Irene Wang, PhD

"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."

MR fingerprinting is a novel technology that uses conventional MRI scanners but can quantify multiple properties of tissue in a single scan, characterizing areas smaller than a single voxel in a fraction of the time. This relatively new technique may be able to address the areas in where conventional MRIs may be limited in, particularly detecting subtle epileptic lesions or identifying active/epileptic lesions among widespread, multifocal lesions.

Although the safety and efficacy of epilepsy surgery has certainly improved in recent years, patients still shy away from the procedure because of the typical fears associated with brain surgery. Irene Wang, PhD, research director and staff scientist, Comprehensive Epilepsy Center, 

, has published several different papers on the use of MR fingerprinting, and claimed that this new approach holds key clinical value in the pre- and post-surgical process.

®, she detailed her personal passion for the imaging technique, the way MR fingerprinting can improve the eligibility and success of epilepsy surgery, and how it also may alleviate the fears of those who should consider undergoing the procedure.

Videos

The research director and staff scientist at Cleveland Clinic’s Epilepsy Center detailed the clinical pre- and post-surgery benefits patients with epilepsy get from MR fingerprinting. [WATCH TIME: 3 minutes]

How MR Fingerprinting Can Improve Epilepsy Surgery: Irene Wang, PhD

"This is a noninvasive technique. A lot of the lesion characterization work can only be done nowadays after the electrodes have been inserted into the brain for recording or after surgery has been done. Now, we’re going way earlier to probe the brain."

In recent years, the use of MR fingerprinting, a multiparametric quantitative imaging tool, has gained increasing interest due to its widespread advantages among different clinical applications. Most quantitative MRI approaches allow for the measurement of tissue properties but are relatively slow and generally provide only a single property at a time, making them limited in nature. The utility of MR fingerprinting is to simultaneously probe for information on all the desired tissue properties with the goal of improving signal-to-noise ratio and scan efficiency of the entire experiment.

There are several different approaches to using this technique, including a radiomics extraction approach that was taken by Irene Wang, PhD et al., which accurately distinguished healthy tissue from that of patients with focal cortical dysplasia. Wang, the research director and staff scientist at the Comprehensive Epilepsy Center of 

, noted that there is potential use of MR fingerprinting to characterize lesions, both epileptic and non-epileptic in the brain, which may ultimately improve the precision of care.

®, Wang provided insight on the benefits MR fingerprinting provides for patients with epilepsy and the neurology space in general. She detailed specific uses for the technique, including why it could serve as a basis in longitudinal imaging studies.

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

The research director and staff scientist at Cleveland Clinic’s Epilepsy Center discussed opportunities for MR fingerprinting to expand, both in the epilepsy field and in general neurology. [WATCH TIME 3 minutes]

Advantages and Potential of MR Fingerprinting in Epilepsy, Neurology: Irene Wang, PhD

"We are now combining this quantitative-MRI with quantitative post-processing. I think of this as quantitative based on quantitative, so it’s essentially quantitative squared.”

Focal cortical dysplasia (FCD) is one of the most common pathologies for medically intractable focal epilepsy; however, using conventional weighted MRI may be limited in detecting or characterizing FCD. MR fingerprinting, a novel technique developed in the past decade, may provide the quantitative look that clinicians need to better understand the presentation of the disease. A study presented at the 

2021 American Epilepsy Society (AES) Annual Meeting

, December 3-7, adopted a MR fingerprinting-based radiomics feature extraction approach to characterize FCD lesions.

At the end of the analysis, the MF fingerprinting radiomics model with the optimal 30 features showed high area under the curve, accuracy, sensitivity, and specificity of 0.86 (±0.02), 84% (±1), 87% (±1) and 80% (±2), respectively. Senior author Irene Wang, PhD, has been at the forefront of developing and expanding the use of MR fingerprinting. She and her colleagues have worked on several other research papers using this technique, including 2 others at AES 2021.

Wang, the research director and staff scientist at the Comprehensive Epilepsy Center of 

, noted that the decision to use a radiomics-based approach was because its radar independent. In an interview with 

®, she provided background on the results observed, the most notable take-home points, and the advantages of adjusting MR fingerprinting. She also discussed whether her approach could be replicated for further use in other epilepsy-related areas.

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; Chicago, IL. Poster 3.235

The research director and staff scientist at Cleveland Clinic’s Epilepsy Center provided insight on her study presented at AES 2021, which showed that MR fingerprinting can differentiate focal cortical dysplasia from healthy tissue. [WATCH TIME: 4 minutes]

Using Radiomics-Based MR Fingerprinting to Detect Focal Cortical Dysplasia: Irene Wang, PhD

"What we do currently with MRI is look at dark or bright. This is similar to feeling a high or low fever. But what we need to do is have that number that could tell us about the state of the brain—the healthy state of the brain, so to speak."

MR fingerprinting is a relatively recent approach to the acquisition and evaluation of MRI data aimed at generating quantitative multiparametric data from a single acquisition. The idea behind MR fingerprinting is that it will make comparison across individuals, scanners, and vendors possible, rather than the current situation in which most imaging data is qualitative. The benefits of MR fingerprinting were further showcased at the recently concluded 

, December 3-7, in Chicago, Illinois, with research conducted by Irene Wang, PhD.

Wang, the research director and a staff scientist at the Comprehensive Epilepsy Center of 

, presented 3 abstracts that evaluated MR fingerprinting in the characterization of medically intractable focal epilepsy and focal cortical dysplasia (FCD). FCD, one of the most common pathologies for medically intractable focal epilepsy, can be difficult to detect by using traditional weighted MRI. Using a radiomics extraction approach, the data showed high accuracies of MR fingerprinting to classify FCD from health tissue, and to classify FCD type 2 from type 1.

These projects have been in the works for years, according to Wang. She sat down with 

® to discuss the reasoning behind the research, how this novel approach will change the way epilepsy is viewed, and why clinicians should be excited for it.

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

The research director and staff scientist at Cleveland Clinic’s Epilepsy Center provided background on the momentum behind MR fingerprinting and its potential in epilepsy care. [WATCH TIME: 3 minutes]

Irene Wang, PhD

Articles

How MR Fingerprinting Can Improve Epilepsy Surgery: Irene Wang, PhD

Advantages and Potential of MR Fingerprinting in Epilepsy, Neurology: Irene Wang, PhD

Using Radiomics-Based MR Fingerprinting to Detect Focal Cortical Dysplasia: Irene Wang, PhD

Utilizing MR Fingerprinting to Benefit Epilepsy Care: Irene Wang, PhD

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