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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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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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Shao X, Zhang X, Xu W, Zhang Z, Zhang J, Guo H, Jiang T, Zhang W. Neurite orientation dispersion and density imaging parameters may help for the evaluation of epileptogenic tubers in tuberous sclerosis complex patients. Eur Radiol 2021; 31:5605-5614. [PMID: 33693995 DOI: 10.1007/s00330-020-07626-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/24/2020] [Accepted: 12/10/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To investigate the usefulness of neurite orientation dispersion and density imaging (NODDI) in evaluating cortical tubers, especially epileptogenic tubers in tuberous sclerosis complex (TSC) patients. METHODS High-resolution conventional MRI and multi-shell diffusion-weighted imaging were performed in 27 TSC patients. Diffusion images were fitted to NODDI and DTI models. Tubers were visually assessed on different image types and scored by two neuroradiologists. For 10 patients who underwent epilepsy surgery, the contrast ratios between lesion and background tissue were measured on different image types, and these were compared between 16 epileptogenic tubers and 92 non-epileptogenic tubers. RESULTS There were significant differences in lesion conspicuity scores and lesion-background contrast ratios across different sequences (both p < 0.001). The post hoc analysis showed that both the conspicuity scores and contrast ratios of intracellular volume fraction (ICVF) derived from NODDI were higher than other image types. For the 16 epileptogenic tubers, lesion visibility on ICVF was better/equal in 4/12 tubers compared with conventional MRI and better/equal in 5/11 tubers compared with DTI. Significant differences were observed between epileptogenic and non-epileptogenic tubers on diffusion maps, especially on orientation dispersion index derived from NODDI (p < 0.0001). CONCLUSIONS ICVF demonstrated higher contrast than conventional MRI and DTI, which helped detection of subtle epileptogenic tubers. Moreover, NODDI parameters showed the potential to identify epileptogenicity. KEY POINTS • The noninvasive localization of epileptogenic cortical tubers is essential for the preparation of epilepsy surgery for TSC patients. • ICVF derived from NODDI showed greater contrast than conventional MRI and DTI in detecting tubers, especially subtle epileptogenic ones. • Diffusion parameters, especially ODI derived from NODDI, can support the identification of epileptogenicity.
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Affiliation(s)
- Xiali Shao
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Xuewei Zhang
- Department of Interventional Radiology, Emergency General Hospital, Beijing, People's Republic of China
| | - Wenrui Xu
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing, People's Republic of China
| | - Zhe Zhang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Jieying Zhang
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, People's Republic of China
| | - Hua Guo
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, People's Republic of China
| | - Tao Jiang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China. .,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing, 100050, People's Republic of China. .,Beijing Neurosurgical Institute, Capital Medical University, Beijing, People's Republic of China.
| | - Weihong Zhang
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, People's Republic of China.
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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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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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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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Soares BP, Porter SG, Saindane AM, Dehkharghani S, Desai NK. Utility of double inversion recovery MRI in paediatric epilepsy. Br J Radiol 2015; 89:20150325. [PMID: 26529229 DOI: 10.1259/bjr.20150325] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Detecting focal abnormalities in MRI examinations of children with epilepsy can be a challenging task given the frequently subtle appearance of cortical dysplasia, mesial temporal sclerosis and similar lesions. In this report, we demonstrate the utility of double inversion recovery MRI in the detection of paediatric epileptogenic abnormalities, promoted primarily by increased lesion conspicuity due to complementary suppression of both cerebrospinal fluid and normal white matter signal.
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Affiliation(s)
- Bruno P Soares
- 1 Department of Radiology and Imaging Sciences, Neuroradiology Division, Emory University, Atlanta, GA, USA.,2 Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA
| | - Samuel G Porter
- 1 Department of Radiology and Imaging Sciences, Neuroradiology Division, Emory University, Atlanta, GA, USA
| | - Amit M Saindane
- 1 Department of Radiology and Imaging Sciences, Neuroradiology Division, Emory University, Atlanta, GA, USA
| | - Seena Dehkharghani
- 1 Department of Radiology and Imaging Sciences, Neuroradiology Division, Emory University, Atlanta, GA, USA
| | - Nilesh K Desai
- 1 Department of Radiology and Imaging Sciences, Neuroradiology Division, Emory University, Atlanta, GA, USA.,2 Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA
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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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Calabrese M, Favaretto A, Martini V, Gallo P. Grey matter lesions in MS: from histology to clinical implications. Prion 2012; 7:20-7. [PMID: 23093801 DOI: 10.4161/pri.22580] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Although multiple sclerosis (MS) is a chronic inflammatory-demyelinating disease of the white matter (WM) of the central nervous system, several pathological and magnetic resonance imaging (MRI) studies have shown that a large amount of lesions are located in the cortical and deep gray matter. The histopathological and immunological characteristics of cortical lesions differ significantly from those located in the WM, which suggests a location-dependent expression of the MS immunopathological process. More recently, the availability of not-conventional MRI sequences having higher sensitivity for the gray matter has allowed to depict in vivo a portion of such lesions. The available MRI data obtained on large cohorts of patients, having different clinical forms of the disease, indicate that cortical lesions can be detected early in the disease course, sometimes even before the appearance of WM lesions, and correlate with the severity of physical disability and cognitive impairment, and with the evolution of the disease toward the secondary progressive phase. This review provides a summary of the main histopathological and MRI findings of cortical lesions in MS and discusses their possible clinical implications.
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Affiliation(s)
- Massimiliano Calabrese
- The Multiple Sclerosis Center, Deptartment of Neurosciences, University Hospital of Padova, Padua, Italy.
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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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Absinta M, Rocca MA, Colombo B, Copetti M, Feo D, Falini A, Comi G, Filippi M. Patients with migraine do not have MRI-visible cortical lesions. J Neurol 2012; 259:2695-8. [DOI: 10.1007/s00415-012-6571-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 05/16/2012] [Accepted: 05/24/2012] [Indexed: 11/24/2022]
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Griffiths PD, Hoggard N. Distribution and conspicuity of intracranial abnormalities on MR imaging in adults with tuberous sclerosis complex: A comparison of sequences including ultrafast T2-weighted images. Epilepsia 2009; 50:2605-10. [DOI: 10.1111/j.1528-1167.2009.02107.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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13
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Calabrese M, Filippi M, Rovaris M, Bernardi V, Atzori M, Mattisi I, Favaretto A, Grossi P, Barachino L, Rinaldi L, Romualdi C, Perini P, Gallo P. Evidence for relative cortical sparing in benign multiple sclerosis: a longitudinal magnetic resonance imaging study. Mult Scler 2008; 15:36-41. [PMID: 18755823 DOI: 10.1177/1352458508096686] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Using double inversion recovery (DIR) MRI, cortical lesions can be seen in the brain of patients with multiple sclerosis (MS). The burden of such lesions seems to be well correlated with the severity of MS-related disability. OBJECTIVE To investigate whether the extent of cortical damage in patients with benign MS (BMS) might contribute to explain their favorable clinical status. METHODS Forty-eight patients with BMS (Expanded Disability Status Scale [EDSS] score < or =3.0 and disease duration > or =15 years) and 96 patients with non-disabling, early relapsing-remitting (RR) MS (EDSS score < or =3.0 and disease duration < or =5 years) were studied. Brain MRI, including a DIR and a fluid-attenuated inversion recovery (FLAIR) sequence, was acquired at baseline and after 12 months. On DIR images, intracortical (ICL) and cortical-subcortical lesions (CSL) were identified and their number and volume calculated. Total white matter (WM) lesion volume was quantified on FLAIR images. RESULTS Compared with early RRMS, patients with BMS had lower number of ICL at both study time points (P < or = 0.001 for both comparisons). At one-year follow-up, a significant increase of ICL and CSL number and total volume was observed only in early patients with RRMS. The number and volume of cortical lesions was not correlated with WM lesion volume. Total ICL number at baseline, total cortical lesion volume at baseline, and total cortical lesion volume change were independent predictors of MS phenotype. CONCLUSION In patients with BMS, the selective sparing of the cortex from disease-related focal pathology might be one of the factors associated to their favorable clinical status, independently of the (possible) accrual of WM lesions.
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Affiliation(s)
- M Calabrese
- The Multiple Sclerosis Centre of Veneto Region - First Neurology Clinic, Department of Neurosciences, University Hospital of Padua, Padua, Italy
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Abstract
PURPOSE OF REVIEW In this review we discuss recent advances in the neuroimaging of patients with tuberous sclerosis complex (TSC), highlighting its application in improving clinical management, particularly in the case of intractable epilepsy. RECENT FINDINGS Progress in structural and functional imaging has led to further characterization of the brain lesions in TSC. New magnetic resonance imaging techniques that can delineate the extent of structural brain abnormalities in TSC have been developed. Diffusion tensor imaging unveils the microstructural abnormalities of the brain lesions and of the morphologically normal appearing white matter in TSC. It can potentially identify the epileptogenic zone. Positron emission tomography scanning with 2-deoxy-2-[18F]fluoro-D-glucose can assess the full extent of functional brain abnormalities in TSC. The use of alpha [11C] methyl-L-tryptophan positron emission tomography scanning has proven to be a useful tool in the identification of epileptogenic tubers and has improved the outcome of surgery for epilepsy in TSC. SUMMARY Major advances of neuroimaging in TSC have shown evidence of widespread structural and functional brain abnormalities. In TSC patients with intractable epilepsy, new neuroimaging modalities can now provide an accurate assessment of the epileptogenic zone, thereby permitting improved identification of patients who can have good seizure outcome following surgery for epilepsy.
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Affiliation(s)
- Aimee F Luat
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan 48201, USA
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