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Clay JL, Mirza FA, Hulou KD, Raslau FD. Value and potential pitfalls of morphometric analysis of magnetic resonance imaging in epilepsy. Epilepsia 2024. [PMID: 39031775 DOI: 10.1111/epi.18049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 06/11/2024] [Accepted: 06/12/2024] [Indexed: 07/22/2024]
Affiliation(s)
- Jordan L Clay
- Comprehensive Epilepsy Program, Department of Neurology, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Farhan A Mirza
- Comprehensive Epilepsy Program, Department of Neurological Surgery, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Kamar D Hulou
- Comprehensive Epilepsy Program, Department of Radiology, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Flavius D Raslau
- Comprehensive Epilepsy Program, Department of Neurology, University of Kentucky College of Medicine, Lexington, Kentucky, USA
- Comprehensive Epilepsy Program, Department of Neurological Surgery, University of Kentucky College of Medicine, Lexington, Kentucky, USA
- Comprehensive Epilepsy Program, Department of Radiology, University of Kentucky College of Medicine, Lexington, Kentucky, USA
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2
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Ding Z, Hu S, Su TY, Choi JY, Morris S, Wang X, Sakaie K, Murakami H, Huppertz HJ, Blümcke I, Jones S, Najm I, Ma D, Wang ZI. Combining magnetic resonance fingerprinting with voxel-based morphometric analysis to reduce false positives for focal cortical dysplasia detection. Epilepsia 2024; 65:1631-1643. [PMID: 38511905 PMCID: PMC11166521 DOI: 10.1111/epi.17951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/09/2024] [Accepted: 03/04/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE We aim to improve focal cortical dysplasia (FCD) detection by combining high-resolution, three-dimensional (3D) magnetic resonance fingerprinting (MRF) with voxel-based morphometric magnetic resonance imaging (MRI) analysis. METHODS We included 37 patients with pharmacoresistant focal epilepsy and FCD (10 IIa, 15 IIb, 10 mild Malformation of Cortical Development [mMCD], and 2 mMCD with oligodendroglial hyperplasia and epilepsy [MOGHE]). Fifty-nine healthy controls (HCs) were also included. 3D lesion labels were manually created. Whole-brain MRF scans were obtained with 1 mm3 isotropic resolution, from which quantitative T1 and T2 maps were reconstructed. Voxel-based MRI postprocessing, implemented with the morphometric analysis program (MAP18), was performed for FCD detection using clinical T1w images, outputting clusters with voxel-wise lesion probabilities. Average MRF T1 and T2 were calculated in each cluster from MAP18 output for gray matter (GM) and white matter (WM) separately. Normalized MRF T1 and T2 were calculated by z-scores using HCs. Clusters that overlapped with the lesion labels were considered true positives (TPs); clusters with no overlap were considered false positives (FPs). Two-sample t-tests were performed to compare MRF measures between TP/FP clusters. A neural network model was trained using MRF values and cluster volume to distinguish TP/FP clusters. Ten-fold cross-validation was used to evaluate model performance at the cluster level. Leave-one-patient-out cross-validation was used to evaluate performance at the patient level. RESULTS MRF metrics were significantly higher in TP than FP clusters, including GM T1, normalized WM T1, and normalized WM T2. The neural network model with normalized MRF measures and cluster volume as input achieved mean area under the curve (AUC) of .83, sensitivity of 82.1%, and specificity of 71.7%. This model showed superior performance over direct thresholding of MAP18 FCD probability map at both the cluster and patient levels, eliminating ≥75% FP clusters in 30% of patients and ≥50% of FP clusters in 91% of patients. SIGNIFICANCE This pilot study suggests the efficacy of MRF for reducing FPs in FCD detection, due to its quantitative values reflecting in vivo pathological changes. © 2024 International League Against Epilepsy.
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Affiliation(s)
- Zheng Ding
- Epilepsy Center, Neurological Institute - Cleveland Clinic, Cleveland, Ohio
- Biomedical Engineering - Case Western Reserve University, Cleveland, Ohio
| | - Siyuan Hu
- Biomedical Engineering - Case Western Reserve University, Cleveland, Ohio
| | - Ting-Yu Su
- Epilepsy Center, Neurological Institute - Cleveland Clinic, Cleveland, Ohio
- Biomedical Engineering - Case Western Reserve University, Cleveland, Ohio
| | - Joon Yul Choi
- Epilepsy Center, Neurological Institute - Cleveland Clinic, Cleveland, Ohio
- Biomedical Engineering - Yonsei University, Wonju, Republic of Korea
| | - Spencer Morris
- Epilepsy Center, Neurological Institute - Cleveland Clinic, Cleveland, Ohio
- Biomedical Engineering - Case Western Reserve University, Cleveland, Ohio
| | - Xiaofeng Wang
- Quantitative Health Science - Cleveland Clinic, Cleveland, Ohio
| | - Ken Sakaie
- Imaging Institute - Cleveland Clinic, Cleveland, Ohio
| | - Hiroatsu Murakami
- Epilepsy Center, Neurological Institute - Cleveland Clinic, Cleveland, Ohio
| | | | - Ingmar Blümcke
- Epilepsy Center, Neurological Institute - Cleveland Clinic, Cleveland, Ohio
- Neuropathology - University Hospital Erlangen, Erlangen, Germany
| | - Stephen Jones
- Imaging Institute - Cleveland Clinic, Cleveland, Ohio
| | - Imad Najm
- Epilepsy Center, Neurological Institute - Cleveland Clinic, Cleveland, Ohio
| | - Dan Ma
- Biomedical Engineering - Case Western Reserve University, Cleveland, Ohio
| | - Zhong Irene Wang
- Epilepsy Center, Neurological Institute - Cleveland Clinic, Cleveland, Ohio
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Wang W, Huang Q, Zhou Q, Han J, Zhang X, Li L, Lin Y, Wang Y. Multimodal non-invasive evaluation in MRI-negative epilepsy patients. Epilepsia Open 2024; 9:765-775. [PMID: 38258486 PMCID: PMC10984307 DOI: 10.1002/epi4.12896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 12/15/2023] [Accepted: 12/24/2023] [Indexed: 01/24/2024] Open
Abstract
Presurgical evaluation is still challenging for MRI-negative epilepsy patients. As non-invasive modalities are the easiest acceptable and economic methods in determining the epileptogenic zone, we analyzed the localization value of common non-invasive methods in MRI-negative epilepsy patients. In this study, we included epilepsy patients undergoing presurgical evaluation with presurgical negative MRI. MRI post-processing was performed using a Morphometric Analysis Program (MAP) on T1-weighted volumetric MRI. The relationship between MAP, magnetoencephalography (MEG), scalp electroencephalogram (EEG), and seizure outcomes was analyzed to figure out the localization value of different non-invasive methods. Eighty-six patients were included in this study. Complete resection of the MAP-positive regions or the MEG-positive regions was positively associated with seizure freedom (p = 0.028 and 0.007, respectively). When an area is co-localized by MAP and MEG, the resection of the area was significantly associated with seizure freedom (p = 0.006). However, neither the EEG lateralization nor the EEG localization showed statistical association with the surgical outcome (p = 0.683 and 0.505, respectively). In conclusion, scalp EEG had a limited role in presurgical localization and predicting seizure outcome, combining MAP and MEG results can significantly improve the localization of epileptogenic lesions and have a positive association with seizure-free outcome. PLAIN LANGUAGE SUMMARY: Due to the lack of obvious structure abnormalities on neuroimaging examinations, the identification of epilepsy lesions in MRI-negative epilepsy patients can be difficult. In this study, we intended to use non-invasive examinations to explore the potential epileptic lesions in MRI-negative epilepsy patients and to determine the results accuracy by comparing the neuroimaging results with the epilepsy surgery outcomes. A total of 86 epilepsy patients without obvious structure lesions on MRI were included, and we found that the combinations of different non-invasive examinations and neuroimaging post-processing methods are significantly associated with the seizure freedom results of epilepsy surgery.
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Affiliation(s)
- Wei Wang
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Qian Huang
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Qilin Zhou
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Jiaqi Han
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Xiating Zhang
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Liping Li
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Yicong Lin
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Yuping Wang
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
- Beijing Key Laboratory of NeuromodulationBeijingChina
- Center of Epilepsy, Beijing Institute for Brain DisordersCapital Medical UniversityBeijingChina
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Habibabadi JM, Doroudinia A, Koma AY, Fesharaki SSH, Aarabi S. Comparison of non-invasive imaging modalities in presurgical evaluation of temporal lobe epilepsy patients: a multicenter study. Acta Neurol Belg 2021; 121:1815-1821. [PMID: 33230739 DOI: 10.1007/s13760-020-01550-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/08/2020] [Indexed: 11/28/2022]
Abstract
Intractable drug-resistant magnetic resonance imaging (MRI) negative epilepsy in one of the complicated issues in neurology. Epilepsy surgery is beneficial treatment of intractable seizures, but precise localization of epileptogenic zone is a major concern. Thirty-four MRI negative drug-resistant epilepsy patients underwent video electroencephalography (EEG), positron emission tomography (PET) scan, and voxel-based morphometry (VBM) MRI from 2014 to 2019. Then, the findings of PET scan and VBM were compared with semiology and long-term electrophysiology. Cohen's kappa-coefficient (k) test was utilized to measure the agreement between our modalities. Among 34 patients with age ranging from 8 to 49 (mean: 29.00 ± standard deviation: 10.35), 19 were male (55.9%) and 15 were female (44.1%). Twenty-one patients (61.76%) had right temporal, 12 patients (35.3%) had left and one patient had bilateral temporal ictal focus according to video EEG. Inter-rater agreement analysis showed that the kappa index between video EEG and PET scan was of almost acceptable (more than 0.4) and there was poor agreement between video EEG and VBM (kappa index = 0.099). PET is highly concordant with video EEG in temporal lobe epilepsy (TLE) and has a considerable agreement in localizing epileptogenic zone while VBM is less.
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Affiliation(s)
| | - Abtin Doroudinia
- Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Yousefi Koma
- Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Sobhan Aarabi
- Comprehensive Epilepsy Program, Epilepsy Monitoring Unit, Pars Hospital, Tehran, Iran.
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Demerath T, Kaller CP, Heers M, Staack A, Schwarzwald R, Kober T, Reisert M, Schulze-Bonhage A, Huppertz HJ, Urbach H. Fully automated detection of focal cortical dysplasia: Comparison of MPRAGE and MP2RAGE sequences. Epilepsia 2021; 63:75-85. [PMID: 34800337 DOI: 10.1111/epi.17127] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/05/2021] [Accepted: 11/05/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The detection of focal cortical dysplasia (FCD) in magnetic resonance imaging is challenging. Voxel-based morphometric analysis and automated FCD detection using an artificial neural network (ANN) integrated into the Morphometric Analysis Program (MAP18) have been shown to facilitate FCD detection. This study aimed to evaluate whether the detection of FCD can be further improved by feeding this approach with magnetization prepared two rapid acquisition gradient echoes (MP2RAGE) instead of magnetization-prepared rapid acquisition gradient echo (MPRAGE) datasets. METHODS MPRAGE and MP2RAGE datasets were acquired in a consecutive sample of 32 patients with FCD and postprocessed using MAP18. Visual analysis and, if available, histopathology served as the gold standard for assessing the sensitivity and specificity of FCD detection. Out-of-sample specificity was evaluated in a cohort of 32 healthy controls. RESULTS The sensitivity and specificity of FCD detection were 82.4% and 62.5% for the MPRAGE and 97.1% and 34.4% for the MP2RAGE sequences, respectively. Median volumes of true-positive voxel clusters were .16 ml for the MPRAGE and .52 ml for the MP2RAGE sequences compared to .08- and .04-ml volumes of false-positive clusters. With regard to cluster volumes, FCD detection was substantially improved for the MP2RAGE data when the estimated optimal threshold of .23 ml was applied (sensitivity = 72.9%, specificity = 83.0%). In contrast, the estimated optimal threshold of .37 ml for the MPRAGE data did not improve FCD lesion detection (sensitivity = 42.9%, specificity = 79.5%). SIGNIFICANCE In this study, the sensitivity of FCD detection by morphometric analysis and an ANN integrated into MAP18 was higher for MP2RAGE than for MPRAGE sequences. Additional usage of cluster volume information helped to discriminate between true- and false-positive MP2RAGE results.
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Affiliation(s)
- Theo Demerath
- Department of Neuroradiology, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Christoph P Kaller
- Department of Neuroradiology, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Marcel Heers
- Epilepsy Center, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | | | - Ralf Schwarzwald
- Department of Neuroradiology, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Tobias Kober
- Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland
| | - Marco Reisert
- Department of Medical Physics, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Andreas Schulze-Bonhage
- Epilepsy Center, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | | | - Horst Urbach
- Department of Neuroradiology, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
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Holthausen H, Coras R, Tang Y, Bai L, Wang I, Pieper T, Kudernatsch M, Hartlieb T, Staudt M, Winkler P, Hofer W, Jabari S, Kobow K, Blumcke I. Multilobar unilateral hypoplasia with emphasis on the posterior quadrant and severe epilepsy in children with FCD ILAE Type 1A. Epilepsia 2021; 63:42-60. [PMID: 34741301 DOI: 10.1111/epi.17114] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 10/08/2021] [Accepted: 10/18/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Focal cortical dysplasia (FCD) Type 1 and its three subtypes have yet not been fully characterized at the clinical, anatomopathological, and molecular level (International League Against Epilepsy [ILAE] FCD classification from 2011). We aimed to describe the clinical phenotype of patients with histopathologically confirmed FCD1A obtained from a single epilepsy center between 2002 and 2016. METHODS Medical records were retrieved from the hospital's archive. Results from electroencephalography (EEG) video recordings, neuroimaging, and histopathology were reevaluated. Magnetic resonance imaging (MRI) post-processing was retrospectively performed in nine patients. DNA methylation studies were carried out from archival surgical brain tissue in 11 patients. RESULTS Nineteen children with a histopathological diagnosis of FCD1A were included. The average onset of epilepsy was 0.9 years (range 0.2-10 years). All children had severe cognitive impairment and one third had mild motor deficits, yet fine finger movements were preserved in all patients. All patients had daily seizures, being drug resistant from disease onset. Interictal electroencephalography revealed bilateral multi-regional epileptiform discharges. Interictal status epilepticus was observed in 8 and countless subclinical seizures in 11 patients. Regional continuous irregular slow waves were of higher lateralizing and localizing yield than spikes. Posterior background rhythms were normal in 16 of 19 children. Neuroimaging showed unilateral multilobar hypoplasia and increased T2-FLAIR signals of the white matter in 18 of 19 patients. All children underwent tailored multilobar resections, with seizure freedom achieved in 47% (Engel class I). There was no case with frontal involvement without involvement of the posterior quadrant by MRI and histopathology. DNA methylation profiling distinguished FCD1A samples from all other epilepsy specimens and controls. SIGNIFICANCE We identified a cohort of young children with drug resistance from seizure onset, bad EEG with posterior emphasis, lack of any focal neurological deficits but severe cognitive impairment, subtle hypoplasia of the epileptogenic area on MRI, and histopathologically defined and molecularly confirmed by DNA methylation analysis as FCD ILAE Type 1A.
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Affiliation(s)
- Hans Holthausen
- Center for Pediatric Neurology, Neurorehabilitation, and Epileptology, Schoen-Clinic, Vogtareuth, Germany
| | - Roland Coras
- Department of Neuropathology, University Hospitals Erlangen, Erlangen, Germany
| | - Yingying Tang
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.,Epilepsy Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lily Bai
- Epilepsy Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Irene Wang
- Epilepsy Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Tom Pieper
- Center for Pediatric Neurology, Neurorehabilitation, and Epileptology, Schoen-Clinic, Vogtareuth, Germany
| | - Manfred Kudernatsch
- Center for Pediatric Neurology, Neurorehabilitation, and Epileptology, Schoen-Clinic, Vogtareuth, Germany.,Paracelsus Private Medical University, Salzburg, Austria
| | - Till Hartlieb
- Center for Pediatric Neurology, Neurorehabilitation, and Epileptology, Schoen-Clinic, Vogtareuth, Germany.,Paracelsus Private Medical University, Salzburg, Austria
| | - Martin Staudt
- Center for Pediatric Neurology, Neurorehabilitation, and Epileptology, Schoen-Clinic, Vogtareuth, Germany
| | - Peter Winkler
- Center for Pediatric Neurology, Neurorehabilitation, and Epileptology, Schoen-Clinic, Vogtareuth, Germany
| | - Wiebke Hofer
- Center for Pediatric Neurology, Neurorehabilitation, and Epileptology, Schoen-Clinic, Vogtareuth, Germany
| | - Samir Jabari
- Department of Neuropathology, University Hospitals Erlangen, Erlangen, Germany
| | - Katja Kobow
- Department of Neuropathology, University Hospitals Erlangen, Erlangen, Germany
| | - Ingmar Blumcke
- Department of Neuropathology, University Hospitals Erlangen, Erlangen, Germany.,Epilepsy Center, Cleveland Clinic, Cleveland, Ohio, USA
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Chen C, Xie JJ, Ding F, Jiang YS, Jin B, Wang S, Ding Y, Li H, Jiang B, Zhu JM, Ding MP, Chen Z, Wu ZY, Zhang BR, Hsu YC, Lai HY, Wang S. 7T MRI with post-processing for the presurgical evaluation of pharmacoresistant focal epilepsy. Ther Adv Neurol Disord 2021; 14:17562864211021181. [PMID: 34163537 PMCID: PMC8191069 DOI: 10.1177/17562864211021181] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 05/07/2021] [Indexed: 11/17/2022] Open
Abstract
Background: We aimed to evaluate the diagnostic yield of seven-tesla (7T) magnetic resonance imaging (MRI) with post-processing of three-dimensional (3D) T1-weighted (T1W) images by the morphometric analysis program (MAP) in epilepsy surgical candidates whose 3T MRI results were inconclusive or negative. Methods: We recruited 35 patients with pharmacoresistant focal epilepsy. A multidisciplinary team including an experienced neuroradiologist evaluated their seizure semiology, video-electroencephalography data, 3T MRI and post-processing results, and co-registered FDG-PET. Eleven patients had suspicious lesions on 3T MRI and the other 24 patients were strictly MRI-negative. 7T MRI evaluation was then performed to aid clinical decision. Among patients with pathologically proven focal cortical dysplasia (FCD) type II, signs of FCD were retrospectively evaluated in each MRI sequence (T1W, T2W, and FLAIR), and positive rates were analyzed in each MAP feature map (junction, extension, and thickness). Results: 7T MRI evaluation confirmed the lesion in nine of the 11 (81.8%) patients with suspicious lesions on 3T MRI. It also revealed new lesions in four of the 24 (16.7%) strictly MRI-negative patients. Histopathology showed FCD type II in 11 of the 13 (84.6%) 7T MRI-positive cases. Unexpectedly, three of the four newly identified FCD lesions were located in the posterior quadrant. Blurred gray–white boundary was the most frequently observed sign of FCD, appearing on 7T T1W image in all cases and on T2W and FLAIR images in only about half cases. The 7T junction map successfully detected FCD (10/11) in more cases than the extension (1/11) and thickness (0/11) maps. The 3D T1W images at 7T exhibited superior cerebral gray–white matter contrast, more obviously blurred gray–white boundary of FCD, and larger and brighter positive zones in post-processing than 3T T1W images. Conclusion: 7T MRI with post-processing can enhance the detection of subtle epileptogenic lesions for MRI-negative epilepsy and may optimize surgical strategies for patients with focal epilepsy.
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Affiliation(s)
- Cong Chen
- Department of Neurology and Epilepsy Center, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Juan-Juan Xie
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Fang Ding
- Department of Neurology and Epilepsy Center, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ya-Si Jiang
- Department of Neurology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Bo Jin
- Department of Neurology, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Shan Wang
- Department of Neurology and Epilepsy Center, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yao Ding
- Department of Neurology and Epilepsy Center, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hong Li
- Department of Radiology, and Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Biao Jiang
- Department of Radiology, and Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jun-Ming Zhu
- Epilepsy Center and Department of Neurosurgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mei-Ping Ding
- Department of Neurology and Epilepsy Center, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhong Chen
- Epilepsy Center, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhi-Ying Wu
- Department of Neurology, and Research Center of Neurology in Second Affiliated Hospital, Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Bao-Rong Zhang
- Department of Neurology and Epilepsy Center, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yi-Cheng Hsu
- MR collaboration NE Asia, Siemens Healthcare, Shanghai, China
| | - Hsin-Yi Lai
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Shuang Wang
- Department of Neurology and Epilepsy Center, Research Center of Neurology in Second Affiliated Hospital, Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
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Sun K, Yu T, Yang D, Ren Z, Qiao L, Ni D, Wang X, Zhao Y, Chen X, Xiang J, Chen N, Gao R, Yang K, Lin Y, Kober T, Zhang G. Fluid and White Matter Suppression Imaging and Voxel-Based Morphometric Analysis in Conventional Magnetic Resonance Imaging-Negative Epilepsy. Front Neurol 2021; 12:651592. [PMID: 33995250 PMCID: PMC8116947 DOI: 10.3389/fneur.2021.651592] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/18/2021] [Indexed: 01/23/2023] Open
Abstract
Purpose: Delineation of subtle lesions in magnetic resonance imaging (MRI)-negative patients is of great importance in preoperative epilepsy evaluation. The aim of our study was to explore the diagnostic value of the novel fluid and white matter suppression (FLAWS) sequence in comparison with a voxel-based MRI postprocessing morphometric analysis program (MAP) in a consecutive cohort of non-lesional patients. Methods: Surgical candidates with a negative finding on an official neuroradiology report were enrolled. High-resolution FLAWS image and MAP maps generated based on high-resolution three-dimensional (3D) T1 image were visually inspected for each patient. The findings of FLAWS or MAP-positive (FLAWS/MAP+) regions were compared with the surgical resection cavity in correlation with surgical outcome and pathology. Results: Forty-five patients were enrolled; the pathological examination revealed focal cortical dysplasia (FCD) in 32 patients and other findings in 13 patients. The positive rate, sensitivity, and specificity were 48.9%, 0.43, and 0.87, respectively, for FLAWS and 64.4%, 0.57, and 0.8, respectively, for MAP. Concordance between surgical resection and FLAWS+ or MAP+ regions was significantly associated with a seizure-free outcome (FLAWS: p = 0.002; MAP: p = 0.0003). A positive finding in FLAWS and MAP together with abnormalities in the same gyrus (FLAWS–MAP gyral+) was detected in 31.1% of patients. FLAWS+ only and MAP+ only were found in 7 (15.5%) and 14 (31.1%) patients, respectively. Conclusions: FLAWS showed a promising value for identifying subtle epileptogenic lesions and can be used as a complement to current MAP in patients with MRI-negative epilepsy.
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Affiliation(s)
- Ke Sun
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Tao Yu
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Dongju Yang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhiwei Ren
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Liang Qiao
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Duanyu Ni
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xueyuan Wang
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yongxiang Zhao
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xin Chen
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jing Xiang
- Department of Neurology, MEG Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Nan Chen
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Runshi Gao
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Kun Yang
- Department of Evidence-Based Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yicong Lin
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Tobias Kober
- Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland.,Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,LTS5, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Guojun Zhang
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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9
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González-Ortiz S, Medrano S, Capellades J, Vilas M, Mestre A, Serrano L, Conesa G, Pérez-Enríquez C, Arumi M, Bargalló N, Delgado-Martinez I, Rocamora R. Voxel-based morphometry for the evaluation of patients with pharmacoresistant epilepsy with apparently normal MRI. J Neuroimaging 2021; 31:560-568. [PMID: 33817887 DOI: 10.1111/jon.12849] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND PURPOSE Magnetic resonance imaging (MRI) is essential in the diagnosis of pharmacoresistant epilepsy (PRE), because patients with lesions detected by MRI have a better prognosis after surgery. Focal cortical dysplasia (FCD) is one of the most frequent etiologies of PRE but can be difficult to identify by MRI. Voxel-based morphometric analysis programs, like the Morphometric Analysis Program (MAP), have been developed to help improve MRI detection. Our objective was to evaluate the clinical usefulness of MAP in patients with PRE and an apparently normal MRI. METHODS We studied 70 patients with focal PRE and a nonlesional MRI. The 3DT1 sequence was processed with MAP, obtaining three z-score maps. Patients were classified as MAP+ if one or more z-score maps showed a suspicious area of brightness, and MAP- if the z-score maps did not show any suspicious areas. For MAP+ cases, a second-look MRI was performed with a dedicated inspection based on the MAP findings. The MAP results were correlated with the epileptogenic zone. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. RESULTS Thirty-one percent of patients were classified as MAP+ and 69% were MAP-. Results showed a sensitivity of 0.57, specificity of 0.8, PPV of 0.91, and NPV of 0.35. In 19% of patients, an FCD was found in the second-look MRI after MAP. CONCLUSIONS MAP was helpful in the detection of lesions in PRE patients with a nonlesional MRI, which could have important repercussions for the clinical management and postoperative prognosis of these patients.
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Affiliation(s)
- Sofía González-Ortiz
- Radiology Department, Hospital del Mar, Barcelona, Spain.,Epilpsy Reserach Group, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | | | | | - Marta Vilas
- Radiology Department, Hospital del Mar, Barcelona, Spain
| | - Antoni Mestre
- Nuclear Medicine Department, Hospital Trueta, Girona, Spain
| | - Laura Serrano
- Neurosurgery Department, Hospital del Mar, Barcelona, Spain
| | - Gerardo Conesa
- Neurosurgery Department, Hospital del Mar, Barcelona, Spain.,Epilpsy Reserach Group, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Carmen Pérez-Enríquez
- Neurology Department, Hospital del Mar, Barcelona, Spain.,Epilpsy Reserach Group, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Montserrat Arumi
- Anatomic Pathology Department, Hospital del Mar, Barcelona, Spain
| | - Nuria Bargalló
- Centre de Diagnosi per la Imatge, Hospital Clínic, Barcelona, Spain
| | - Ignacio Delgado-Martinez
- Neurosurgery Department, Hospital del Mar, Barcelona, Spain.,Epilpsy Reserach Group, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Rodrigo Rocamora
- Neurology Department, Hospital del Mar, Barcelona, Spain.,Epilpsy Reserach Group, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
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10
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Stecher X, Schonstedt V, Manterola C, Carreño F, Zamorano F, Velasquez A, Castillo M. Morphometric analysis program: Detection of epileptic foci in young children using an adult normative database: Initial experience. Epilepsia Open 2021; 6:235-238. [PMID: 33681667 PMCID: PMC7918321 DOI: 10.1002/epi4.12456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/29/2020] [Accepted: 11/17/2020] [Indexed: 11/25/2022] Open
Abstract
Objective To report our initial experience using an adult-template MAP in drug-resistant focal epilepsy in five children with apparently normal MRI. Methods Patients selected were highly suspicious of harboring focal structural lesions and had negative brain MRI studies. MAP was performed using a locally obtained adult database as a template. Results were reviewed by two neuroradiologists. Pertinence of MAP-positive areas was confirmed by the focal epileptic hypothesis or by pathology when possible (J Neuroradiol, 39, 2012, 87). Visual analysis was performed using Mango Software. MRI studies were reanalyzed at the workstation with knowledge of the clinical suspicion to confirm or discard the possibility of FCD. Results Five patients aged 19-48 months were studied, all with initial 3T MRI studies interpreted as normal. All had focal epileptic hypothesis with coherence of clinical seizure characterization and electroencephalographic findings. In two patients, histology showed type 1 FCD. Due to the age of our subjects, the junction map always highlighted the subcortical white matter in relationship to maturity differences. FCD was identified as asymmetric U-shaped highlighted regions in the junction map. Significance FCD is the most frequent pathology reported in pediatric epilepsy surgery series (Epileptic Disord, 18, 2016, 240). Significant number of FCDs may be overlooked on MRIs, reducing the odds of seizure freedom after surgery (Epilepsy Res, 89, 2010, 310). MAP is an image postprocessing method for enhanced visualization of FCD; however, when using an adult template in developing brains, normal subcortical regions may be highlighted as pathological. Creating a pediatric template is difficult, due to the need for general anesthesia to acquire the MRI database. Here, we were able to show that MAP identified FCDs as asymmetric "U-" shaped highlighted regions in the junction maps of all five patients, which may indicate that obtaining childhood databases for this purpose may not be necessary and that adult ones suffice for diagnosis of FCD.
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Affiliation(s)
- Ximena Stecher
- Radiology DepartmentClínica Alemana de SantiagoVitacuraChile
- Facultad de MedicinaClínica Alemana ‐ Universidad del DesarrolloSantiagoChile
| | | | - Carla Manterola
- Pediatric DepartmentClínica Alemana de SantiagoVitacuraChile
- Facultad de MedicinaUniversidad de ChileSantiagoChile
| | | | - Francisco Zamorano
- Radiology DepartmentClínica Alemana de SantiagoVitacuraChile
- Facultad de MedicinaClínica Alemana ‐ Universidad del DesarrolloSantiagoChile
- Laboratorio de Neurociencia Social y NeuromodulaciónCentro de Investigación en Complejidad Social (neuroCICS)Facultad de GobiernoUniversidad del DesarrolloSantiagoChile
| | - Alvaro Velasquez
- Facultad de MedicinaClínica Alemana ‐ Universidad del DesarrolloSantiagoChile
- Pediatric DepartmentClínica Alemana de SantiagoVitacuraChile
- Chilean League against epilepsySantiagoChile
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11
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Wang I, Oh S, Blümcke I, Coras R, Krishnan B, Kim S, McBride A, Grinenko O, Lin Y, Overmyer M, Aung TT, Lowe M, Larvie M, Alexopoulos AV, Bingaman W, Gonzalez-Martinez JA, Najm I, Jones SE. Value of 7T MRI and post-processing in patients with nonlesional 3T MRI undergoing epilepsy presurgical evaluation. Epilepsia 2020; 61:2509-2520. [PMID: 32949471 PMCID: PMC7722133 DOI: 10.1111/epi.16682] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/27/2020] [Accepted: 08/12/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Ultra-high-field 7-Tesla (7T) magnetic resonance imaging (MRI) offers increased signal-to-noise and contrast-to-noise ratios, which may improve visualization of cortical malformations. We aim to assess the clinical value of in vivo structural 7T MRI and its post-processing for the noninvasive identification of epileptic brain lesions in patients with pharmacoresistant epilepsy and nonlesional 3T MRI who are undergoing presurgical evaluation. METHODS Sixty-seven patients were included who had nonlesional 3T MRI by official radiology report. Epilepsy protocols were used for the 3T and 7T acquisitions. Post-processing of the 7T T1-weighted magnetization-prepared two rapid acquisition gradient echoes sequence was performed using the morphometric analysis program (MAP) with comparison to a normal database consisting of 50 healthy controls. Review of 7T was performed by an experienced board-certified neuroradiologist and at the multimodal patient management conference. The clinical significance of 7T findings was assessed based on intracranial electroencephalography (ICEEG) ictal onset, surgery, postoperative seizure outcomes, and histopathology. RESULTS Unaided visual review of 7T detected previously unappreciated subtle lesions in 22% (15/67). When aided by 7T MAP, the total yield increased to 43% (29/67). The location of the 7T-identified lesion was identical to or contained within the ICEEG ictal onset in 13 of 16 (81%). Complete resection of the 7T-identified lesion was associated with seizure freedom (P = .03). Histopathology of the 7T-identified lesions encountered mainly focal cortical dysplasia (FCD). 7T MAP yielded 25% more lesions (6/24) than 3T MAP, and showed improved conspicuity in 46% (11/24). SIGNIFICANCE Our data suggest a major benefit of 7T with post-processing for detecting subtle FCD lesions for patients with pharmacoresistant epilepsy and nonlesional 3T MRI.
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Affiliation(s)
- Irene Wang
- Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
| | - Sehong Oh
- Division of Biomedical Engineering, Hankuk University of Foreign Studies, Yongin, Republic of Korea
- Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ingmar Blümcke
- Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
- Institute of Neuropathology, University Hospitals Erlangen, Erlangen, Germany
| | - Roland Coras
- Institute of Neuropathology, University Hospitals Erlangen, Erlangen, Germany
| | - Balu Krishnan
- Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
| | - Sanghoon Kim
- Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Aaron McBride
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, USA
| | | | - Yicong Lin
- Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Margit Overmyer
- Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Tin Tun Aung
- Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mark Lowe
- Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mykol Larvie
- Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | | | | | - Imad Najm
- Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
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12
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Middlebrooks EH, Lin C, Westerhold E, Okromelidze L, Vibhute P, Grewal SS, Gupta V. Improved detection of focal cortical dysplasia using a novel 3D imaging sequence: Edge-Enhancing Gradient Echo (3D-EDGE) MRI. NEUROIMAGE-CLINICAL 2020; 28:102449. [PMID: 33032066 PMCID: PMC7552096 DOI: 10.1016/j.nicl.2020.102449] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/18/2020] [Accepted: 09/22/2020] [Indexed: 11/29/2022]
Abstract
Detection of focal cortical dysplasia remains a substantial challenge in radiology. 3D-EDGE is a novel MR method to directly image abnormalities of gray-white boundary. 3D-EDGE had a significantly higher contrast for FCD than FLAIR and MP2RAGE.
Epilepsy is a common neurological disorder with focal cortical dysplasia (FCD) being one of the most common lesional causes. Detection of FCD by MRI is a major determinant of surgical outcome. Evolution of MRI sequences and hardware has greatly increased the detection rate of FCD, but these gains have largely been related to the more visible Type IIb FCD, with Type I and IIa remaining elusive. While most sequence improvements have relied on increasing contrast between gray and white matter, we propose a novel imaging approach, 3D Edge-Enhancing Gradient Echo (3D-EDGE), to directly image the gray-white boundary. By acquiring images at an inversion time where gray and white matter have equal signal but opposite phases, voxels with a mixture of gray and white matter (e.g., at the gray-white boundary) will have cancellation of longitudinal magnetization producing a thin area of signal void at the normal boundary. By creating greater sensitivity for minor changes in T1 relaxation, microarchitectural abnormalities present in FCD produce greater contrast than on other common MRI sequences. 3D-EDGE had a significantly greater contrast ratio between lesion and white matter for FCD compared to MP2RAGE (98% vs 17%; p = 0.0006) and FLAIR (98% vs 19%; p = 0.0006), which highlights its potential to improve outcomes in epilepsy. We present a discussion of the framework for 3D-EDGE, optimization strategies, and analysis of a series of FCDs to highlight the benefit of 3D-EDGE in FCD detection compared to commonly used sequences in epilepsy.
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Affiliation(s)
- Erik H Middlebrooks
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA; Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA.
| | - Chen Lin
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | | | | | | | | | - Vivek Gupta
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
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13
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Demerath T, Rubensdörfer L, Schwarzwald R, Schulze-Bonhage A, Altenmüller DM, Kaller C, Kober T, Huppertz HJ, Urbach H. Morphometric MRI Analysis: Improved Detection of Focal Cortical Dysplasia Using the MP2RAGE Sequence. AJNR Am J Neuroradiol 2020; 41:1009-1014. [PMID: 32499249 DOI: 10.3174/ajnr.a6579] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 03/24/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Focal cortical dysplasias are the most common resected epileptogenic lesions in children and the third most common lesion in adults, but they are often subtle and frequently overlooked on MR imaging. The purpose of this study was to evaluate whether MP2RAGE-based morphometric MR imaging analysis is superior to MPRAGE-based analysis in the detection of focal cortical dysplasia. MATERIALS AND METHODS MPRAGE and MP2RAGE datasets were acquired in a consecutive series of 640 patients with epilepsy. Datasets were postprocessed using the Morphometric Analysis Program to generate morphometric z score maps such as junction, extension, and thickness images based on both MPRAGE and MP2RAGE images. Focal cortical dysplasia lesions were manually segmented in the junction images, and volumes and mean z scores of the lesions were measured. RESULTS Of 21 focal cortical dysplasias discovered, all were clearly visible on MP2RAGE junction images, whereas 2 were not visible on MPRAGE junction images. In all except 4 patients, the volume of the focal cortical dysplasia was larger and mean lesion z scores were higher on MP2RAGE junction images compared with the MPRAGE-based images (P = .005, P = .013). CONCLUSIONS In this study, MP2RAGE-based morphometric analysis created clearer output maps with larger lesion volumes and higher z scores than the MPRAGE-based analysis. This new approach may improve the detection of subtle, otherwise overlooked focal cortical dysplasia.
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Affiliation(s)
- T Demerath
- From the Departments of Neuroradiology (T.D., L.R., R.S., C.K., H.U.)
| | - L Rubensdörfer
- From the Departments of Neuroradiology (T.D., L.R., R.S., C.K., H.U.)
| | - R Schwarzwald
- From the Departments of Neuroradiology (T.D., L.R., R.S., C.K., H.U.)
| | - A Schulze-Bonhage
- Epileptology (A.S.-B., D.-M.A.), Faculty of Medicine, Medical Center-University of Freiburg, Freiburg, Germany
| | - D-M Altenmüller
- Epileptology (A.S.-B., D.-M.A.), Faculty of Medicine, Medical Center-University of Freiburg, Freiburg, Germany
| | - C Kaller
- From the Departments of Neuroradiology (T.D., L.R., R.S., C.K., H.U.)
| | - T Kober
- Advanced Clinical Imaging Technology (T.K.), Siemens Healthcare AG, Lausanne, Switzerland
| | - H-J Huppertz
- Swiss Epilepsy Clinic (H.-J.H.), Klinik Lengg AG, Zurich, Switzerland
| | - H Urbach
- From the Departments of Neuroradiology (T.D., L.R., R.S., C.K., H.U.)
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14
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Pearce K, Dixon L, D'Arco F, Pujar S, Das K, Tahir Z, Tisdall M, Mankad K. Epilepsy surgery in children: what the radiologist needs to know. Neuroradiology 2020; 62:1061-1078. [PMID: 32435887 DOI: 10.1007/s00234-020-02448-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 03/27/2020] [Indexed: 12/18/2022]
Abstract
This review updates the radiologist on current epilepsy surgery practice in children, with a specific focus on the role of imaging in pre-surgical work-up, current and novel surgical techniques, expected post-surgical imaging appearances and important post-operative complications. A comprehensive review of the current and emerging international practices in paediatric epilepsy surgical planning and post-operative imaging is provided with details on case-based radiological findings. A detailed discussion of the pathophysiology and imaging features of different epileptogenic lesions will not be discussed as this is not the objective of this paper. Epilepsy surgery can be an effective method to control seizures in certain children with drug-resistant focal epilepsy. Early surgery in selected appropriate cases can lead to improved cognitive and developmental outcome. Advances in neurosurgical techniques, imaging and neuroanaesthesia have driven a parallel expansion in the array of epilepsy conditions which are potentially treatable with surgery. The range of surgical options is now wide, including minimally invasive ablative procedures for small lesions such as hypothalamic hamartomata, resections for focal lesions like hippocampal sclerosis and complex disconnective surgeries for multilobar conditions like Sturge Weber Syndrome and diffuse cortical malformations. An awareness of the surgical thinking when planning epilepsy surgery in children, and the practical knowledge of the operative steps involved will promote more accurate radiology reporting of the post-operative scan.
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Affiliation(s)
- Kirsten Pearce
- Department of Radiology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond St, London, WC1N 3JH, UK
| | - Luke Dixon
- Department of Radiology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond St, London, WC1N 3JH, UK
| | - Felice D'Arco
- Department of Radiology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond St, London, WC1N 3JH, UK
| | - Suresh Pujar
- Department of Neurology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond St, London, WC1N 3JH, UK
| | - Krishna Das
- Department of Neurology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond St, London, WC1N 3JH, UK
| | - Zubair Tahir
- Department of Neurosurgery, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond St, London, WC1N 3JH, UK
| | - Martin Tisdall
- Department of Neurosurgery, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond St, London, WC1N 3JH, UK
| | - Kshitij Mankad
- Department of Radiology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond St, London, WC1N 3JH, UK.
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15
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Wang W, Zhou Q, Zhang X, Li L, Xu C, Piao Y, Wu S, Wang Y, Du W, Zhao Z, Lin Y, Wang Y. Pilot Study of Voxel-Based Morphometric MRI Post-processing in Patients With Non-lesional Operculoinsular Epilepsy. Front Neurol 2020; 11:177. [PMID: 32265823 PMCID: PMC7096577 DOI: 10.3389/fneur.2020.00177] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 02/24/2020] [Indexed: 12/02/2022] Open
Abstract
Objective: The aim of this study was to use voxel-based MRI post-processing in detection of subtle FCD in drug-resistant operculoinsular epilepsy patients with negative presurgical MRI, and by combining magnetoencephalography (MEG) to improve the localization of epileptogenic zone. Methods: Operculoinsular epilepsy patients with a negative presurgical MRI were included in this study. MRI post-processing was performed using a Morphometric Analysis Program (MAP) on T1-weighted volumetric MRI. Clinical information including semiology, MEG, scalp electroencephalogram (EEG), intracranial EEG and surgical strategy was retrospectively reviewed. The pertinence of MAP-positive areas was confirmed by surgical outcome and pathology. Results: A total of 20 patients were diagnosed with operculoinsular epilepsy had non-lesional MRI during 2010–2018, of which 11 patients with resective surgeries were included. MEG showed clusters of single equivalent current dipole (SECD) in inferior frontal regions in five patients and temporal-insular/ frontal-temporal-insular/parietal-insular regions in five patients. Four out of 11 patients had positive MAP results. The MAP positive rate was 36.4%. The positive regions were in insular in one patient and operculoinsular regions in three patients. Three of the four patients who were MAP-positive got seizure-free after successfully resect the MAP-positive and MEG-positive regions (the pathology results were FCD IIb in two patients and FCD IIa in one patient). Conclusions: MAP is a useful tool in detection the epileptogenic lesions in patients with MRI-negative operculoinsular epilepsy. Notably, in order to make a right surgical regime decision, MAP results should always be interpreted in the context of the patient's anatomo-electroclinical presentation.
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Affiliation(s)
- Wei Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qilin Zhou
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiating Zhang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Liping Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Cuiping Xu
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Yueshan Piao
- Department of Pathology, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Siqi Wu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yajie Wang
- Department of Pathology, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Wei Du
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Zhilian Zhao
- Department of Radiology, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Yicong Lin
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuping Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China.,Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
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16
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Fitsiori A, Hiremath SB, Boto J, Garibotto V, Vargas MI. Morphological and Advanced Imaging of Epilepsy: Beyond the Basics. CHILDREN (BASEL, SWITZERLAND) 2019; 6:E43. [PMID: 30862078 PMCID: PMC6462967 DOI: 10.3390/children6030043] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/27/2019] [Accepted: 03/05/2019] [Indexed: 12/26/2022]
Abstract
The etiology of epilepsy is variable and sometimes multifactorial. Clinical course and response to treatment largely depend on the precise etiology of the seizures. Along with the electroencephalogram (EEG), neuroimaging techniques, in particular, magnetic resonance imaging (MRI), are the most important tools for determining the possible etiology of epilepsy. Over the last few years, there have been many developments in data acquisition and analysis for both morphological and functional neuroimaging of people suffering from this condition. These innovations have increased the detection of underlying structural pathologies, which have till recently been classified as "cryptogenic" epilepsy. Cryptogenic epilepsy is often refractory to anti-epileptic drug treatment. In drug-resistant patients with structural or consistent functional lesions related to the epilepsy syndrome, surgery is the only treatment that can offer a seizure-free outcome. The pre-operative detection of the underlying structural condition increases the odds of successful surgical treatment of pharmacoresistant epilepsy. This article provides a comprehensive overview of neuroimaging techniques in epilepsy, highlighting recent advances and innovations and summarizes frequent etiologies of epilepsy in order to improve the diagnosis and management of patients suffering from seizures, especially young patients and children.
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Affiliation(s)
- Aikaterini Fitsiori
- Unit of Neurodiagnostic, Division of Neuroradiology, Geneva University Hospital, rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland.
| | | | - José Boto
- Unit of Neurodiagnostic, Division of Neuroradiology, Geneva University Hospital, rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland.
| | - Valentina Garibotto
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital and Faculty of Medicine, Geneva University, 1205 Geneva, Switzerland.
| | - Maria Isabel Vargas
- Unit of Neurodiagnostic, Division of Neuroradiology, Geneva University Hospital, rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland.
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