1
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Sundermann B, Billebaut B, Bauer J, Iacoban CG, Alykova O, Schülke C, Gerdes M, Kugel H, Neduvakkattu S, Bösenberg H, Mathys C. Practical Aspects of novel MRI Techniques in Neuroradiology: Part 2 - Acceleration Methods and Implications for Individual Regions. ROFO-FORTSCHR RONTG 2022; 194:1195-1203. [PMID: 35798335 DOI: 10.1055/a-1800-8789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Recently introduced MRI techniques facilitate accelerated examinations or increased resolution with the same duration. Further techniques offer homogeneous image quality in regions with anatomical transitions. The question arises whether and how these techniques can be adopted for routine diagnostic imaging. METHODS Narrative review with an educational focus based on current literature research and practical experiences of different professions involved (physicians, MRI technologists/radiographers, physics/biomedical engineering). Different hardware manufacturers are considered. RESULTS AND CONCLUSIONS Compressed sensing and simultaneous multi-slice imaging are novel acceleration techniques with different yet complimentary applications. They do not suffer from classical signal-to-noise-ratio penalties. Combining 3 D and acceleration techniques facilitates new broader examination protocols, particularly for clinical brain imaging. In further regions of the nervous systems mainly specific applications appear to benefit from recent technological improvements. KEY POINTS · New acceleration techniques allow for faster or higher resolution examinations.. · New brain imaging approaches have evolved, including more universal examination protocols.. · Other regions of the nervous system are dominated by targeted applications of recently introduced MRI techniques.. CITATION FORMAT · Sundermann B, Billebaut B, Bauer J et al. Practical Aspects of novel MRI Techniques in Neuroradiology: Part 2 - Acceleration Methods and Implications for Individual Regions. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1800-8789.
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Affiliation(s)
- Benedikt Sundermann
- Institute of Radiology and Neuroradiology, Evangelisches Krankenhaus, Medical Campus University of Oldenburg, Germany.,Research Center Neurosensory Science, University of Oldenburg, Germany.,Clinic for Radiology, University Hospital Münster, Germany
| | - Benoit Billebaut
- Clinic for Radiology, University Hospital Münster, Germany.,School for Radiologic Technologists, University Hospital Münster, Germany
| | - Jochen Bauer
- Clinic for Radiology, University Hospital Münster, Germany
| | - Catalin George Iacoban
- Institute of Radiology and Neuroradiology, Evangelisches Krankenhaus, Medical Campus University of Oldenburg, Germany
| | - Olga Alykova
- Institute of Radiology and Neuroradiology, Evangelisches Krankenhaus, Medical Campus University of Oldenburg, Germany
| | | | - Maike Gerdes
- Institute of Radiology and Neuroradiology, Evangelisches Krankenhaus, Medical Campus University of Oldenburg, Germany
| | - Harald Kugel
- Clinic for Radiology, University Hospital Münster, Germany
| | | | - Holger Bösenberg
- Institute of Radiology and Neuroradiology, Evangelisches Krankenhaus, Medical Campus University of Oldenburg, Germany
| | - Christian Mathys
- Institute of Radiology and Neuroradiology, Evangelisches Krankenhaus, Medical Campus University of Oldenburg, Germany.,Research Center Neurosensory Science, University of Oldenburg, Germany.,Department of Diagnostic and Interventional Radiology, University of Düsseldorf, Germany
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2
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Urbach H, Kellner E, Kremers N, Blümcke I, Demerath T. MRI of focal cortical dysplasia. Neuroradiology 2022; 64:443-452. [PMID: 34839379 PMCID: PMC8850246 DOI: 10.1007/s00234-021-02865-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 11/17/2021] [Indexed: 11/09/2022]
Abstract
Focal cortical dysplasia (FCD) are histopathologically categorized in ILAE type I to III. Mild malformations of cortical development (mMCD) including those with oligodendroglial hyperplasia (MOGHE) are to be integrated into this classification yet. Only FCD type II have distinctive MRI and molecular genetics alterations so far. Subtle FCD including FCD type II located in the depth of a sulcus are often overlooked requiring the use of dedicated sequences (MP2RAGE, FLAWS, EDGE) and/or voxel (VBM)- or surface-based (SBM) postprocessing. The added value of 7 Tesla MRI has to be proven yet.
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Affiliation(s)
- Horst Urbach
- Dept. of Neuroradiology, Medical Center - University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany.
| | - Elias Kellner
- Dept. of Medical Physics, Medical Center - University of Freiburg, Freiburg, Germany
| | - Nico Kremers
- Dept. of Neuroradiology, Medical Center - University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany
| | - Ingmar Blümcke
- Dept. of Neuropathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Theo Demerath
- Dept. of Neuroradiology, Medical Center - University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany
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3
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Tóth M, Barsi P, Tóth Z, Borbély K, Lückl J, Emri M, Repa I, Janszky J, Dóczi T, Horváth Z, Halász P, Juhos V, Gyimesi C, Bóné B, Kuperczkó D, Horváth R, Nagy F, Kelemen A, Jordán Z, Újvári Á, Hagiwara K, Isnard J, Pál E, Fekésházy A, Fabó D, Vajda Z. The role of hybrid FDG-PET/MRI on decision-making in presurgical evaluation of drug-resistant epilepsy. BMC Neurol 2021; 21:363. [PMID: 34537017 PMCID: PMC8449490 DOI: 10.1186/s12883-021-02352-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 08/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background When MRI fails to detect a potentially epileptogenic lesion, the chance of a favorable outcome after epilepsy surgery becomes significantly lower (from 60 to 90% to 20–65%). Hybrid FDG-PET/MRI may provide additional information for identifying the epileptogenic zone. We aimed to investigate the possible effect of the introduction of hybrid FDG-PET/MRI into the algorithm of the decision-making in both lesional and non-lesional drug-resistant epileptic patients. Methods In a prospective study of patients suffering from drug-resistant focal epilepsy, 30 nonlesional and 30 lesional cases with discordant presurgical results were evaluated using hybrid FDG-PET/MRI. Results The hybrid imaging revealed morphological lesion in 18 patients and glucose hypometabolism in 29 patients within the nonlesional group. In the MRI positive group, 4 patients were found to be nonlesional, and in 9 patients at least one more epileptogenic lesion was discovered, while in another 17 cases the original lesion was confirmed by means of hybrid FDG-PET/MRI. As to the therapeutic decision-making, these results helped to indicate resective surgery instead of intracranial EEG (iEEG) monitoring in 2 cases, to avoid any further invasive diagnostic procedures in 7 patients, and to refer 21 patients for iEEG in the nonlesional group. Hybrid FDG-PET/MRI has also significantly changed the original therapeutic plans in the lesional group. Prior to the hybrid imaging, a resective surgery was considered in 3 patients, and iEEG was planned in 27 patients. However, 3 patients became eligible for resective surgery, 6 patients proved to be inoperable instead of iEEG, and 18 cases remained candidates for iEEG due to the hybrid FDG-PET/MRI. Two patients remained candidates for resective surgery and one patient became not eligible for any further invasive intervention. Conclusions The results of hybrid FDG-PET/MRI significantly altered the original plans in 19 of 60 cases. The introduction of hybrid FDG-PET/MRI into the presurgical evaluation process had a potential modifying effect on clinical decision-making. Trial registration Trial registry: Scientific Research Ethics Committee of the Medical Research Council of Hungary. Trial registration number: 008899/2016/OTIG. Date of registration: 08 February 2016.
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Affiliation(s)
- Márton Tóth
- Department of Neurology, Medical School, University of Pécs, Rét u. 2, Pécs, H-7623, Hungary.
| | - Péter Barsi
- Department of Medical Imaging, Semmelweis University, Balassa út 6, Budapest, H-1083, Hungary
| | - Zoltán Tóth
- Dr. József Baka Diagnostic, Radiation oncology, Research and Teaching Center, Somogy County Moritz Kaposi Teaching Hospital, Guba Sándor u. 40, Kaposvár, H-7400, Hungary.,MEDICOPUS Healthcare Provider and Public Nonprofit Ltd., Somogy County Moritz Kaposi Teaching Hospital, Guba Sándor u. 40, Kaposvár, H-7400, Hungary
| | - Katalin Borbély
- PET/CT Ambulance, National Institute of Oncology, Ráth György u.7-9, Budapest, H-1122, Hungary
| | - János Lückl
- Dr. József Baka Diagnostic, Radiation oncology, Research and Teaching Center, Somogy County Moritz Kaposi Teaching Hospital, Guba Sándor u. 40, Kaposvár, H-7400, Hungary
| | - Miklós Emri
- MEDICOPUS Healthcare Provider and Public Nonprofit Ltd., Somogy County Moritz Kaposi Teaching Hospital, Guba Sándor u. 40, Kaposvár, H-7400, Hungary.,Division of Nuclear Medicine and Translational Imaging, Department of Medical Imaging, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, Debrecen, H-4032, Hungary
| | - Imre Repa
- Dr. József Baka Diagnostic, Radiation oncology, Research and Teaching Center, Somogy County Moritz Kaposi Teaching Hospital, Guba Sándor u. 40, Kaposvár, H-7400, Hungary
| | - József Janszky
- Department of Neurology, Medical School, University of Pécs, Rét u. 2, Pécs, H-7623, Hungary.,MTA-PTE Clinical Neuroscience MRI Research Group, Ifjúság u. 20, Pécs, H-7624, Hungary
| | - Tamás Dóczi
- MTA-PTE Clinical Neuroscience MRI Research Group, Ifjúság u. 20, Pécs, H-7624, Hungary.,Department of Neurosurgery, Medical School, University of Pécs, Rét u. 2, Pécs, H-7623, Hungary
| | - Zsolt Horváth
- Department of Neurosurgery, Medical School, University of Pécs, Rét u. 2, Pécs, H-7623, Hungary
| | - Péter Halász
- National Institute of Clinical Neurosciences, Amerikai út 57, Budapest, H-1145, Hungary
| | - Vera Juhos
- Epihope Non-Profit Kft, Szilágyi Erzsébet fasor 17-21, Budapest, 1026, Hungary
| | - Csilla Gyimesi
- Department of Neurology, Medical School, University of Pécs, Rét u. 2, Pécs, H-7623, Hungary
| | - Beáta Bóné
- Department of Neurology, Medical School, University of Pécs, Rét u. 2, Pécs, H-7623, Hungary
| | - Diána Kuperczkó
- Department of Neurology, Medical School, University of Pécs, Rét u. 2, Pécs, H-7623, Hungary
| | - Réka Horváth
- Department of Neurology, Medical School, University of Pécs, Rét u. 2, Pécs, H-7623, Hungary
| | - Ferenc Nagy
- Department of Neurology, Somogy County Moritz Kaposi Teaching Hospital, Sándor u. 40, Guba, H-7400, Hungary
| | - Anna Kelemen
- National Institute of Clinical Neurosciences, Amerikai út 57, Budapest, H-1145, Hungary
| | - Zsófia Jordán
- National Institute of Clinical Neurosciences, Amerikai út 57, Budapest, H-1145, Hungary
| | - Ákos Újvári
- National Institute of Clinical Neurosciences, Amerikai út 57, Budapest, H-1145, Hungary
| | - Koichi Hagiwara
- Epilepsy and Sleep Center, Fukuoka Sanno Hospital, 3-6-45, Momochihama, Sawara-ku, Fukuoka, 814-0001, Japan
| | - Jean Isnard
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, Hospital for Neurology and Neurosurgery Pierre Wertheimer, 59 Boulevard Pinel, 69500, Lyon, France
| | - Endre Pál
- Department of Neurology, Medical School, University of Pécs, Rét u. 2, Pécs, H-7623, Hungary
| | - Attila Fekésházy
- Dr. József Baka Diagnostic, Radiation oncology, Research and Teaching Center, Somogy County Moritz Kaposi Teaching Hospital, Guba Sándor u. 40, Kaposvár, H-7400, Hungary.,MEDICOPUS Healthcare Provider and Public Nonprofit Ltd., Somogy County Moritz Kaposi Teaching Hospital, Guba Sándor u. 40, Kaposvár, H-7400, Hungary
| | - Dániel Fabó
- National Institute of Clinical Neurosciences, Amerikai út 57, Budapest, H-1145, Hungary
| | - Zsolt Vajda
- Dr. József Baka Diagnostic, Radiation oncology, Research and Teaching Center, Somogy County Moritz Kaposi Teaching Hospital, Guba Sándor u. 40, Kaposvár, H-7400, Hungary.,Department of Neurosurgery, Medical School, University of Pécs, Rét u. 2, Pécs, H-7623, Hungary
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4
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Saute RL, Peixoto-Santos JE, Velasco TR, Leite JP. Improving surgical outcome with electric source imaging and high field magnetic resonance imaging. Seizure 2021; 90:145-154. [PMID: 33608134 DOI: 10.1016/j.seizure.2021.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/26/2021] [Accepted: 02/04/2021] [Indexed: 12/14/2022] Open
Abstract
While most patients with focal epilepsy present with clear structural abnormalities on standard, 1.5 or 3 T MRI, some patients are MRI-negative. For those, quantitative MRI techniques, such as volumetry, voxel-based morphometry, and relaxation time measurements can aid in finding the epileptogenic focus. High-field MRI, just recently approved for clinical use by the FDA, increases the resolution and, in several publications, was shown to improve the detection of focal cortical dysplasias and mild cortical malformations. For those cases without any tissue abnormality in neuroimaging, even at 7 T, scalp EEG alone is insufficient to delimitate the epileptogenic zone. They may benefit from the use of high-density EEG, in which the increased number of electrodes helps improve spatial sampling. The spatial resolution of even low-density EEG can benefit from electric source imaging techniques, which map the source of the recorded abnormal activity, such as interictal epileptiform discharges, focal slowing, and ictal rhythm. These EEG techniques help localize the irritative, functional deficit, and seizure-onset zone, to better estimate the epileptogenic zone. Combining those technologies allows several drug-resistant cases to be submitted to surgery, increasing the odds of seizure freedom and providing a must needed hope for patients with epilepsy.
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Affiliation(s)
- Ricardo Lutzky Saute
- Department of Neurosciences and Behavioral Sciences, Ribeirao Preto Medical School, University of Sao Paulo, Brazil
| | - Jose Eduardo Peixoto-Santos
- Discipline of Neuroscience, Department of Neurology and Neurosurgery, Paulista School of Medicine, Unifesp, Brazil
| | - Tonicarlo R Velasco
- Department of Neurosciences and Behavioral Sciences, Ribeirao Preto Medical School, University of Sao Paulo, Brazil
| | - Joao Pereira Leite
- Department of Neurosciences and Behavioral Sciences, Ribeirao Preto Medical School, University of Sao Paulo, Brazil.
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5
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Hedderich DM, Avram M, Menegaux A, Nuttall R, Zimmermann J, Schneider SC, Schmitz-Koep B, Daamen M, Scheef L, Boecker H, Zimmer C, Baumann N, Bartmann P, Wolke D, Bäuml JG, Sorg C. Hippocampal subfield volumes are nonspecifically reduced in premature-born adults. Hum Brain Mapp 2020; 41:5215-5227. [PMID: 32845045 PMCID: PMC7670635 DOI: 10.1002/hbm.25187] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/07/2020] [Accepted: 08/11/2020] [Indexed: 01/06/2023] Open
Abstract
Reduced global hippocampus volumes have been demonstrated in premature‐born individuals, from newborns to adults; however, it is unknown whether hippocampus subfield (HCSF) volumes are differentially affected by premature birth and how relevant they are for cognitive performance. To address these questions, we investigated magnetic resonance imaging (MRI)‐derived HCSF volumes in very premature‐born adults, and related them with general cognitive performance in adulthood. We assessed 103 very premature‐born (gestational age [GA] <32 weeks and/or birth weight <1,500 g) and 109 term‐born individuals with cognitive testing and structural MRI at 26 years of age. HCSFs were automatically segmented based on three‐dimensional T1‐ and T2‐weighted sequences and studied both individually and grouped into three functional units, namely hippocampus proper (HP), subicular complex (SC), and dentate gyrus (DG). Cognitive performance was measured using the Wechsler‐Adult‐Intelligence‐Scale (full‐scale intelligence quotient [FS‐IQ]) at 26 years. We observed bilateral volume reductions for almost all HCSF volumes in premature‐born adults and associations with GA and neonatal treatment intensity but not birth weight. Left‐sided HP, SC, and DG volumes were associated with adult FS‐IQ. Furthermore, left DG volume was a mediator of the association between GA and adult FS‐IQ in premature‐born individuals. Results demonstrate nonspecifically reduced HCSF volumes in premature‐born adults; but specific associations with cognitive outcome highlight the importance of the left DG. Data suggest that specific interventions toward hippocampus function might be promising to lower adverse cognitive effects of prematurity.
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Affiliation(s)
- Dennis M Hedderich
- Department of Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.,Technical University of Munich-NIC Neuroimaging Center, Munich, Germany
| | - Mihai Avram
- Department of Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.,Technical University of Munich-NIC Neuroimaging Center, Munich, Germany
| | - Aurore Menegaux
- Department of Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.,Technical University of Munich-NIC Neuroimaging Center, Munich, Germany
| | - Rachel Nuttall
- Department of Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.,Technical University of Munich-NIC Neuroimaging Center, Munich, Germany
| | - Juliana Zimmermann
- Department of Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.,Technical University of Munich-NIC Neuroimaging Center, Munich, Germany
| | - Sebastian C Schneider
- Department of Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.,Technical University of Munich-NIC Neuroimaging Center, Munich, Germany
| | - Benita Schmitz-Koep
- Department of Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.,Technical University of Munich-NIC Neuroimaging Center, Munich, Germany
| | - Marcel Daamen
- Functional Neuroimaging Group, Department of Radiology, University Hospital Bonn, Bonn, Germany.,Department of Neonatology, University Hospital Bonn, Bonn, Germany
| | - Lukas Scheef
- Functional Neuroimaging Group, Department of Radiology, University Hospital Bonn, Bonn, Germany
| | - Henning Boecker
- Functional Neuroimaging Group, Department of Radiology, University Hospital Bonn, Bonn, Germany
| | - Claus Zimmer
- Department of Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.,Technical University of Munich-NIC Neuroimaging Center, Munich, Germany
| | - Nicole Baumann
- Department of Psychology, University of Warwick, Coventry, UK.,Warwick Medical School, University of Warwick, Coventry, UK
| | - Peter Bartmann
- Department of Neonatology, University Hospital Bonn, Bonn, Germany
| | - Dieter Wolke
- Department of Psychology, University of Warwick, Coventry, UK.,Warwick Medical School, University of Warwick, Coventry, UK
| | - Josef G Bäuml
- Department of Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.,Technical University of Munich-NIC Neuroimaging Center, Munich, Germany
| | - Christian Sorg
- Department of Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.,Technical University of Munich-NIC Neuroimaging Center, Munich, Germany.,Department of Psychiatry, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
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6
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Jurcoane A, Daamen M, Keil VC, Scheef L, Bäuml JG, Meng C, Wohlschläger AM, Sorg C, Busch B, Baumann N, Wolke D, Bartmann P, Boecker H, Lüchters G, Marinova M, Hattingen E. Automated quantitative evaluation of brain MRI may be more accurate for discriminating preterm born adults. Eur Radiol 2019; 29:3533-3542. [PMID: 30903339 DOI: 10.1007/s00330-019-06099-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 02/01/2019] [Accepted: 02/11/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the structural brain abnormalities and their diagnostic accuracy through qualitative and quantitative analysis in term born and very preterm birth or with very low birth weight (VP/VLBW) adults. METHODS We analyzed 3-T MRIs acquired in 2011-2013 from 67 adults (27 term born controls, mean age 26.4 years, 8 females; 40 VP/VLBWs, mean age 26.6 years, 16 females). We compared automatic segmentations of the white matter, deep gray matter and cortical gray matter, manual corpus callosum measurements and visual ratings of the ventricles and white matter with t tests, logistic regression, and receiver operator characteristic (ROC) curves. RESULTS Automatic segmentation correctly classified 84% of cases; visual ratings correctly classified 63%. Quantitative volumetry based on automatic segmentation revealed higher ventricular volume, lower posterior corpus callosum, and deep gray matter volumes in VP/VLBW subjects compared to controls (p < 0.01). Visual rating and manual measurement revealed a thinner corpus callosum in VP/VLBW adults (p = 0.04) and deformed lateral ventricles (p = 0.03) and tendency towards more "dirty" white matter (p = 0.06). Automatic/manual measures combined with visual ratings correctly classified 87% of cases. Stepwise logistic regression identified three independent features that correctly classify 81% of cases: ventricular volume, deep gray matter volume, and white matter aspect. CONCLUSION Enlarged and deformed lateral ventricles, thinner corpus callosum, and "dirty" white matter are prevalent in preterm born adults. Their visual evaluation has low diagnostic accuracy. Automatic volume quantification is more accurate but time consuming. It may be useful to ask for prematurity before initiating further diagnostics in subjects with these alterations. KEY POINTS • Our study confirms prior reports showing that structural brain abnormalities related to preterm birth persist into adulthood. • In the clinical practice, if large and deformed lateral ventricles, small and thin corpus callosum, and "dirty" white matter are visible on MRI, ask for prematurity before considering other diagnoses. • Although prevalent, visual findings have low accuracy; adding automatic segmentation of lateral ventricles and deep gray matter nuclei improves the diagnostic accuracy.
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Affiliation(s)
- Alina Jurcoane
- Functional Neuroimaging Group, Department of Radiology, University Hospital Bonn, Bonn, Germany.
- Section of Neuroradiology, Department of Radiology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany.
- Department of Neonatology, University Hospital Bonn, Bonn, Germany.
- Institute for Neuroradiology, University Hospital Frankfurt, Frankfurt, Germany.
| | - Marcel Daamen
- Functional Neuroimaging Group, Department of Radiology, University Hospital Bonn, Bonn, Germany
- Department of Neonatology, University Hospital Bonn, Bonn, Germany
| | - Vera C Keil
- Section of Neuroradiology, Department of Radiology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Lukas Scheef
- Functional Neuroimaging Group, Department of Radiology, University Hospital Bonn, Bonn, Germany
| | - Josef G Bäuml
- Department of Neuroradiology, Klinikum rechts der Isar, Munich, Germany
- TUM-NIC Neuroimaging Center, Technische Universität München, Munich, Germany
| | - Chun Meng
- Department of Neuroradiology, Klinikum rechts der Isar, Munich, Germany
- TUM-NIC Neuroimaging Center, Technische Universität München, Munich, Germany
| | - Afra M Wohlschläger
- Department of Neuroradiology, Klinikum rechts der Isar, Munich, Germany
- TUM-NIC Neuroimaging Center, Technische Universität München, Munich, Germany
| | - Christian Sorg
- Department of Neuroradiology, Klinikum rechts der Isar, Munich, Germany
- TUM-NIC Neuroimaging Center, Technische Universität München, Munich, Germany
- Department of Psychiatry, Klinikum rechts der Isar, Munich, Germany
| | - Barbara Busch
- Department of Neonatology, University Hospital Bonn, Bonn, Germany
| | - Nicole Baumann
- Department of Psychology, University of Warwick, Coventry, UK
| | - Dieter Wolke
- Department of Psychology, University of Warwick, Coventry, UK
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Peter Bartmann
- Department of Neonatology, University Hospital Bonn, Bonn, Germany
| | - Henning Boecker
- Functional Neuroimaging Group, Department of Radiology, University Hospital Bonn, Bonn, Germany
| | - Guido Lüchters
- Center for Development Research, University of Bonn, Bonn, Germany
| | - Milka Marinova
- Section of Neuroradiology, Department of Radiology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Elke Hattingen
- Section of Neuroradiology, Department of Radiology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
- Institute for Neuroradiology, University Hospital Frankfurt, Frankfurt, Germany
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7
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Neuroradiological findings in patients with “non-lesional” focal epilepsy revealed by research protocol. Clin Radiol 2019; 74:78.e1-78.e11. [DOI: 10.1016/j.crad.2018.08.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 08/26/2018] [Indexed: 11/21/2022]
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8
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Chen X, Qian T, Kober T, Zhang G, Ren Z, Yu T, Piao Y, Chen N, Li K. Gray-matter-specific MR imaging improves the detection of epileptogenic zones in focal cortical dysplasia: A new sequence called fluid and white matter suppression (FLAWS). NEUROIMAGE-CLINICAL 2018; 20:388-397. [PMID: 30128277 PMCID: PMC6095948 DOI: 10.1016/j.nicl.2018.08.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 06/09/2018] [Accepted: 08/07/2018] [Indexed: 11/25/2022]
Abstract
Objectives To evaluate the diagnostic value and characteristic features of FCD epileptogenic zones using a novel sequence called fluid and white matter suppression (FLAWS). Materials and methods Thirty-nine patients with pathologically confirmed FCD and good surgery outcomes (class I or II, according to the Engel Epilepsy Surgery Outcome Scale) were retrospectively included in the study. All the patients underwent a preoperative whole-brain MRI examination that included conventional sequences (T2WI, T1WI, two-dimensional (2D) axial, coronal fluid-attenuated inversion recovery [FLAIR]) and FLAWS. An additional 3D-FLAIR MRI sequence was performed in 17 patients. To evaluate the sensitivity and specificity of FLAWS and investigate the cause of false-positives, 36 healthy volunteers were recruited as normal controls. Two radiologists evaluated all the image data. The detection rates of the FCD epileptogenic zone on different sequences were compared based on five criteria: abnormal cortical morphology (thickening, thinning, or abnormally deep sulcus); abnormal cortical signal intensity; blurred gray-white matter junction; abnormal signal intensity of the subcortical white matter, and the transmantle sign. The sensitivity and specificity of FLAWS for detecting the FCD lesions were calculated with the reviewers blinded to all the clinical information, i.e. to the patient identity and the location of the resected regions. To explore how many features were sufficient for the diagnosis of the epileptogenic zones, the frequency of each criterion in the resected regions and their combinations were assessed on FLAWS, according to the results of the assessment when the reviewers were aware of the location of the resected regions. Based on the findings of the 17 patients with an additional 3D-FLAIR scan when the reviewers were aware of the location of the resected regions, quantitative analysis of the regions of interest was used to compare the tissue contrast among 2D-axial FLAIR, 3D-FLAIR, and the FLAWS sequence. Visualization score analysis was used to evaluate the visualization of the five features on conventional, 3D-FLAIR, and FLAWS images. Finally, to explore the reason for false-positive results, a further evaluation of the whole brain FLAWS images was conducted for all the subjects. Results The sensitivity and specificity for detecting the FCD lesions on the FLAWS sequence were 71.9% and 71.1%, respectively. When the reviewers were blinded to the location of the resected regions, the detection rate of the FLAWS sequence was significantly higher than that of the conventional sequences (P = 0.00). In the 17 patients who underwent an additional 3D FLAIR scan, no statistically significant difference was found between the FLAWS and the 3D-FLAIR (P = 0.25). All the patients had at least two imaging features, one of which was “the blurred junction of the gray-white matter.” The transmantle sign, which is widely believed to be a specific feature of FCD type II, could also be observed in type I on the FLAWS sequence. The relative tissue contrast of FLAWS was higher than that of the 2D-FLAIR with respect to lesion/white matter (WM), deep gray matter (GM)/WM, and cortex/WM (P = 0.00 for all three measures) and higher than that of the 3D-FLAIR with respect to the lesion/WM (P = 0.01). The visualization score analysis showed that the visualization of FLAWS was more enhanced than that of the conventional and 3D-FLAIR images with respect to the blurred junction (P = 0.00 for both comparisons) and the abnormal signal intensity of the subcortical white matter (P = 0.01 for both comparisons). The thin-threadlike signal and individual FCD features outside the epileptogenic regions were considered the primary cause of the false-positive results of FLAWS. Conclusions FLAWS can help in the detection of FCD epileptogenic zones. It is recommended that epileptogenic zone on FLAWS be diagnosed based on a combination of two features, one of which should be the “blurred junction of the gray-white matter” in types I and II. In type III, the combination of “the blurred junction of the gray-white matter” with “abnormal signal intensity of subcortical white matter” is recommended. FLAWS can help in the detection of FCD epileptogenic zones. Diagnosis of FCD lesions should be based on a combination of two features. The transmantle sign is not specific for FCD type II on FLAWS.
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Affiliation(s)
- Xin Chen
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, PR China; Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, PR China
| | - Tianyi Qian
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, PR China; MR Collaborations NE Asia, Siemens Healthcare, Beijing, PR China
| | - Tobias Kober
- Advanced Clinical Imaging Technology, Siemens Healthcare HC CEMEA SUI DI PI, Lausanne, Switzerland; Department of Radiology, University Hospital (CHUV), Lausanne, Switzerland; LTS5, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Guojun Zhang
- Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, PR China
| | - Zhiwei Ren
- Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, PR China
| | - Tao Yu
- Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, PR China
| | - Yueshan Piao
- Department of Pathology, Xuanwu Hospital, Capital Medical University, Beijing, PR China
| | - Nan Chen
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, PR China; Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, PR China.
| | - Kuncheng Li
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, PR China; Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, PR China
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Bø HK, Solheim O, Jakola AS, Kvistad KA, Reinertsen I, Berntsen EM. Intra-rater variability in low-grade glioma segmentation. J Neurooncol 2016; 131:393-402. [DOI: 10.1007/s11060-016-2312-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 11/07/2016] [Indexed: 11/29/2022]
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Radue EW, Weigel M, Wiest R, Urbach H. Introduction to Magnetic Resonance Imaging for Neurologists. Continuum (Minneap Minn) 2016; 22:1379-1398. [PMID: 27740981 DOI: 10.1212/con.0000000000000391] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE OF REVIEW In neuroradiology, highly sophisticated methods such as MRI are implemented to investigate different entities of the central nervous system and to acquire miscellaneous images where tissues display varying degrees of characteristic signal intensity or brightness. Compared to x-ray, CT, and ultrasound, MRI produces clearer images of tissues, body fluids, and fat. The basics of MRI may be unknown to neurologists; this article introduces MRI physics, techniques, and interpretation guidelines. RECENT FINDINGS This article discusses the basics of MRI to provide clinicians with the scientific underpinning of MRI technology and to help them better understand image features and improve their diagnosis and differential diagnosis by combining MRI characteristics with their knowledge of pathology and neurology. SUMMARY This article will help neurologists deepen their knowledge and understanding of MRI by introducing the basics of MRI physics, technology, image acquisition, protocols, and image interpretation.
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Mascalchi M, Bianchi A, Basile M, Gulino P, Trifan MR, Difeo D, Bartolini E, Defilippi C, Diciotti S. Effectiveness of 3D T2-Weighted FLAIR FSE Sequences with Fat Suppression for Detection of Brain MR Imaging Signal Changes in Children. AJNR Am J Neuroradiol 2016; 37:2376-2381. [PMID: 27585701 DOI: 10.3174/ajnr.a4915] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 07/04/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND PURPOSE T2-weighted FLAIR can be combined with 3D-FSE sequences with isotropic voxels, yielding higher signal-to-noise ratio than 2D-FLAIR. Our aim was to explore whether a T2-weighted FLAIR-volume isotropic turbo spin-echo acquisition sequence (FLAIR-VISTA) with fat suppression shows areas of abnormal brain T2 hyperintensities with better conspicuity in children than a single 2D-FLAIR sequence. MATERIALS AND METHODS One week after a joint training session with 20 3T MR imaging examinations (8 under sedation), 3 radiologists independently evaluated the presence and conspicuity of abnormal areas of T2 hyperintensities of the brain in FLAIR-VISTA with fat suppression (sagittal source and axial and coronal reformatted images) and in axial 2D-FLAIR without fat suppression in a test set of 100 3T MR imaging examinations (34 under sedation) of patients 2-18 years of age performed for several clinical indications. Their agreement was measured with weighted κ statistics. RESULTS Agreement was "substantial" (mean, 0.61 for 3 observers; range, 0.49-0.69 for observer pairs) for the presence of abnormal T2 hyperintensities and "fair" (mean, 0.29; range, 0.23-0.38) for the comparative evaluation of lesion conspicuity. In 21 of 23 examinations in which the 3 radiologists agreed on the presence of abnormal T2 hyperintensities, FLAIR-VISTA with fat suppression images were judged to show hyperintensities with better conspicuity than 2D-FLAIR. In 2 cases, conspicuity was equal, and in no case was conspicuity better in 2D-FLAIR. CONCLUSIONS FLAIR-VISTA with fat suppression can replace the 2D-FLAIR sequence in brain MR imaging protocols for children.
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Affiliation(s)
- M Mascalchi
- From the "Mario Serio" Department of Experimental and Clinical Biomedical Sciences (M.M., A.B.), University of Florence, Florence, Italy .,Structural and Functional Neuroradiology Research Unit (M.M.)
| | - A Bianchi
- From the "Mario Serio" Department of Experimental and Clinical Biomedical Sciences (M.M., A.B.), University of Florence, Florence, Italy
| | - M Basile
- Diagnostic Radiology (M.B., P.G., M.R.T., D.D., C.D.)
| | - P Gulino
- Diagnostic Radiology (M.B., P.G., M.R.T., D.D., C.D.)
| | - M R Trifan
- Diagnostic Radiology (M.B., P.G., M.R.T., D.D., C.D.)
| | - D Difeo
- Diagnostic Radiology (M.B., P.G., M.R.T., D.D., C.D.)
| | - E Bartolini
- Neurology Unit and Laboratories (E.B.), Meyer Children's Hospital, Florence, Italy
| | - C Defilippi
- Diagnostic Radiology (M.B., P.G., M.R.T., D.D., C.D.)
| | - S Diciotti
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi" (S.D.), University of Bologna, Cesena, Italy
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Granata F, Morabito R, Mormina E, Alafaci C, Marino S, Laganà A, Vinci SL, Briguglio M, Calamuneri A, Gaeta M, Salpietro V, Longo M. 3T Double Inversion Recovery Magnetic Resonance Imaging: diagnostic advantages in the evaluation of cortical development anomalies. Eur J Radiol 2016; 85:906-14. [PMID: 27130050 DOI: 10.1016/j.ejrad.2016.02.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 02/15/2016] [Accepted: 02/17/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of this work was to investigate the diagnostic value of the DIR sequence at 3T MR imaging operating in the evaluation of cortical development anomalies. METHODS We studied 40 patients, with a previous diagnosis of cortical dysplasia, by FLAIR-3D, DIR, FSE T2 and MPR-GE T1 sequences at 3T MRI. Two independent observers evaluated, for each sequence and lesion, some semiological aspects (cortical thickness, cortical signal intensity, white-gray matter blurring, subcortical white matter intensity). We made also a quantitative evaluation of the cortical signal intensity in lesion site, drawing a ROI on each MRI sequences and comparing them to the correspondent normal contralateral cortical area. RESULTS We identified 44 cortical development anomalies. Qualitative analyses showed a high level of agreement between the observers concerning DIR potentialities in detecting and characterizing the cortical development disorders. Particularly DIR sequence was able to demonstrate the blurring and the subcortical white matter anomalies. The quantitative analyses didn't show a significant difference between DIR and traditional sequences in the evaluation of the cortical signal intensity. CONCLUSION 3T MRI-DIR sequence is a useful and better suitable sequence compared to the traditional sequences in the characterization of some semiological aspects of the cortical development disorders, particularly blurring and subcortical white matter hyperintensity.
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Affiliation(s)
- Francesca Granata
- Neuroradiology Unit-Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Italy.
| | - Rosa Morabito
- Neuroradiology Unit-Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Italy; Biomedical department of internal and specialistic medicine, University of Palermo, Italy.
| | - Enricomaria Mormina
- Neuroradiology Unit-Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Italy.
| | - Concetta Alafaci
- Department of Neurosciences, Psychiatric and Anaesthesiological Sciences, Neurosurgery Unit, University of Messina, Italy.
| | - Silvia Marino
- IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy.
| | - Angela Laganà
- Department of Neurosciences, University of Messina, Italy.
| | - Sergio Lucio Vinci
- Neuroradiology Unit-Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Italy.
| | - Marilena Briguglio
- Department of Pediatric, Gynecological, Microbiological and Biomedical Sciences, University of Messina, Italy.
| | | | - Michele Gaeta
- Neuroradiology Unit-Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Italy.
| | - Vincenzo Salpietro
- Department of Pediatric, Gynecological, Microbiological and Biomedical Sciences, University of Messina, Italy.
| | - Marcello Longo
- Neuroradiology Unit-Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Italy.
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