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Aly MAA, Saleh TM, Elfatatry AMA, Montasser MM. The value of double inversion recovery MRI sequence in assessment of epilepsy patients. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00604-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The double inversion recovery (DIR) pulse sequence was introduced several years ago and since that it grew important value in clinical neuroimaging. We aimed to assess the added value of double inversion recovery in evaluation of epileptic patients.
Results
In mesial temporal sclerosis, the measured contrast parameters (SNR, CR, CNR and AI) were found to be significantly higher in DIR than in FLAIR and T2 sequences. In cases of focal cortical dysplasia, significantly higher CNR and AI in DIR than in T2 and FLAIR. Also DIR showed higher detection of the increased cortical thickness and cortical signal intensity than the T2 and FLAIR sequences. In tuberous sclerosis cases, the DIR showed higher visibility of the lesions than the T2 and FLAIR. Also DIR showed higher ability to detected grey-white matters junction blurring.
Conclusions
Our study concluded that the greatest value of the double inversion recovery sequence is its higher ability in detecting multiple characteristics of the lesions in a one sequence.
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Parsons MS, Sharma A, Hildebolt C. Using Correlative Properties of Neighboring Pixels to Enhance Contrast-to-Noise Ratio of Abnormal Hippocampus in Patients With Intractable Epilepsy and Mesial Temporal Sclerosis. Acad Radiol 2019; 26:e1-e8. [PMID: 29907398 DOI: 10.1016/j.acra.2018.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 04/30/2018] [Accepted: 05/10/2018] [Indexed: 10/14/2022]
Abstract
RATIONALE AND OBJECTIVES To test whether an image-processing algorithm can aid in visualization of mesial temporal sclerosis on magnetic resonance imaging by selectively increasing contrast-to-noise ratio (CNR) between abnormal hippocampus and normal brain. MATERIALS AND METHODS In this Institutional Review Board-approved and Health Insurance Portability and Accountability Act-compliant study, baseline coronal fluid-attenuated inversion recovery images of 18 adults (10 females, eight males; mean age 41.2 years) with proven mesial temporal sclerosis were processed using a custom algorithm to produce corresponding enhanced images. Average (Hmean) and maximum (Hmax) CNR for abnormal hippocampus were calculated relative to normal ipsilateral white matter. CNR values for normal gray matter (GM) were similarly calculated using ipsilateral cingulate gyrus as the internal control. To evaluate effect of image processing on visual conspicuity of hippocampal signal alteration, a neuroradiologist masked to the side of hippocampal abnormality rated signal intensity (SI) of hippocampi on baseline and enhanced images using a five-point scale (definitely abnormal to definitely normal). Differences in Hmean, Hmax, GM, and SI ratings for abnormal hippocampi on baseline and enhanced images were assessed for statistical significance. RESULTS Both Hmean and Hmax were significantly higher in enhanced images as compared to baseline images (p < 0.0001 for both). There was no significant difference in the GM between baseline and enhanced images (p = 0.9375). SI ratings showed a more confident identification of abnormality on enhanced images (p = 0.0001). CONCLUSION Image-processing resulted in increased CNR of abnormal hippocampus without affecting the CNR of normal gray matter. This selective increase in conspicuity of abnormal hippocampus was associated with more confident identification of hippocampal signal alteration.
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Umino M, Maeda M, Ii Y, Tomimoto H, Sakuma H. 3D double inversion recovery MR imaging: Clinical applications and usefulness in a wide spectrum of central nervous system diseases. J Neuroradiol 2018; 46:107-116. [PMID: 30016704 DOI: 10.1016/j.neurad.2018.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/03/2018] [Accepted: 06/23/2018] [Indexed: 12/31/2022]
Abstract
Double inversion recovery (DIR) imaging provides two inversion pulses that attenuate signals from cerebrospinal fluid and normal white matter. This review was undertaken to describe the principle of the DIR sequence, the clinical applications of 3D DIR in various central nervous system diseases and the clinical benefits of the 3D DIR compared with those of other MR sequences. 3D DIR imaging provides better lesion conspicuity and topography than other MR techniques. It is particularly useful for diagnosing the following disease entities: cortical and subcortical abnormalities such as multiple sclerosis, cortical microinfarcts and cortical development anomalies; sulcal abnormalities such as meningitis and subacute/chronic subarachnoid hemorrhage; and optic neuritis caused by multiple sclerosis or neuromyelitis optica.
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Affiliation(s)
- Maki Umino
- Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, 514-8507 Tsu, Mie, Japan.
| | - Masayuki Maeda
- Department of Advanced Diagnostic Imaging, Mie University School of Medicine, Tsu, Mie, Japan
| | - Yuichiro Ii
- Department of Neurology, Mie University School of Medicine, Tsu, Mie, Japan
| | - Hidekazu Tomimoto
- Department of Neurology, Mie University School of Medicine, Tsu, Mie, Japan
| | - Hajime Sakuma
- Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, 514-8507 Tsu, Mie, Japan
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Shen Y, Zhao B, Yan L, Jann K, Wang G, Wang J, Wang B, Pfeuffer J, Qian T, Wang DJJ. Cerebral Hemodynamic and White Matter Changes of Type 2 Diabetes Revealed by Multi-TI Arterial Spin Labeling and Double Inversion Recovery Sequence. Front Neurol 2017; 8:717. [PMID: 29312135 PMCID: PMC5743674 DOI: 10.3389/fneur.2017.00717] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 12/12/2017] [Indexed: 01/07/2023] Open
Abstract
Diabetes has been reported to affect the microvasculature and lead to cerebral small vessel disease (SVD). Past studies using arterial spin labeling (ASL) at single post-labeling delay reported reduced cerebral blood flow (CBF) in patients with type 2 diabetes. The purpose of this study was to characterize cerebral hemodynamic changes of type 2 diabetes using a multi-inversion-time 3D GRASE pulsed ASL (PASL) sequence to simultaneously measure CBF and bolus arrival time (BAT). Thirty-six patients with type 2 diabetes (43-71 years, 17 male) and 36 gender- and age-matched control subjects underwent MRI scans at 3 T. Mean CBF/BAT values were computed for gray and white matter (GM and WM) of each subject, while a voxel-wise analysis was performed for comparison of regional CBF and BAT between the two groups. In addition, white matter hyperintensities (WMHs) were detected by a double inversion recovery (DIR) sequence with relatively high sensitivity and spatial resolution. Mean CBF of the WM, but not GM, of the diabetes group was significantly lower than that of the control group (p < 0.0001). Regional CBF decreases were detected in the left middle occipital gyrus (p = 0.0075), but failed to reach significance after correction of partial volume effects. BAT increases were observed in the right calcarine fissure (p < 0.0001), left middle occipital gyrus (p < 0.0001), and right middle occipital gyrus (p = 0.0011). Within the group of diabetic patients, BAT in the right middle occipital gyrus was positively correlated with the disease duration (r = 0.501, p = 0.002), BAT in the left middle occipital gyrus was negatively correlated with the binocular visual acuity (r = -0.408, p = 0.014). Diabetic patients also had more WMHs than the control group (p = 0.0039). Significant differences in CBF, BAT, and more WMHs were observed in patients with diabetes, which may be related to impaired vision and risk of SVD of type 2 diabetes.
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Affiliation(s)
- Yelong Shen
- School of Medicine, Shandong Medical Imaging Research Institute, Shandong University, Jinan, China.,Laboratory of FMRI Technology (LOFT), Keck School of Medicine, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California (USC), Los Angeles, CA, United States
| | - Bin Zhao
- School of Medicine, Shandong Medical Imaging Research Institute, Shandong University, Jinan, China
| | - Lirong Yan
- Laboratory of FMRI Technology (LOFT), Keck School of Medicine, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California (USC), Los Angeles, CA, United States
| | - Kay Jann
- Laboratory of FMRI Technology (LOFT), Keck School of Medicine, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California (USC), Los Angeles, CA, United States
| | - Guangbin Wang
- School of Medicine, Shandong Medical Imaging Research Institute, Shandong University, Jinan, China
| | - Junli Wang
- School of Medicine, Shandong Medical Imaging Research Institute, Shandong University, Jinan, China
| | - Bao Wang
- School of Medicine, Shandong Medical Imaging Research Institute, Shandong University, Jinan, China
| | | | - Tianyi Qian
- Siemens Healthcare, MR Collaborations NE Asia, Beijing, China
| | - Danny J J Wang
- Laboratory of FMRI Technology (LOFT), Keck School of Medicine, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California (USC), Los Angeles, CA, United States
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Wychowski T, Hussain A, Tivarus ME, Birbeck GL, Berg MJ, Potchen M. Qualitative analysis of double inversion recovery MRI in drug-resistant epilepsy. Epilepsy Res 2016; 127:195-199. [PMID: 27619358 DOI: 10.1016/j.eplepsyres.2016.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 08/12/2016] [Accepted: 09/01/2016] [Indexed: 11/17/2022]
Abstract
PURPOSE To determine whether Double Inversion Recovery (DIR) on 3T MRI can enhance detection of epileptogenic lesions Methods: 29 adult patients with DRE were enrolled in a prospective pilot study. Brain MRIs were obtained using a specialized protocol that included: (1) Fast-Spin EchoT2, (2) T2 fluid attenuated inversion recovery (FLAIR), and (3) DIR sequences. Two neuroradiologists blinded to clinical information independently reviewed each sequence in the order listed above for T2-hyperintense lesions. Cortical lesions were determined to be concordant with the epileptic focus based upon available clinical and electrodiagnostic testing. RESULTS Of 29 studies, 21 had a lesion identified with 13/21 abnormalities being non-specific. Of 8 remaining studies, 3 revealed a lesion only with DIR sequencing. DIR-lesions were concordant with clinical data in 1 subject, non-discordant in 1 subject, and discordant in 1 subject. SIGNIFICANCE DIR has the potential to be more sensitive in detecting cortically based lesions relative to standard imaging. More data are needed to assess the sensitivity and specificity of DIR, particularly as it pertains to identification of epileptogenic lesions using electrodiagnostic testing and outcome after surgery.
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Affiliation(s)
- Thomas Wychowski
- Department of Neurology, Strong Memorial Hospital, University of Rochester, 601 Elmwood Ave., Box 673, Rochester, NY 14642 USA.
| | - Ali Hussain
- Department of Imaging Sciences, Strong Memorial Hospital, University of Rochester, 601 Elmwood Ave., Box 648, Rochester, NY 14642 USA
| | - Madalina E Tivarus
- Department of Imaging Sciences, Strong Memorial Hospital, University of Rochester, 601 Elmwood Ave., Box 648, Rochester, NY 14642 USA
| | - Gretchen L Birbeck
- Department of Neurology, Strong Memorial Hospital, University of Rochester, 601 Elmwood Ave., Box 673, Rochester, NY 14642 USA
| | - Michel J Berg
- Department of Neurology, Strong Memorial Hospital, University of Rochester, 601 Elmwood Ave., Box 673, Rochester, NY 14642 USA
| | - Michael Potchen
- Department of Imaging Sciences, Strong Memorial Hospital, University of Rochester, 601 Elmwood Ave., Box 648, Rochester, NY 14642 USA
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Double Inversion Recovery Magnetic Resonance Imaging in Identifying Focal Cortical Dysplasia. Pediatr Neurol 2016; 61:87-93. [PMID: 27241231 DOI: 10.1016/j.pediatrneurol.2016.04.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 04/26/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Focal cortical dysplasia is commonly recognized in pediatric epilepsy surgery. Despite characteristic radiographic features, focal cortical dysplasia can be subtle on magnetic resonance imaging. Double inversion recovery acquisition suppresses the white matter signal, which may enhance visualization of abnormal features at the gray-white matter interface. We assessed the ability of double inversion recovery to distinguish focal cortical dysplasia from periventricular nodular heterotopia and normal brain. METHODS Patients with focal cortical dysplasia were identified from our patient database, as was a control group comprising patients with periventricular nodular heterotopia and healthy persons. A senior neuroradiologist reviewed all clinical images and classified them as patients with focal cortical dysplasia (n = 16) or control subjects (periventricular nodular heterotopia, n = 13; normal, n = 20). Four neuroradiologists reviewed the de-identified and randomized double inversion recovery and magnetization prepared rapid acquired gradient echoes (MPRAGE) sequences for each person and scored them as normal, focal cortical dysplasia, or periventricular nodular heterotopia. RESULTS Among individual reviewers, double inversion recovery showed sensitivity from 50% to 88% and specificity from 67% to 91% in detecting focal cortical dysplasia. The sensitivity was notably higher in reviewers with more clinical experience with the technique. Consensus agreement among the three most experienced reviewers gave a sensitivity of 88% (95% confidence interval [CI], 72% to 97%) and specificity of 88% (95% CI, 62% to 98%) for double inversion recovery and sensitivity of 44% (95% CI, 20% to 70%) and specificity of 100% (95% CI, 89% to 100%) for MPRAGE. CONCLUSIONS Double inversion recovery is sensitive for detection of focal cortical dysplasia with experienced users, particularly when there is consensus agreement. The use of two clinically available magnetic resonance imaging acquisitions-double inversion recovery and another sequence with high specificity such as MPRAGE-would be complementary in the evaluation of lesional epilepsy.
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Martinez-Rios C, McAndrews MP, Logan W, Krings T, Lee D, Widjaja E. MRI in the evaluation of localization-related epilepsy. J Magn Reson Imaging 2016; 44:12-22. [PMID: 27115073 DOI: 10.1002/jmri.25269] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 03/28/2016] [Indexed: 11/06/2022] Open
Abstract
This article covers the MRI evaluation of patients with epilepsy, with a focus on neuroimaging in those with localization-related epilepsy who may be potential epilepsy surgery candidates. The article includes structural MRI to identify a lesion, functional MRI to identify the eloquent cortex and diffusion tensor imaging to identify the eloquent white matter tracts. We consider the equipment, protocol or procedures, and reporting of MRI in patients with epilepsy. Recommendations for both adult and pediatric patients are described for protocols and procedures. The authors hope that this article will provide a standardized approach for clinical imaging of patients with suspected localization-related epilepsy who may be evaluated for epilepsy surgery. J. Magn. Reson. Imaging 2016.
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Affiliation(s)
| | | | - William Logan
- Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Timo Krings
- University Health Network, Toronto, Ontario, Canada
| | - Donald Lee
- London Health Sciences Center, London, Ontario, Canada
| | - Elysa Widjaja
- Department of Radiology, Hospital for Sick Children, Toronto, Ontario, Canada
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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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Stylianou P, Hoffmann C, Blat I, Harnof S. Neuroimaging for patient selection for medial temporal lobe epilepsy surgery: Part 1 Structural neuroimaging. J Clin Neurosci 2015; 23:14-22. [PMID: 26362835 DOI: 10.1016/j.jocn.2015.04.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 03/27/2015] [Accepted: 04/05/2015] [Indexed: 11/19/2022]
Abstract
The objective of part one of this review is to present the structural neuroimaging techniques that are currently used to evaluate patients with temporal lobe epilepsy (TLE), and to discuss their potential to define patient eligibility for medial temporal lobe surgery. A PubMed query, using Medline and Embase, and subsequent review, was performed for all English language studies published after 1990, reporting neuroimaging methods for the evaluation of patients with TLE. The extracted data included demographic variables, population and study design, imaging methods, gold standard methods, imaging findings, surgical outcomes and conclusions. Overall, 56 papers were reviewed, including a total of 1517 patients. This review highlights the following structural neuroimaging techniques: MRI, diffusion-weighted imaging, tractography, electroencephalography and magnetoencephalography. The developments in neuroimaging during the last decades have led to remarkable improvements in surgical precision, postsurgical outcome, prognosis, and the rate of seizure control in patients with TLE. The use of multiple imaging methods provides improved outcomes, and further improvements will be possible with future studies of larger patient cohorts.
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Affiliation(s)
- Petros Stylianou
- Department of Neurosurgery, The Chaim Sheba Medical Center, Nissim Aloni 16, Tel Aviv-Yafo 62919, Israel.
| | - Chen Hoffmann
- Department of Radiology, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Ilan Blat
- Department of Neurology, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Sagi Harnof
- Department of Neurosurgery, The Chaim Sheba Medical Center, Nissim Aloni 16, Tel Aviv-Yafo 62919, Israel
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Abstract
Advanced MR imaging techniques have found extensive utility in the clinical practice of neuroradiology. A variety of these techniques are incorporated into imaging protocols for routine use, specific applications to particular disease entities, or as problem-solving tools on an ad hoc basis. This article summarizes and illustrates the spectrum of advanced MR imaging tools used clinically in the practice of neuroradiology.
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Morimoto E, Okada T, Kanagaki M, Yamamoto A, Fushimi Y, Matsumoto R, Takaya S, Ikeda A, Kunieda T, Kikuchi T, Paul D, Miyamoto S, Takahashi R, Togashi K. Evaluation of focus laterality in temporal lobe epilepsy: A quantitative study comparing double inversion-recovery MR imaging at 3T with FDG-PET. Epilepsia 2013; 54:2174-83. [DOI: 10.1111/epi.12396] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Emiko Morimoto
- Diagnostic Imaging and Nuclear Medicine; Kyoto University Graduate School of Medicine; Kyoto Japan
| | - Tomohisa Okada
- Diagnostic Imaging and Nuclear Medicine; Kyoto University Graduate School of Medicine; Kyoto Japan
| | - Mitsunori Kanagaki
- Diagnostic Imaging and Nuclear Medicine; Kyoto University Graduate School of Medicine; Kyoto Japan
| | - Akira Yamamoto
- Diagnostic Imaging and Nuclear Medicine; Kyoto University Graduate School of Medicine; Kyoto Japan
| | - Yasutaka Fushimi
- Diagnostic Imaging and Nuclear Medicine; Kyoto University Graduate School of Medicine; Kyoto Japan
| | - Riki Matsumoto
- Neurology; Kyoto University Graduate School of Medicine; Kyoto Japan
| | - Shigetoshi Takaya
- Human Brain Research Center; Kyoto University Graduate School of Medicine; Kyoto Japan
- Radioisotope Research Center; Kyoto University; Kyoto Japan
- Athinoula A. Martinos Center for Biomedical Imaging; Harvard Medical School; Massachusetts General Hospital; Charlestown Massachusetts U.S.A
| | - Akio Ikeda
- Neurology; Kyoto University Graduate School of Medicine; Kyoto Japan
| | - Takeharu Kunieda
- Neurosurgery; Kyoto University Graduate School of Medicine; Kyoto Japan
| | - Takayuki Kikuchi
- Neurosurgery; Kyoto University Graduate School of Medicine; Kyoto Japan
| | | | - Susumu Miyamoto
- Neurosurgery; Kyoto University Graduate School of Medicine; Kyoto Japan
| | - Ryosuke Takahashi
- Neurology; Kyoto University Graduate School of Medicine; Kyoto Japan
| | - Kaori Togashi
- Diagnostic Imaging and Nuclear Medicine; Kyoto University Graduate School of Medicine; Kyoto Japan
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Harris RJ, Cloughesy TF, Pope WB, Godinez S, Natsuaki Y, Nghiemphu PL, Meyer H, Paul D, Behbahanian Y, Lai A, Ellingson BM. Pre- and post-contrast three-dimensional double inversion-recovery MRI in human glioblastoma. J Neurooncol 2013; 112:257-66. [PMID: 23344788 DOI: 10.1007/s11060-013-1057-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 01/15/2013] [Indexed: 11/26/2022]
Abstract
Fluid attenuated inversion recovery (FLAIR) MRI sequences have become an indispensible tool for defining the malignant boundary in patients with brain tumors by nulling the signal contribution from cerebrospinal fluid allowing both regions of edema and regions of non-enhancing, infiltrating tumor to become hyperintense on resulting images. In the current study we examined the utility of a three-dimensional double inversion recovery (DIR) sequence that additionally nulls the MR signal associated with white matter, implemented either pre-contrast or post-contrast, in order to determine whether this sequence allows for better differentiation between tumor and normal brain tissue. T1- and T2-weighted, FLAIR, dynamic susceptibility contrast (DSC)-MRI estimates of cerebral blood volume (rCBV), contrast-enhanced T1-weighted images (T1+C), and DIR data (pre- or post-contrast) were acquired in 22 patients with glioblastoma. Contrast-to-noise (CNR) and tumor volumes were compared between DIR and FLAIR sequences. Line profiles across regions of tumor were generated to evaluate similarities between image contrasts. Additionally, voxel-wise associations between DIR and other sequences were examined. Results suggested post-contrast DIR images were hyperintense (bright) in regions spatially similar those having FLAIR hyperintensity and hypointense (dark) in regions with contrast-enhancement or elevated rCBV due to the high sensitivity of 3D turbo spin echo sequences to susceptibility differences between different tissues. DIR tumor volumes were statistically smaller than tumor volumes as defined by FLAIR (Paired t test, P = 0.0084), averaging a difference of approximately 14 mL or 24 %. DIR images had approximately 1.5× higher lesion CNR compared with FLAIR images (Paired t test, P = 0.0048). Line profiles across tumor regions and scatter plots of voxel-wise coherence between different contrasts confirmed a positive correlation between DIR and FLAIR signal intensity and a negative correlation between DIR and both post-contrast T1-weighted image signal intensity and rCBV. Additional discrepancies between FLAIR and DIR abnormal regions were also observed, together suggesting DIR may provide additional information beyond that of FLAIR.
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Affiliation(s)
- Robert J Harris
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90024, USA
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Anterior temporal lobe white matter abnormal signal (ATLAS) as an indicator of seizure focus laterality in temporal lobe epilepsy: comparison of double inversion recovery, FLAIR and T2W MR imaging. Eur Radiol 2012; 23:3-11. [PMID: 22811046 DOI: 10.1007/s00330-012-2565-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 05/17/2012] [Accepted: 05/28/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To investigate the diagnostic capability of anterior temporal lobe white matter abnormal signal (ATLAS) for determining seizure focus laterality in temporal lobe epilepsy (TLE) by comparing different MR sequences. METHODS This prospective study was approved by the institutional review board and written informed consent was obtained. Three 3D sequences (double inversion recovery (DIR), fluid-attenuated inversion recovery (FLAIR) and T2-weighted imaging (T2WI)) and two 2D sequences (FLAIR and T2WI) were acquired at 3 T. Signal changes in the anterior temporal white matter of 21 normal volunteers were evaluated. ATLAS laterality was evaluated in 21 TLE patients. Agreement of independent evaluations by two neuroradiologists was assessed using κ statistics. Differences in concordance between ATLAS laterality and clinically defined seizure focus laterality were analysed using McNemar's test with multiple comparisons. RESULTS Pre-amygdala high signals (PAHS) were detected in all volunteers only on 3D-DIR. Inter-evaluator agreement was moderate to almost perfect for each sequence. Correct diagnosis of seizure laterality was significantly more frequent on 3D-DIR than on any other sequences (P ≤ 0.031 for each evaluator). CONCLUSIONS The most sensitive sequence for detecting ATLAS laterality was 3D-DIR. ATLAS laterality on 3D-DIR can be a good indicator for determining seizure focus localization in TLE.
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