1
|
Hassankhani A, Stein JM, Haboosheh AG, Vossough A, Loevner LA, Nabavizadeh SA. Anatomical Variations, Mimics, and Pitfalls in Imaging of Patients with Epilepsy. J Neuroimaging 2020; 31:20-34. [PMID: 33314527 DOI: 10.1111/jon.12809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/22/2020] [Accepted: 10/26/2020] [Indexed: 11/27/2022] Open
Abstract
Epilepsy is among one of the most common neurologic disorders. The role of magnetic resonance imaging (MRI) in the diagnosis and management of patients with epilepsy is well established, and most patients with epilepsy are likely to undergo at least one or more MRI examinations in the course of their disease. Recent advances in high-field MRI have enabled high resolution in vivo visualization of small and intricate anatomic structures that are of great importance in the assessment of seizure disorders. Familiarity with normal anatomic variations is essential in the accurate diagnosis and image interpretation, as these variations may be mistaken for epileptogenic foci, leading to unnecessary follow-up imaging, or worse, unnecessary treatment. After a brief overview of normal imaging anatomy of the mesial temporal lobe, this article will review a few important common and uncommon anatomic variations, mimics, and pitfalls that may be encountered in the imaging evaluation of patients with epilepsy.
Collapse
Affiliation(s)
- Alvand Hassankhani
- Division of Neuroradiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Joel M Stein
- Division of Neuroradiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Amit G Haboosheh
- Department of Radiology, Hadassah Ein Karem Hospital, Jerusalem, Israel
| | - Arastoo Vossough
- Division of Neuroradiology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Laurie A Loevner
- Division of Neuroradiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Seyed Ali Nabavizadeh
- Division of Neuroradiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
2
|
Liao C, Wang K, Cao X, Li Y, Wu D, Ye H, Ding Q, He H, Zhong J. Detection of Lesions in Mesial Temporal Lobe Epilepsy by Using MR Fingerprinting. Radiology 2018; 288:804-812. [PMID: 29916782 DOI: 10.1148/radiol.2018172131] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To improve diagnosis of hippocampal sclerosis (HS) in patients with mesial temporal lobe epilepsy (MTLE) by using MR fingerprinting and compare with visual assessment of T1- and T2-weighted MR images. Materials and Methods For this prospective study performed between April and November 2016, T1 and T2 maps were obtained and tissue segmentation performed in consecutive patients with drug-resistant MTLE with unilateral or bilateral HS. T1 and T2 maps were compared between 33 patients with MTLE (23 women and 10 men; mean age, 32.6 years; age range, 16-60 years) and 30 healthy participants (20 women and 10 men; mean age, 28.8 years; age range, 18-40 years). Differences in individual bilateral hippocampi were compared by using a Wilcoxon signed rank test, whereas the Wilcoxon rank-sum test was used for difference analysis between healthy control participants and patients with MTLE. Results The diagnosis rate (ie, ratio of HS diagnosed on the basis of a 2.5-minute MR fingerprinting examination compared with standard methods: MRI, electroencephalography, and PET) was 32 of 33 (96.9%; 95% confidence interval: 84.9%, 100%), reflecting improved accuracy of diagnosis (P = 1.92 × 10-12) over routine MR examinations that had a diagnostic rate of 23 of 33 (69.7%; 95% confidence interval: 51.5%, 81.6%). The comparison between atrophic and normal-appearing hippocampus in 33 patients with MTLE and healthy control participants demonstrated that both T1 and T2 values in HS lesions were higher than those of normal hippocampal tissue of healthy participants (T1: 1361 msec ± 85 vs 1249 msec ± 59, respectively; T2: 135 msec ± 15 vs 104 msec ± 9, respectively; P < .0001). Conclusion MR fingerprinting allowed for multiparametric mapping of temporal lobe within 2.5 minutes and helped to identify lesions suspicious for HS in patients with MTLE with improved accuracy.
Collapse
Affiliation(s)
- Congyu Liao
- From the Center for Brain Imaging Science and Technology, Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering and Instrumental Science (C.L., X.C., Y.L., H.Y., Q.D., H.H., J.Z.), Department of Neurology, The First Affiliated Hospital (K.W., D.W.), State Key Laboratory of Modern Optical Instrumentation, College of Optical Science and Engineering (H.Y.), and Center for Innovative and Collaborative Detection and Treatment of Infectious Diseases (J.Z.), Zhejiang University, 38 Zheda Rd, Hangzhou, Zhejiang 310027, China; and the Department of Imaging Sciences, University of Rochester, Rochester, NY (J.Z.)
| | - Kang Wang
- From the Center for Brain Imaging Science and Technology, Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering and Instrumental Science (C.L., X.C., Y.L., H.Y., Q.D., H.H., J.Z.), Department of Neurology, The First Affiliated Hospital (K.W., D.W.), State Key Laboratory of Modern Optical Instrumentation, College of Optical Science and Engineering (H.Y.), and Center for Innovative and Collaborative Detection and Treatment of Infectious Diseases (J.Z.), Zhejiang University, 38 Zheda Rd, Hangzhou, Zhejiang 310027, China; and the Department of Imaging Sciences, University of Rochester, Rochester, NY (J.Z.)
| | - Xiaozhi Cao
- From the Center for Brain Imaging Science and Technology, Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering and Instrumental Science (C.L., X.C., Y.L., H.Y., Q.D., H.H., J.Z.), Department of Neurology, The First Affiliated Hospital (K.W., D.W.), State Key Laboratory of Modern Optical Instrumentation, College of Optical Science and Engineering (H.Y.), and Center for Innovative and Collaborative Detection and Treatment of Infectious Diseases (J.Z.), Zhejiang University, 38 Zheda Rd, Hangzhou, Zhejiang 310027, China; and the Department of Imaging Sciences, University of Rochester, Rochester, NY (J.Z.)
| | - Yueping Li
- From the Center for Brain Imaging Science and Technology, Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering and Instrumental Science (C.L., X.C., Y.L., H.Y., Q.D., H.H., J.Z.), Department of Neurology, The First Affiliated Hospital (K.W., D.W.), State Key Laboratory of Modern Optical Instrumentation, College of Optical Science and Engineering (H.Y.), and Center for Innovative and Collaborative Detection and Treatment of Infectious Diseases (J.Z.), Zhejiang University, 38 Zheda Rd, Hangzhou, Zhejiang 310027, China; and the Department of Imaging Sciences, University of Rochester, Rochester, NY (J.Z.)
| | - Dengchang Wu
- From the Center for Brain Imaging Science and Technology, Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering and Instrumental Science (C.L., X.C., Y.L., H.Y., Q.D., H.H., J.Z.), Department of Neurology, The First Affiliated Hospital (K.W., D.W.), State Key Laboratory of Modern Optical Instrumentation, College of Optical Science and Engineering (H.Y.), and Center for Innovative and Collaborative Detection and Treatment of Infectious Diseases (J.Z.), Zhejiang University, 38 Zheda Rd, Hangzhou, Zhejiang 310027, China; and the Department of Imaging Sciences, University of Rochester, Rochester, NY (J.Z.)
| | - Huihui Ye
- From the Center for Brain Imaging Science and Technology, Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering and Instrumental Science (C.L., X.C., Y.L., H.Y., Q.D., H.H., J.Z.), Department of Neurology, The First Affiliated Hospital (K.W., D.W.), State Key Laboratory of Modern Optical Instrumentation, College of Optical Science and Engineering (H.Y.), and Center for Innovative and Collaborative Detection and Treatment of Infectious Diseases (J.Z.), Zhejiang University, 38 Zheda Rd, Hangzhou, Zhejiang 310027, China; and the Department of Imaging Sciences, University of Rochester, Rochester, NY (J.Z.)
| | - Qiuping Ding
- From the Center for Brain Imaging Science and Technology, Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering and Instrumental Science (C.L., X.C., Y.L., H.Y., Q.D., H.H., J.Z.), Department of Neurology, The First Affiliated Hospital (K.W., D.W.), State Key Laboratory of Modern Optical Instrumentation, College of Optical Science and Engineering (H.Y.), and Center for Innovative and Collaborative Detection and Treatment of Infectious Diseases (J.Z.), Zhejiang University, 38 Zheda Rd, Hangzhou, Zhejiang 310027, China; and the Department of Imaging Sciences, University of Rochester, Rochester, NY (J.Z.)
| | - Hongjian He
- From the Center for Brain Imaging Science and Technology, Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering and Instrumental Science (C.L., X.C., Y.L., H.Y., Q.D., H.H., J.Z.), Department of Neurology, The First Affiliated Hospital (K.W., D.W.), State Key Laboratory of Modern Optical Instrumentation, College of Optical Science and Engineering (H.Y.), and Center for Innovative and Collaborative Detection and Treatment of Infectious Diseases (J.Z.), Zhejiang University, 38 Zheda Rd, Hangzhou, Zhejiang 310027, China; and the Department of Imaging Sciences, University of Rochester, Rochester, NY (J.Z.)
| | - Jianhui Zhong
- From the Center for Brain Imaging Science and Technology, Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering and Instrumental Science (C.L., X.C., Y.L., H.Y., Q.D., H.H., J.Z.), Department of Neurology, The First Affiliated Hospital (K.W., D.W.), State Key Laboratory of Modern Optical Instrumentation, College of Optical Science and Engineering (H.Y.), and Center for Innovative and Collaborative Detection and Treatment of Infectious Diseases (J.Z.), Zhejiang University, 38 Zheda Rd, Hangzhou, Zhejiang 310027, China; and the Department of Imaging Sciences, University of Rochester, Rochester, NY (J.Z.)
| |
Collapse
|
3
|
Fu P, Zhang F, Gao J, Jing J, Pan L, Li D, Wei L. NeuroGam Software Analysis in Epilepsy Diagnosis Using 99mTc-ECD Brain Perfusion SPECT Imaging. Med Sci Monit 2015; 21:2801-8. [PMID: 26386662 PMCID: PMC4581683 DOI: 10.12659/msm.894566] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The aim of this study was to explore the value of NeuroGam software in diagnosis of epilepsy by 99Tcm-ethyl cysteinate dimer (ECD) brain imaging. MATERIAL AND METHODS NeuroGam was used to analyze 52 cases of clinically proven epilepsy by 99Tcm-ECD brain imaging. The results were compared with EEG and MRI, and the positive rates and localization to epileptic foci were analyzed. RESULTS NeuroGam analysis showed that 42 of 52 epilepsy cases were abnormal. 99Tcm-ECD brain imaging revealed a positive rate of 80.8% (42/52), with 36 out of 42 patients (85.7%) clearly showing an abnormal area. Both were higher than that of brain perfusion SPECT, with a consistency of 64.5% (34/52) using these 2 methods. Decreased regional cerebral blood flow (rCBF) was observed in frontal (18), temporal (20), and parietal lobes (2). Decreased rCBF was seen in frontal and temporal lobes in 4 out of 36 patients, and in temporal and parietal lobes of 2 out of 36 patients. NeuroGam further showed that the abnormal area was located in a different functional area of the brain. EEG abnormalities were detected in 29 out of 52 patients (55.8%) with 16 cases (55.2%) clearly showing an abnormal area. MRI abnormalities were detected in 17 out of 43 cases (39.5%), including 9 cases (52.9%) clearly showing an abnormal area. The consistency of NeuroGam software analysis, and EEG and MRI were 48.1% (25/52) and 34.9% (15/43), respectively. CONCLUSIONS NeuroGam software analysis offers a higher sensitivity in detecting epilepsy than EEG or MRI. It is a powerful tool in 99Tcm-ECD brain imaging.
Collapse
Affiliation(s)
- Peng Fu
- Department of Nuclear Medicine, 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Fang Zhang
- Department of Nuclear Medicine, 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Jianqing Gao
- Department of Nuclear Medicine, 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Jianmin Jing
- Department of Nuclear Medicine, 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Liping Pan
- Department of Nuclear Medicine, 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Dongxue Li
- Department of Nuclear Medicine, 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Lingge Wei
- Department of Nuclear Medicine, 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| |
Collapse
|