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• Clinical Article •
GluCEST imaging and structural changes in bilateral thalami of epileptic children with negative conventional MRI
WANG Wen  XIA Shuyuan  LI Xianglin  XU Donghao  LIU Quanyuan  REN Qingfa  YIN Zhijie  WANG Jing  LIU Xinkai 

DOI:10.12015/issn.1674-8034.2026.07.001.


[Abstract] Objective The glutamate-weighted chemical exchange saturation transfer (GluCEST) imaging technique was used to evaluate the changes of glutamate (Glu) in the thalamus of children with negative MRI - confirmed epilepsy. Furthermore, the volume changes of the subregions of the thalamus in these children were explored, and the correlation between the Glu changes measured by GluCEST and the volume of the thalamic subregions was analyzed.Materials and Methods A total of 73 pediatric patients diagnosed with epilepsy were prospectively enrolled between January 2024 and May 2026 at the Department of Pediatric Neurology, Binzhou Medical University Hospital. They were divided into the focal epilepsy (FE) group with 37 cases and the generalized epilepsy (GE) group with 36 cases. Thirty-six healthy control (HCs) subjects were recruited. The brain magnetic resonance images of the three groups were collected to exclude data with brain diseases. Those meeting the requirements were subjected to three-dimensional T1-weighted magnetization prepared rapid gradient echo (MPRAGE) imaging and GluCEST imaging. The GluCEST images were processed using Matlab software to obtain the asymmetric magnetization rate (MTRasym) value of the thalamus region, representing the relative Glu concentration value of this area; the MPRAGE images were automatically segmented using FreeSurfer to obtain the volume of the thalamic subregions. SPSS was used to compare the MTRasym values of the left and right thalamus in the three groups, and to compare the thalamic MTRasym values and subregion volumes between the GE group and the HCs group, as well as between the FE group and the HCs group.Results The MTRasym value of the ipsilateral thalamus in the focal epilepsy (FE) group was significantly higher than that of the contralateral thalamus, with a statistically significant difference (t = 3.252, P = 0.002). In the generalized epilepsy (GE) group, both the left (Z = -4.944, P < 0.001) and right (t = 4.816, P < 0.001) thalamic MTRasym values were significantly elevated compared to those in the healthy control (HC) group. Similarly, both the ipsilateral (t = 4.547, P < 0.001) and contralateral (t = 3.293, P = 0.002) thalamic MTRasym values in the FE group were significantly higher than those in the HC group. Regarding thalamic subregion volumes, the volume of the right medial nucleus in the GE group was significantly smaller than that in the HC group (t = -2.667, P = 0.009); however, no significant differences were observed between the FE group and the HC group in any thalamic subregion (P > 0.05). Furthermore, no significant correlation was found between thalamic MTRasym values and the volumes of thalamic subregions in either the GE or FE groups (P > 0.05).Conclusions This study employed GluCEST imaging in conjunction with structural MRI to investigate glutamate concentration and volumetric alterations in the thalamus among children with epilepsy and negative conventional MRI findings. Furthermore, the correlation between MTRasym values and the volumes of specific thalamic subregions was examined. It is helpful to understand the neuro-metabolic differences of different types of epilepsy, and it opens up a new perspective for the diagnosis, treatment and prognosis of children with epilepsy. GluCEST technology is expected to provide a new, non-invasive imaging tool for exploring the pathophysiological mechanism of childhood epilepsy.
[Keywords] epilepsy；Children；glutamate chemical exchange saturation transfer；magnetic resonance imaging；thalamus；glutamate

WANG Wen1   XIA Shuyuan1   LI Xianglin2   XU Donghao3   LIU Quanyuan1   REN Qingfa1   YIN Zhijie1   WANG Jing1   LIU Xinkai1*  

1 Department of Radiology, Binzhou Medical University Hospital, Binzhou 256600, China

2 School of Medical Imaging, Binzhou Medical University, Yantai 264003, China

3 Department of Radiology, Central Hospital of Shengli Oilfield, Dongying 257100, China

Corresponding author: LIU X K, E-mail: 104158000@qq.com

Conflicts of interest   None.

Received  2026-01-21
Accepted  2026-04-21
DOI: 10.12015/issn.1674-8034.2026.07.001
DOI:10.12015/issn.1674-8034.2026.07.001.

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