2H-glucose and 2H glutamate/glutamine levels were analyzed using a two-level linear mixed model (factors: time and tissue type) comparing the PER and contralateral (contra-PER), hippocampus and temporal pole regions. Results Plasma glucose and 2H-Glucose (Glc) atom-percent excess rose within 40 min post ingestion and then stabilized. Brain 2H-Glc and 2H-glutamate/glutamine (Glx) increased over time (p < 0.001). For 2H-Glc, regional differences were small, with only a modest elevation in hippocampus-PER relative to temporal-contra (p = 0.04). In contrast, 2H-Glx showed clear regional variation (p < 0.001), with the highest levels in hippocampus-PER, significantly exceeding PER, Temporal-PER, and Temporal-Contra (p ≤ 0.01). These findings remained consistent when averaging the final four time points. Conclusions Ultra-high-field DMI revealed elevated hippocampal glutamatergic turnover in MRI negative epilepsy patients, with the highest levels in the epileptogenic hippocampus. These findings indicate the presence of subtle metabolic alterations in hippocampal tissue, supporting the potential of DMI to capture pathophysiological changes that remain invisible to conventional imaging.

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