{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T08:34:56Z","timestamp":1793003696039,"version":"4.5.0"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T00:00:00Z","timestamp":1792713600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T00:00:00Z","timestamp":1792713600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Radiol Exp"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Recent evidence highlights the limited specificity of diffusion tensor imaging (DTI) along perivascular spaces (ALPS) as a noninvasive glymphatic biomarker because microstructural tract degeneration and crossing-fiber geometry confound it. We aimed to reassess the interpretation of the DTI-ALPS index in people with focal epilepsy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>Seventy-nine people with drug-resistant focal epilepsy (PWFE) underwent comprehensive presurgical work-up and 3-T magnetic resonance imaging (MRI). Etiologies included MRI-negative epilepsy, malformations of cortical development, temporal lobe epilepsy, and low-grade epilepsy-associated tumors. DTI preprocessing was conducted using QSIPrep with automated region-of-interest (ROI) placement. Linear regression models and Wilcoxon signed-rank tests were used to assess group differences and associations with clinical variables. Twenty-five age- and sex-matched healthy controls were included for comparison.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Seventy-nine patients (28.6 years\u2009\u00b1\u200911.3 [mean\u2009\u00b1\u2009standard deviation]; 47 men, 32 women) and 25 healthy controls (mean age, 26.7 years \u00b1 4.2; 11 men, 14 women) were evaluated. DTI-ALPS findings were more abnormal in lesions in proximity to the ROI (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.014), implicating local white matter disruption as a modifier, which was further corroborated by reduced postoperative values. No associations were identified with disease duration, sex, or normalized gray-or white matter volumes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our results demonstrate a distance-dependent correlation of DTI-ALPS values to the seizure onset zone in focal epilepsy, whilst no significant associations to disease duration or normalized brain volumes were found. Together, these findings suggest that local disruption of fiber tracts may act as important modifiers of this measure and warrant caution in the interpretation of the DTI-ALPS index.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Question<\/jats:italic>\n                      <\/jats:bold>\n                      Microstructural changes may significantly confound the interpretation of the DTI-ALPS index as a surrogate parameter for glymphatic system dysfunction in epilepsy.\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Findings<\/jats:italic>\n                      <\/jats:bold>\n                      No significant differences in the DTI-ALPS index were observed comparing PWFE with healthy controls; however, lesion proximity and post-operative status significantly alter the metric.\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Relevance statement<\/jats:italic>\n                      <\/jats:bold>\n                      Local white-matter disruption and microstructural architecture may significantly alter the DTI-ALPS index; therefore, caution is warranted when interpreting the index as a glymphatic biomarker in focal epilepsy.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s41747-026-00799-8","type":"journal-article","created":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T14:11:49Z","timestamp":1792764709000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Reassessment of the DTI-ALPS index in focal epilepsy"],"prefix":"10.1186","volume":"10","author":[{"given":"Stefanie","family":"Chambers","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leo","family":"Hofer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Tranfa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patric","family":"Kienast","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Shawarba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Radheshyam","family":"Stepponat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith","family":"Jud","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanne","family":"Aull-Watschinger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ekaterina","family":"Pataraia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian Ph.S","family":"Fischmeister","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederik","family":"Barkhof","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gilbert","family":"Hangel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl","family":"R\u00f6ssler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Pontillo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregor","family":"Kasprian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1556-1770","authenticated-orcid":false,"given":"Lukas","family":"Haider","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,23]]},"reference":[{"key":"799_CR1","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1111\/epi.12550","volume":"55","author":"RS Fisher","year":"2014","unstructured":"Fisher RS, Acevedo C, Arzimanoglou A et al (2014) ILAE official report: a practical clinical definition of epilepsy. 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Patients participated following informed written consent.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"TM is a member of the\n                      European Radiology Experimental\n                      Editorial Board, and as such, they have not participated in the review or selection processes for this article. FB is supported by grants or contracts from EPSRC, EU-JU(IMI), NIHR-BRC, GEHC, and ADDI, and has received consultancy payments from Combinostics, IXICO, Roche, and Scottish Brain Sciences, as well as further payments from EISAI, Biogen, Prothena, and Merck. LHa as received payments for educational courses from EISAI and Lilly. All other authors declare that they have no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"162"}}