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Macdonald-Laurs E, Warren AEL, Francis P, Mandelstam SA, Lee WS, Coleman M, Stephenson SEM, Barton S, D'Arcy C, Lockhart PJ, Leventer RJ, Harvey AS. The clinical, imaging, pathological and genetic landscape of bottom-of-sulcus dysplasia. Brain 2024; 147:1264-1277. [PMID: 37939785 DOI: 10.1093/brain/awad379] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/20/2023] [Accepted: 10/22/2023] [Indexed: 11/10/2023] Open
Abstract
Bottom-of-sulcus dysplasia (BOSD) is increasingly recognized as a cause of drug-resistant, surgically-remediable, focal epilepsy, often in seemingly MRI-negative patients. We describe the clinical manifestations, morphological features, localization patterns and genetics of BOSD, with the aims of improving management and understanding pathogenesis. We studied 85 patients with BOSD diagnosed between 2005-2022. Presenting seizure and EEG characteristics, clinical course, genetic findings and treatment response were obtained from medical records. MRI (3 T) and 18F-FDG-PET scans were reviewed systematically for BOSD morphology and metabolism. Histopathological analysis and tissue genetic testing were performed in 64 operated patients. BOSD locations were transposed to common imaging space to study anatomical location, functional network localization and relationship to normal MTOR gene expression. All patients presented with stereotyped focal seizures with rapidly escalating frequency, prompting hospitalization in 48%. Despite 42% patients having seizure remissions, usually with sodium channel blocking medications, most eventually became drug-resistant and underwent surgery (86% seizure-free). Prior developmental delay was uncommon but intellectual, language and executive dysfunction were present in 24%, 48% and 29% when assessed preoperatively, low intellect being associated with greater epilepsy duration. BOSDs were missed on initial MRI in 68%, being ultimately recognized following repeat MRI, 18F-FDG-PET or image postprocessing. MRI features were grey-white junction blurring (100%), cortical thickening (91%), transmantle band (62%), increased cortical T1 signal (46%) and increased subcortical FLAIR signal (26%). BOSD hypometabolism was present on 18F-FDG-PET in 99%. Additional areas of cortical malformation or grey matter heterotopia were present in eight patients. BOSDs predominated in frontal and pericentral cortex and related functional networks, mostly sparing temporal and occipital cortex, and limbic and visual networks. Genetic testing yielded pathogenic mTOR pathway variants in 63% patients, including somatic MTOR variants in 47% operated patients and germline DEPDC5 or NPRL3 variants in 73% patients with familial focal epilepsy. BOSDs tended to occur in regions where the healthy brain normally shows lower MTOR expression, suggesting these regions may be more vulnerable to upregulation of MTOR activity. Consistent with the existing literature, these results highlight (i) clinical features raising suspicion of BOSD; (ii) the role of somatic and germline mTOR pathway variants in patients with sporadic and familial focal epilepsy associated with BOSD; and (iii) the role of 18F-FDG-PET alongside high-field MRI in detecting subtle BOSD. The anatomical and functional distribution of BOSDs likely explain their seizure, EEG and cognitive manifestations and may relate to relative MTOR expression.
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Affiliation(s)
- Emma Macdonald-Laurs
- Department of Neurology, The Royal Children's Hospital, Parkville, Victoria 3052Australia
- Department of Neuroscience, Murdoch Children's Research Institute, Parkville 3052, Australia
- Department of Paediatrics, The University of Melbourne, Parkville 3052, Australia
| | - Aaron E L Warren
- Department of Neuroscience, Murdoch Children's Research Institute, Parkville 3052, Australia
- Department of Medicine (Austin Health), The University of Melbourne, Heidelberg 3084, Australia
| | - Peter Francis
- Department of Medical Imaging, The Royal Children's Hospital, Parkville 3052, Australia
| | - Simone A Mandelstam
- Department of Neuroscience, Murdoch Children's Research Institute, Parkville 3052, Australia
- Department of Paediatrics, The University of Melbourne, Parkville 3052, Australia
- Department of Medical Imaging, The Royal Children's Hospital, Parkville 3052, Australia
| | - Wei Shern Lee
- Department of Paediatrics, The University of Melbourne, Parkville 3052, Australia
- Department of Genomic Medicine, Bruce Lefroy Centre, Murdoch Children's Research Institute, Parkville 3052, Australia
| | - Matthew Coleman
- Department of Paediatrics, The University of Melbourne, Parkville 3052, Australia
- Department of Genomic Medicine, Bruce Lefroy Centre, Murdoch Children's Research Institute, Parkville 3052, Australia
| | - Sarah E M Stephenson
- Department of Paediatrics, The University of Melbourne, Parkville 3052, Australia
- Department of Genomic Medicine, Bruce Lefroy Centre, Murdoch Children's Research Institute, Parkville 3052, Australia
| | - Sarah Barton
- Department of Neurology, The Royal Children's Hospital, Parkville, Victoria 3052Australia
- Department of Neuroscience, Murdoch Children's Research Institute, Parkville 3052, Australia
- Department of Paediatrics, The University of Melbourne, Parkville 3052, Australia
| | - Colleen D'Arcy
- Department of Pathology, The Royal Children's Hospital, Parkville 3052, Australia
| | - Paul J Lockhart
- Department of Paediatrics, The University of Melbourne, Parkville 3052, Australia
- Department of Genomic Medicine, Bruce Lefroy Centre, Murdoch Children's Research Institute, Parkville 3052, Australia
| | - Richard J Leventer
- Department of Neurology, The Royal Children's Hospital, Parkville, Victoria 3052Australia
- Department of Neuroscience, Murdoch Children's Research Institute, Parkville 3052, Australia
- Department of Paediatrics, The University of Melbourne, Parkville 3052, Australia
| | - A Simon Harvey
- Department of Neurology, The Royal Children's Hospital, Parkville, Victoria 3052Australia
- Department of Neuroscience, Murdoch Children's Research Institute, Parkville 3052, Australia
- Department of Paediatrics, The University of Melbourne, Parkville 3052, Australia
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Troiani V, Snyder W, Kozick S, Patti MA, Beiler D. Variability and concordance of sulcal patterns in the orbitofrontal cortex: A twin study. Psychiatry Res Neuroimaging 2022; 324:111492. [PMID: 35597228 DOI: 10.1016/j.pscychresns.2022.111492] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/15/2022] [Accepted: 05/13/2022] [Indexed: 10/18/2022]
Abstract
Sulcogyral patterns have been identified in the orbitofrontal cortex (OFC) based on the continuity of the medial and lateral orbital sulci. Pattern types are named according to their frequency in the population, with Type I present in ∼60%, Type II in ∼25%, Type III in ∼10%, and Type IV in ∼5%. Previous work has demonstrated that psychiatric conditions with high estimated heritability (e.g. schizophrenia, bipolar disorder) are associated with reduced frequency of Type I patterns, but the general heritability of the OFC sulcogyral patterns is unknown. We examined concordance of OFC patterns in 304 monozygotic (MZ) twins relative to 172 dizygotic (DZ) twins using structural magnetic resonance imaging data. We find that the frequency of pattern types within MZ and DZ twins are similar and bilateral concordance rates across all pattern types in DZ twins were 14% and 21% for MZ twins. Results from follow-up analyses confirm that continuity in the rostral-caudal direction is an important source of variability within the OFC, and subtype analyses indicate that variability is present in other sulci that are not represented by overall OFC pattern type. Overall, these results suggest that OFC sulcogyral patterns may reflect important variance that is not genetic in origin.
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Affiliation(s)
- Vanessa Troiani
- Geisinger Autism and Developmental Medicine Institute, 120 Hamm Drive, Suite 2A, Lewisburg, PA 17837, United States.
| | - Will Snyder
- Geisinger Autism and Developmental Medicine Institute, 120 Hamm Drive, Suite 2A, Lewisburg, PA 17837, United States
| | - Shane Kozick
- Geisinger Autism and Developmental Medicine Institute, 120 Hamm Drive, Suite 2A, Lewisburg, PA 17837, United States
| | - Marisa A Patti
- Geisinger Autism and Developmental Medicine Institute, 120 Hamm Drive, Suite 2A, Lewisburg, PA 17837, United States
| | - Donielle Beiler
- Geisinger Autism and Developmental Medicine Institute, 120 Hamm Drive, Suite 2A, Lewisburg, PA 17837, United States
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Chassoux F, Mellerio C, Laurent A, Landre E, Turak B, Devaux B. Benefits and Risks of Epilepsy Surgery in Patients With Focal Cortical Dysplasia Type 2 in the Central Region. Neurology 2022; 99:e11-e22. [PMID: 35418453 DOI: 10.1212/wnl.0000000000200345] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 02/21/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Focal cortical dysplasia type 2 (FCD2) in the central region can cause drug-resistant epilepsy for which surgery remains challenging because of subsequent functional deficits. Advances in imaging and surgical techniques have progressively improved outcome. We aimed to assess the benefits on epilepsy and the functional risks after FCD2 resections in these highly eloquent areas. METHODS We retrospectively studied all consecutive patients with histologically confirmed FCD2 located in the central region operated on between 2000 and 2019 at a single center. We analyzed electroclinical and imaging features (including fMRI), seizure outcome, and early and late postoperative neurologic status correlating to anatomo-functional areas (primary motor cortex [PMC], paracentral lobule [PCL], supplementary motor area [SMA], precentral gyrus [PrCG], postcentral gyrus [PoCG], central operculum [COp]). RESULTS Sixty patients (35 female, age 7-65 years) were included in the study. Epilepsy was characterized by early onset, high seizure frequency with clusters (30-90/d), drop attacks, and status epilepticus. Ictal semiology included sensory-motor auras, motor and postural manifestations, and postictal motor deficits. EEG and stereo-EEG patterns were like those typically recorded in FCD2. MRI was positive in 63% and 18F-fluorodeoxyglucose-PET was positive in 86% of the patients. fMRI demonstrated activations close to the FCD2 (59%) or minor reorganization (41%) but none within the lesion. Seizure-free outcome (2- to 20-year follow-up) was obtained in 53 patients (88%), including 37 achieving Engel class IA (62%), correlating with complete FCD2 removal. Early transitory postoperative deficits occurred in 52 patients (87%), which were severe in 19, mostly after PMC, PCL, and SMA resections, while PrCG, PoCG, and COp resections were associated with minor/moderate deficits. Total recovery was observed in 21 of 52 patients (40%), while a permanent deficit (>2 years) persisted in 31 (minor 19, moderate 9, major 3). The best outcome (seizure freedom without deficit [48%] or with minor deficit (28%]) was significantly more frequent in children (p = 0.025). Antiseizure medications were discontinued in 28 patients (47%). Quality of life correlated with seizure-free outcome and absence of postoperative deficit; 43 patients (72%) reported a schooling or socio-professional improvement. DISCUSSION Excellent seizure outcome and low rates of major permanent disability can be achieved after central FCD2 resections despite functional risks. CLASSIFICATION OF EVIDENCE Due to its retrospective nature, this study provides Class IV evidence that good seizure outcomes with minor additional deficits can be achieved after epilepsy surgery in the central region.
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Affiliation(s)
- Francine Chassoux
- From the Departments of Neurosurgery (F.C., A.L., E.L., B.T., B.D.) and Neuroradiology (C.M.), GHU Paris Psychiatrie et Neurosciences, France.
| | - Charles Mellerio
- From the Departments of Neurosurgery (F.C., A.L., E.L., B.T., B.D.) and Neuroradiology (C.M.), GHU Paris Psychiatrie et Neurosciences, France
| | - Agathe Laurent
- From the Departments of Neurosurgery (F.C., A.L., E.L., B.T., B.D.) and Neuroradiology (C.M.), GHU Paris Psychiatrie et Neurosciences, France
| | - Elisabeth Landre
- From the Departments of Neurosurgery (F.C., A.L., E.L., B.T., B.D.) and Neuroradiology (C.M.), GHU Paris Psychiatrie et Neurosciences, France
| | - Baris Turak
- From the Departments of Neurosurgery (F.C., A.L., E.L., B.T., B.D.) and Neuroradiology (C.M.), GHU Paris Psychiatrie et Neurosciences, France
| | - Bertrand Devaux
- From the Departments of Neurosurgery (F.C., A.L., E.L., B.T., B.D.) and Neuroradiology (C.M.), GHU Paris Psychiatrie et Neurosciences, France
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Rivière D, Leprince Y, Labra N, Vindas N, Foubet O, Cagna B, Loh KK, Hopkins W, Balzeau A, Mancip M, Lebenberg J, Cointepas Y, Coulon O, Mangin JF. Browsing Multiple Subjects When the Atlas Adaptation Cannot Be Achieved via a Warping Strategy. Front Neuroinform 2022; 16:803934. [PMID: 35311005 PMCID: PMC8928460 DOI: 10.3389/fninf.2022.803934] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/17/2022] [Indexed: 11/14/2022] Open
Abstract
Brain mapping studies often need to identify brain structures or functional circuits into a set of individual brains. To this end, multiple atlases have been published to represent such structures based on different modalities, subject sets, and techniques. The mainstream approach to exploit these atlases consists in spatially deforming each individual data onto a given atlas using dense deformation fields, which supposes the existence of a continuous mapping between atlases and individuals. However, this continuity is not always verified, and this "iconic" approach has limits. We present in this study an alternative, complementary, "structural" approach, which consists in extracting structures from the individual data, and comparing them without deformation. A "structural atlas" is thus a collection of annotated individual data with a common structure nomenclature. It may be used to characterize structure shape variability across individuals or species, or to train machine learning systems. This study exhibits Anatomist, a powerful structural 3D visualization software dedicated to building, exploring, and editing structural atlases involving a large number of subjects. It has been developed primarily to decipher the cortical folding variability; cortical sulci vary enormously in both size and shape, and some may be missing or have various topologies, which makes iconic approaches inefficient to study them. We, therefore, had to build structural atlases for cortical sulci, and use them to train sulci identification algorithms. Anatomist can display multiple subject data in multiple views, supports all kinds of neuroimaging data, including compound structural object graphs, handles arbitrary coordinate transformation chains between data, and has multiple display features. It is designed as a programming library in both C++ and Python languages, and may be extended or used to build dedicated custom applications. Its generic design makes all the display and structural aspects used to explore the variability of the cortical folding pattern work in other applications, for instance, to browse axonal fiber bundles, deep nuclei, functional activations, or other kinds of cortical parcellations. Multimodal, multi-individual, or inter-species display is supported, and adaptations to large scale screen walls have been developed. These very original features make it a unique viewer for structural atlas browsing.
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Affiliation(s)
- Denis Rivière
- Université Paris-Saclay, CEA, CNRS UMR 9027, Baobab, NeuroSpin, Gif-sur-Yvette, France
| | - Yann Leprince
- Université Paris-Saclay, CEA, CNRS UMR 9027, Baobab, NeuroSpin, Gif-sur-Yvette, France
| | - Nicole Labra
- Université Paris-Saclay, CEA, CNRS UMR 9027, Baobab, NeuroSpin, Gif-sur-Yvette, France
- PaleoFED Team, UMR 7194, CNRS, Département Homme et Environnement, Muséum National d’Histoire Naturelle, Musée de l’Homme, Paris, France
| | - Nabil Vindas
- Université Paris-Saclay, CEA, CNRS UMR 9027, Baobab, NeuroSpin, Gif-sur-Yvette, France
| | - Ophélie Foubet
- Université Paris-Saclay, CEA, CNRS UMR 9027, Baobab, NeuroSpin, Gif-sur-Yvette, France
| | - Bastien Cagna
- Université Paris-Saclay, CEA, CNRS UMR 9027, Baobab, NeuroSpin, Gif-sur-Yvette, France
| | - Kep Kee Loh
- INT - Institut de Neurosciences de la Timone, Aix-Marseille Univ, CNRS UMR 7289, Marseille, France
| | - William Hopkins
- Department of Comparative Medicine, University of Texas MD Anderson Cancer Center, Bastrop, TX, United States
| | - Antoine Balzeau
- PaleoFED Team, UMR 7194, CNRS, Département Homme et Environnement, Muséum National d’Histoire Naturelle, Musée de l’Homme, Paris, France
- Department of African Zoology, Royal Museum for Central Africa, Tervuren, Belgium
| | - Martial Mancip
- Maison de la Simulation, CNRS, CEA Saclay, Gif-sur-Yvette, France
| | - Jessica Lebenberg
- Université Paris-Saclay, CEA, CNRS UMR 9027, Baobab, NeuroSpin, Gif-sur-Yvette, France
- Université de Paris, INSERM UMR 1141, NeuroDiderot, Paris, France
| | - Yann Cointepas
- Université Paris-Saclay, CEA, CNRS UMR 9027, Baobab, NeuroSpin, Gif-sur-Yvette, France
| | - Olivier Coulon
- INT - Institut de Neurosciences de la Timone, Aix-Marseille Univ, CNRS UMR 7289, Marseille, France
| | - Jean-François Mangin
- Université Paris-Saclay, CEA, CNRS UMR 9027, Baobab, NeuroSpin, Gif-sur-Yvette, France
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5
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de Vareilles H, Rivière D, Sun Z, Fischer C, Leroy F, Neumane S, Stopar N, Eijsermans R, Ballu M, Tataranno ML, Benders M, Mangin JF, Dubois J. Shape variability of the central sulcus in the developing brain: a longitudinal descriptive and predictive study in preterm infants. Neuroimage 2021; 251:118837. [PMID: 34965455 DOI: 10.1016/j.neuroimage.2021.118837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 11/17/2021] [Accepted: 12/18/2021] [Indexed: 02/04/2023] Open
Abstract
Despite growing evidence of links between sulcation and function in the adult brain, the folding dynamics, occurring mostly before normal-term-birth, is vastly unknown. Looking into the development of cortical sulci in infants can give us keys to address fundamental questions: what is the sulcal shape variability in the developing brain? When are the shape features encoded? How are these morphological parameters related to further functional development? In this study, we aimed to investigate the shape variability of the developing central sulcus, which is the frontier between the primary somatosensory and motor cortices. We studied a cohort of 71 extremely preterm infants scanned twice using MRI - once around 30 weeks post-menstrual age (w PMA) and once at term-equivalent age, around 40w PMA -, in order to quantify the sulcus's shape variability using manifold learning, regardless of age-group or hemisphere. We then used these shape descriptors to evaluate the sulcus's variability at both ages and to assess hemispheric and age-group specificities. This led us to propose a description of ten shape features capturing the variability in the central sulcus of preterm infants. Our results suggested that most of these features (8/10) are encoded as early as 30w PMA. We unprecedentedly observed hemispheric asymmetries at both ages, and the one captured at term-equivalent age seems to correspond with the asymmetry pattern previously reported in adults. We further trained classifiers in order to explore the predictive value of these shape features on manual performance at 5 years of age (handedness and fine motor outcome). The central sulcus's shape alone showed a limited but relevant predictive capacity in both cases. The study of sulcal shape features during early neurodevelopment may participate to a better comprehension of the complex links between morphological and functional organization of the developing brain.
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Affiliation(s)
- H de Vareilles
- Université Paris-Saclay, NeuroSpin-BAOBAB, CEA, Gif-sur-Yvette, France.
| | - D Rivière
- Université Paris-Saclay, NeuroSpin-BAOBAB, CEA, Gif-sur-Yvette, France
| | - Z Sun
- Université Paris-Saclay, NeuroSpin-BAOBAB, CEA, Gif-sur-Yvette, France
| | - C Fischer
- Université Paris-Saclay, NeuroSpin-BAOBAB, CEA, Gif-sur-Yvette, France
| | - F Leroy
- Université Paris-Saclay, NeuroSpin-BAOBAB, CEA, Gif-sur-Yvette, France; Université Paris-Saclay, NeuroSpin-UNICOG, Inserm, CEA, Gif-sur-Yvette, France
| | - S Neumane
- Université de Paris, NeuroDiderot, Inserm, Paris, France; Université Paris-Saclay, NeuroSpin-UNIACT, CEA, Gif-sur-Yvette, France
| | - N Stopar
- Utrecht University, University Medical Center Utrecht, Department of Neonatology, Utrecht, the Netherlands
| | - R Eijsermans
- Utrecht University, University Medical Center Utrecht, Department of Neonatology, Utrecht, the Netherlands
| | - M Ballu
- Department of Pure Mathematics and Mathematical Statistics, University of Cambridge, Cambridge, United Kingdom
| | - M L Tataranno
- Utrecht University, University Medical Center Utrecht, Department of Neonatology, Utrecht, the Netherlands
| | - Mjnl Benders
- Utrecht University, University Medical Center Utrecht, Department of Neonatology, Utrecht, the Netherlands
| | - J F Mangin
- Université Paris-Saclay, NeuroSpin-BAOBAB, CEA, Gif-sur-Yvette, France
| | - J Dubois
- Université de Paris, NeuroDiderot, Inserm, Paris, France; Université Paris-Saclay, NeuroSpin-UNIACT, CEA, Gif-sur-Yvette, France
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Cachia A, Borst G, Jardri R, Raznahan A, Murray GK, Mangin JF, Plaze M. Towards Deciphering the Fetal Foundation of Normal Cognition and Cognitive Symptoms From Sulcation of the Cortex. Front Neuroanat 2021; 15:712862. [PMID: 34650408 PMCID: PMC8505772 DOI: 10.3389/fnana.2021.712862] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 08/31/2021] [Indexed: 01/16/2023] Open
Abstract
Growing evidence supports that prenatal processes play an important role for cognitive ability in normal and clinical conditions. In this context, several neuroimaging studies searched for features in postnatal life that could serve as a proxy for earlier developmental events. A very interesting candidate is the sulcal, or sulco-gyral, patterns, macroscopic features of the cortex anatomy related to the fold topology-e.g., continuous vs. interrupted/broken fold, present vs. absent fold-or their spatial organization. Indeed, as opposed to quantitative features of the cortical sheet (e.g., thickness, surface area or curvature) taking decades to reach the levels measured in adult, the qualitative sulcal patterns are mainly determined before birth and stable across the lifespan. The sulcal patterns therefore offer a window on the fetal constraints on specific brain areas on cognitive abilities and clinical symptoms that manifest later in life. After a global review of the cerebral cortex sulcation, its mechanisms, its ontogenesis along with methodological issues on how to measure the sulcal patterns, we present a selection of studies illustrating that analysis of the sulcal patterns can provide information on prenatal dispositions to cognition (with a focus on cognitive control and academic abilities) and cognitive symptoms (with a focus on schizophrenia and bipolar disorders). Finally, perspectives of sulcal studies are discussed.
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Affiliation(s)
- Arnaud Cachia
- Université de Paris, LaPsyDÉ, CNRS, Paris, France.,Université de Paris, IPNP, INSERM, Paris, France
| | - Grégoire Borst
- Université de Paris, LaPsyDÉ, CNRS, Paris, France.,Institut Universitaire de France, Paris, France
| | - Renaud Jardri
- Univ Lille, INSERM U-1172, CHU Lille, Lille Neuroscience & Cognition Centre, Plasticity & SubjectivitY (PSY) team, Lille, France
| | - Armin Raznahan
- Section on Developmental Neurogenomics, Human Genetics Branch, National Institute of Mental Health, Bethesda, MD, United States
| | - Graham K Murray
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | | | - Marion Plaze
- Université de Paris, IPNP, INSERM, Paris, France.,GHU PARIS Psychiatrie & Neurosciences, site Sainte-Anne, Service Hospitalo-Universitaire, Pôle Hospitalo-Universitaire Paris, Paris, France
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Borne L, Rivière D, Cachia A, Roca P, Mellerio C, Oppenheim C, Mangin JF. Automatic recognition of specific local cortical folding patterns. Neuroimage 2021; 238:118208. [PMID: 34089872 DOI: 10.1016/j.neuroimage.2021.118208] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/30/2021] [Accepted: 05/25/2021] [Indexed: 11/15/2022] Open
Abstract
The study of local cortical folding patterns showed links with psychiatric illnesses as well as cognitive functions. Despite the tools now available to visualize cortical folds in 3D, manually classifying local sulcal patterns is a time-consuming and tedious task. In fact, 3D visualization of folds helps experts to identify different sulcal patterns but fold variability is so high that the distinction between these patterns sometimes requires the definition of complex criteria, making manual classification difficult and not reliable. However, the assessment of the impact of these patterns on the functional organization of the cortex could benefit from the study of large databases, especially when studying rare patterns. In this paper, several algorithms for the automatic classification of fold patterns are proposed to allow morphological studies to be extended and confirmed on such large databases. Three methods are proposed, the first based on a Support Vector Machine (SVM) classifier, the second on the Scoring by Non-local Image Patch Estimator (SNIPE) approach and the third based on a 3D Convolution Neural Network (CNN). These methods are generic enough to be applicable to a wide range of folding patterns. They are tested on two types of patterns for which there is currently no method to automatically identify them: the Anterior Cingulate Cortex (ACC) patterns and the Power Button Sign (PBS). The two ACC patterns are almost equally present whereas PBS is a particularly rare pattern in the general population. The three models proposed achieve balanced accuracies of approximately 80% for ACC patterns classification and 60% for PBS classification. The CNN-based model is more interesting for the classification of ACC patterns thanks to its rapid execution. However, SVM and SNIPE-based models are more effective in managing unbalanced problems such as PBS recognition.
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Affiliation(s)
- Léonie Borne
- Université Paris-Saclay, CEA, CNRS, Baobab, Neurospin, Gif-sur-Yvette, France; University of Newcastle, HMRI, Systems Neuroscience Group, NSW, Australia.
| | - Denis Rivière
- Université Paris-Saclay, CEA, CNRS, Baobab, Neurospin, Gif-sur-Yvette, France
| | - Arnaud Cachia
- Université de Paris, LaPsyDÉ, CNRS, Paris, France; Université de Paris, Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM, UMR S1266, Paris, France
| | - Pauline Roca
- Université de Paris, Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM, UMR S1266, Paris, France; Groupe Hospitalier Universitaire Paris Psychiatrie et Neurosciences, Sainte-Anne Hospital, Imaging Department, Paris, France; Pixyl, Research and Development Laboratory, Grenoble, France
| | - Charles Mellerio
- Université de Paris, Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM, UMR S1266, Paris, France; Groupe Hospitalier Universitaire Paris Psychiatrie et Neurosciences, Sainte-Anne Hospital, Imaging Department, Paris, France; Centre d'imagerie du Nord, Saint Denis, France
| | - Catherine Oppenheim
- Université de Paris, Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM, UMR S1266, Paris, France; Groupe Hospitalier Universitaire Paris Psychiatrie et Neurosciences, Sainte-Anne Hospital, Imaging Department, Paris, France
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Mendes Coelho VC, Morita-Sherman M, Yasuda CL, Alvim MMK, Amorim BJ, Tedeschi H, Ghizoni E, Rogerio F, Cendes F. Magnetic resonance imaging findings and clinical characteristics in mild malformation of cortical development with oligodendroglial hyperplasia and epilepsy in a predominantly adult cohort. Epilepsia 2021; 62:1429-1441. [PMID: 33884614 DOI: 10.1111/epi.16907] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 03/28/2021] [Accepted: 04/02/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE We aimed to better characterize the magnetic resonance imaging (MRI) findings of mild malformation of cortical development with oligodendroglial hyperplasia (MOGHE), a rare clinicopathological entity associated with pharmacoresistance recently described in patients with frontal lobe epilepsy. METHODS We studied 12 patients who underwent epilepsy surgery and whose surgical specimens showed histopathological findings of MOGHE, characterized by preserved cortical lamination, blurred gray-white matter interface due to increased number of oligodendrocytes, and heterotopic neurons in the white matter. The age at MRI evaluation ranged from 11 to 58 years, except for one 4.5-year-old patient. RESULTS Following a detailed MRI analysis using an in-house protocol, we found abnormalities in all cases. The lesion was circumscribed in the frontal lobe in six (50%) and in the temporal lobe in three (25%) patients. In the remaining three patients (25%), the lesion was multilobar (frontotemporal and temporoparieto-occipital). Cortical thickening was mild in all patients, except in the 4.5-year-old patient, who had pronounced cortical thickening and white matter blurring. We also identified cortical/subcortical hyperintense T2/fluid-attenuated inversion recovery signal associated with gray/white matter blurring in all but one patient. When present, cleft cortical dimple, and deep sulci aided in localizing the lesion. Overall, the MRI findings were like those in focal cortical dysplasia (FCD) Type IIa. Surgical outcome was excellent in five patients (Engel Class I in 25% and II in 17%). The remaining seven patients (58%) had worthwhile seizure reduction (Engle Class III). Incomplete lesion resection was significantly associated with worse outcomes. SIGNIFICANCE MRI findings associated with MOGHE are similar to those described in FCD Type IIa. Although more frequent in the frontal lobe, MOGHE also occurred in the temporal lobe or involved multiple lobes. Multilobar or extensive MOGHE MRI lesions are associated with less favorable surgical outcomes. Because this is a rare condition, multicenter studies are necessary to characterize MOGHE further.
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Affiliation(s)
| | - Marcia Morita-Sherman
- Department of Neurology, University of Campinas, Campinas, São Paulo, Brazil.,Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Clarissa L Yasuda
- Department of Neurology, University of Campinas, Campinas, São Paulo, Brazil
| | - Marina M K Alvim
- Department of Neurology, University of Campinas, Campinas, São Paulo, Brazil
| | - Barbara Juarez Amorim
- Division of Nuclear Medicine, Department of Radiology, University of Campinas, Campinas, São Paulo, Brazil
| | - Helder Tedeschi
- Department of Neurology, University of Campinas, Campinas, São Paulo, Brazil
| | - Enrico Ghizoni
- Department of Neurology, University of Campinas, Campinas, São Paulo, Brazil
| | - Fabio Rogerio
- Department of Pathology, University of Campinas, Campinas, São Paulo, Brazil
| | - Fernando Cendes
- Department of Neurology, University of Campinas, Campinas, São Paulo, Brazil
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9
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Zhao B, Zhang C, Wang X, Wang Y, Liu C, Mo J, Zheng Z, Zhang K, Shao XQ, Hu W, Zhang J. Sulcus-centered resection for focal cortical dysplasia type II: surgical techniques and outcomes. J Neurosurg 2020; 135:266-272. [PMID: 32764170 DOI: 10.3171/2020.5.jns20751] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/14/2020] [Indexed: 11/06/2022]
Abstract
Focal cortical dysplasia type II (FCD II) is a common histopathological substrate of epilepsy surgery. Here, the authors propose a sulcus-centered resection strategy for this malformation, provide technical details, and assess the efficacy and safety of this technique. The main purpose of the sulcus-centered resection is to remove the folded gray matter surrounding a dysplastic sulcus, particularly that at the bottom of the sulcus. The authors also retrospectively reviewed the records of 88 consecutive patients with FCD II treated with resective surgery between January 2015 and December 2018. The demographics, clinical characteristics, electrophysiological recordings, neuroimaging studies, histopathological findings, surgical outcomes, and complications were collected. After the exclusion of diffusely distributed and gyrus-based lesions, 71 patients (30 females, 41 males) who had undergone sulcus-centered resection were included in this study. The mean (± standard deviation) age of the cohort was 17.78 ± 10.54 years (38 pediatric patients, 33 adults). Thirty-five lesions (49%) were demonstrated on MRI; 42 patients (59%) underwent stereo-EEG monitoring before resective surgery; and 37 (52%) and 34 (48%) lesions were histopathologically proven to be FCD IIa and IIb, respectively. At a mean follow-up of 3.34 ± 1.17 years, 64 patients (90%) remained seizure free, and 7 (10%) had permanent neurological deficits including motor weakness, sensory deficits, and visual field deficits. The study findings showed that in carefully selected FCD II cases, sulcus-centered resection is an effective and safe surgical strategy.
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Affiliation(s)
| | | | | | | | | | | | - Zhong Zheng
- 4Department of Neurosurgery, Beijing Fengtai Hospital, Beijing, People's Republic of China
| | - Kai Zhang
- Departments of1Neurosurgery and
- 2Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University
- 3Beijing Key Laboratory of Neurostimulation; and
| | - Xiao-Qiu Shao
- 5Neurology, Beijing Tiantan Hospital, Capital Medical University
| | - Wenhan Hu
- Departments of1Neurosurgery and
- 2Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University
- 3Beijing Key Laboratory of Neurostimulation; and
| | - Jianguo Zhang
- Departments of1Neurosurgery and
- 2Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University
- 3Beijing Key Laboratory of Neurostimulation; and
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10
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Malformazioni dello sviluppo corticale. Neurologia 2019. [DOI: 10.1016/s1634-7072(19)42019-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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11
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Nakajima M, Wong S, Widjaja E, Baba S, Okanishi T, Takada L, Sato Y, Iwata H, Sogabe M, Morooka H, Whitney R, Ueda Y, Ito T, Yagyu K, Ochi A, Carter Snead O, Rutka JT, Drake JM, Doesburg S, Takeuchi F, Shiraishi H, Otsubo H. Advanced dynamic statistical parametric mapping with MEG in localizing epileptogenicity of the bottom of sulcus dysplasia. Clin Neurophysiol 2018; 129:1182-1191. [DOI: 10.1016/j.clinph.2018.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 02/22/2018] [Accepted: 03/06/2018] [Indexed: 10/17/2022]
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12
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Roux A, Mellerio C, Lechapt-Zalcman E, Still M, Zerah M, Bourgeois M, Pallud J. Left Frontal Meningioangiomatosis Associated with Type IIIc Focal Cortical Dysplasia Causing Refractory Epilepsy and Literature Review. World Neurosurg 2018; 114:281-288. [DOI: 10.1016/j.wneu.2018.03.145] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 03/20/2018] [Accepted: 03/21/2018] [Indexed: 01/29/2023]
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13
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18F-FDG PET in drug-resistant epilepsy due to focal cortical dysplasia type 2: additional value of electroclinical data and coregistration with MRI. Eur J Nucl Med Mol Imaging 2018; 45:1449-1460. [DOI: 10.1007/s00259-018-3994-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 03/16/2018] [Indexed: 10/17/2022]
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Abstract
Inhibitory control (IC) is a core executive function that enables humans to resist habits, temptations, or distractions. IC efficiency in childhood is a strong predictor of academic and professional success later in life. Based on analysis of the sulcal pattern, a qualitative feature of cortex anatomy determined during fetal life and stable during development, we searched for evidence that interindividual differences in IC partly trace back to prenatal processes. Using anatomical magnetic resonance imaging (MRI), we analyzed the sulcal pattern of two key regions of the IC neural network, the dorsal anterior cingulate cortex (ACC) and the inferior frontal cortex (IFC), which limits the inferior frontal gyrus. We found that the sulcal pattern asymmetry of both the ACC and IFC contributes to IC (Stroop score) in children and adults: participants with asymmetrical ACC or IFC sulcal patterns had better IC efficiency than participants with symmetrical ACC or IFC sulcal patterns. Such additive effects of IFC and ACC sulcal patterns on IC efficiency suggest that distinct early neurodevelopmental mechanisms targeting different brain regions likely contribute to IC efficiency. This view shares some analogies with the “common variant–small effect” model in genetics, which states that frequent genetic polymorphisms have small effects but collectively account for a large portion of the variance. Similarly, each sulcal polymorphism has a small but additive effect: IFC and ACC sulcal patterns, respectively, explained 3% and 14% of the variance of the Stroop interference scores.
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15
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7.0 Tesla MRI tractography in patients with trigeminal neuralgia. Magn Reson Imaging 2018; 54:265-270. [PMID: 29305127 DOI: 10.1016/j.mri.2017.12.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 12/29/2017] [Indexed: 02/07/2023]
Abstract
7.0 Tesla (T) high-resolution diffusion tensor imaging (DTI) can supply information on changing microstructures in cranial nerves. We investigated DTI parameters and the feasibility of DTI criteria for diagnosing trigeminal neuralgia (TN). In this study, 14 patients (28 hemispheres) of mean age 49.0 years (range, 31-64) with TN underwent DTI using 7.0 TMRI. We compared fractional anisotropy (FA), axial diffusivity (AD), mean diffusivity (MD), and radial diffusivity (RD) of affected-side and unaffected-side trigeminal nerves using DTI. We examined associations between DTI parameters and clinical characteristics for patients with TN. In patients with TN, affected sides showed significantly decreased FA and significantly increased MD, and RD compared with unaffected sides of trigeminal nerves. Nuclei were not significantly different among patients with TN. Barrow Neurological Institute (BNI) pain scores did not correlate with affected sides. 7.0 T DTI was useful for detecting neurovascular compression in patients with TN. The increased signal-to-noise ratio provided by 7 T MRI should be advantageous for increasing spatial resolution to detect microstructure changes to trigeminal nerves in patients with TN.
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Tan YL, Kim H, Lee S, Tihan T, Ver Hoef L, Mueller SG, Barkovich AJ, Xu D, Knowlton R. Quantitative surface analysis of combined MRI and PET enhances detection of focal cortical dysplasias. Neuroimage 2017; 166:10-18. [PMID: 29097316 DOI: 10.1016/j.neuroimage.2017.10.065] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 10/29/2017] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE Focal cortical dysplasias (FCDs) often cause pharmacoresistant epilepsy, and surgical resection can lead to seizure-freedom. Magnetic resonance imaging (MRI) and positron emission tomography (PET) play complementary roles in FCD identification/localization; nevertheless, many FCDs are small or subtle, and difficult to find on routine radiological inspection. We aimed to automatically detect subtle or visually-unidentifiable FCDs by building a classifier based on an optimized cortical surface sampling of combined MRI and PET features. METHODS Cortical surfaces of 28 patients with histopathologically-proven FCDs were extracted. Morphology and intensity-based features characterizing FCD lesions were calculated vertex-wise on each cortical surface, and fed to a 2-step (Support Vector Machine and patch-based) classifier. Classifier performance was assessed compared to manual lesion labels. RESULTS Our classifier using combined feature selections from MRI and PET outperformed both quantitative MRI and multimodal visual analysis in FCD detection (93% vs 82% vs 68%). No false positives were identified in the controls, whereas 3.4% of the vertices outside FCD lesions were also classified to be lesional ("extralesional clusters"). Patients with type I or IIa FCDs displayed a higher prevalence of extralesional clusters at an intermediate distance to the FCD lesions compared to type IIb FCDs (p < 0.05). The former had a correspondingly lower chance of positive surgical outcome (71% vs 91%). CONCLUSIONS Machine learning with multimodal feature sampling can improve FCD detection. The spread of extralesional clusters characterize different FCD subtypes, and may represent structurally or functionally abnormal tissue on a microscopic scale, with implications for surgical outcomes.
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Affiliation(s)
- Yee-Leng Tan
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA; Department of Neurology, National Neuroscience Institute, Singapore.
| | - Hosung Kim
- Laboratory of Neuro Imaging, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA.
| | - Seunghyun Lee
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA.
| | - Tarik Tihan
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.
| | - Lawrence Ver Hoef
- Department of Neurology, University of Alabama, Birmingham, United Kingdom.
| | - Susanne G Mueller
- Department of Radiology, Seoul National University Hospital, Republic of Korea.
| | | | - Duan Xu
- Department of Radiology, Seoul National University Hospital, Republic of Korea.
| | - Robert Knowlton
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.
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17
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Veersema TJ, Ferrier CH, van Eijsden P, Gosselaar PH, Aronica E, Visser F, Zwanenburg JM, de Kort GAP, Hendrikse J, Luijten PR, Braun KPJ. Seven tesla MRI improves detection of focal cortical dysplasia in patients with refractory focal epilepsy. Epilepsia Open 2017; 2:162-171. [PMID: 29588945 PMCID: PMC5719847 DOI: 10.1002/epi4.12041] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2016] [Indexed: 11/30/2022] Open
Abstract
Objective The aim of this study is to determine whether the use of 7 tesla (T) MRI in clinical practice leads to higher detection rates of focal cortical dysplasias in possible candidates for epilepsy surgery. Methods In our center patients are referred for 7 T MRI if lesional focal epilepsy is suspected, but no abnormalities are detected at one or more previous, sufficient‐quality lower‐field MRI scans, acquired with a dedicated epilepsy protocol, or when concealed pathology is suspected in combination with MR‐visible mesiotemporal sclerosis—dual pathology. We assessed 40 epilepsy patients who underwent 7 T MRI for presurgical evaluation and whose scans (both 7 T and lower field) were discussed during multidisciplinary epilepsy surgery meetings that included a dedicated epilepsy neuroradiologist. We compared the conclusions of the multidisciplinary visual assessments of 7 T and lower‐field MRI scans. Results In our series of 40 patients, multidisciplinary evaluation of 7 T MRI identified additional lesions not seen on lower‐field MRI in 9 patients (23%). These findings were guiding in surgical planning. So far, 6 patients underwent surgery, with histological confirmation of focal cortical dysplasia or mild malformation of cortical development. Significance Seven T MRI improves detection of subtle focal cortical dysplasia and mild malformations of cortical development in patients with intractable epilepsy and may therefore contribute to identification of surgical candidates and complete resection of the epileptogenic lesion, and thus to postoperative seizure freedom.
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Affiliation(s)
- Tim J. Veersema
- Department of Neurology and NeurosurgeryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Cyrille H. Ferrier
- Department of Neurology and NeurosurgeryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Pieter van Eijsden
- Department of Neurology and NeurosurgeryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Peter H. Gosselaar
- Department of Neurology and NeurosurgeryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Eleonora Aronica
- Department of (Neuro)PathologyAcademic Medical CenterUniversity of AmsterdamAmsterdamthe Netherlands
- Center for NeuroscienceSwammerdam Institute for Life SciencesUniversity of AmsterdamAmsterdamthe Netherlands
- SEIN—Stichting Epilepsie Instellingen NederlandHeemstedethe Netherlands
| | | | - Jaco M. Zwanenburg
- Department of RadiologyUniversity Medical Center UtrechtUtrechtthe Netherlands
| | | | - Jeroen Hendrikse
- Department of RadiologyUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Peter R. Luijten
- Department of RadiologyUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Kees P. J. Braun
- Department of Neurology and NeurosurgeryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrechtthe Netherlands
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18
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Abstract
PURPOSE OF REVIEW Advanced MRI postprocessing techniques are increasingly used to complement visual analysis and elucidate structural epileptogenic lesions. This review summarizes recent developments in MRI postprocessing in the context of epilepsy presurgical evaluation, with the focus on patients with unremarkable MRI by visual analysis (i.e. 'nonlesional' MRI). RECENT FINDINGS Various methods of MRI postprocessing have been reported to show additional clinical values in the following areas: lesion detection on an individual level; lesion confirmation for reducing the risk of over reading the MRI; detection of sulcal/gyral morphologic changes that are particularly difficult for visual analysis; and delineation of cortical abnormalities extending beyond the visible lesion. Future directions to improve the performance of MRI postprocessing include using higher magnetic field strength for better signal-to-noise ratio and contrast-to-noise ratio adopting a multicontrast frame work and integration with other noninvasive modalities. SUMMARY MRI postprocessing can provide essential value to increase the yield of structural MRI and should be included as part of the presurgical evaluation of nonlesional epilepsies. MRI postprocessing allows for more accurate identification/delineation of cortical abnormalities, which should then be more confidently targeted and mapped.
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19
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Bartolini L, Whitehead MT, Ho C, Sepeta LN, Oluigbo CO, Havens K, Freilich ER, Schreiber JM, Gaillard WD. Temporal lobe epilepsy and focal cortical dysplasia in children: A tip to find the abnormality. Epilepsia 2016; 58:113-122. [DOI: 10.1111/epi.13615] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2016] [Indexed: 12/16/2022]
Affiliation(s)
- Luca Bartolini
- Center for Neuroscience Children's National Health System George Washington University Washington District of Columbia U.S.A
| | - Matthew T. Whitehead
- Department of Diagnostic Imaging and Radiology Children's National Health System George Washington University Washington District of Columbia U.S.A
| | - Cheng‐Ying Ho
- Department of Pathology Children's National Health System George Washington University Washington District of Columbia U.S.A
- Department of Pathology University of Maryland Baltimore Maryland U.S.A
| | - Leigh N. Sepeta
- Center for Neuroscience Children's National Health System George Washington University Washington District of Columbia U.S.A
| | - Chima O. Oluigbo
- Center for Neuroscience Children's National Health System George Washington University Washington District of Columbia U.S.A
| | - Kathryn Havens
- Center for Neuroscience Children's National Health System George Washington University Washington District of Columbia U.S.A
| | - Emily R. Freilich
- Center for Neuroscience Children's National Health System George Washington University Washington District of Columbia U.S.A
| | - John M. Schreiber
- Center for Neuroscience Children's National Health System George Washington University Washington District of Columbia U.S.A
| | - William D. Gaillard
- Center for Neuroscience Children's National Health System George Washington University Washington District of Columbia U.S.A
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Radhakrishnan R, Leach JL, Mangano FT, Gelfand MJ, Rozhkov L, Miles L, Greiner HM. Prospective detection of cortical dysplasia on clinical MRI in pediatric intractable epilepsy. Pediatr Radiol 2016; 46:1430-8. [PMID: 27112159 DOI: 10.1007/s00247-016-3623-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 02/08/2016] [Accepted: 03/30/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cortical dysplasia is the most common cause of pediatric refractory epilepsy. MRI detection of epileptogenic lesion is associated with good postsurgical outcome. Additional electrophysiological information is suggested to be helpful in localization of cortical dysplasia. Educational measures were taken to increase the awareness of cortical dysplasia at our institution in the context of a recent International League Against Epilepsy (ILAE 2011) classification of cortical dysplasia. OBJECTIVE To determine changes in the rate of prospective identification of cortical dysplasia on an initial radiology report and also evaluate the benefit of MRI review as part of a multidisciplinary epilepsy conference in identifying previously overlooked MRI findings. MATERIALS AND METHODS We retrospectively evaluated surgically treated children with refractory epilepsy from 2007 to 2014 with cortical dysplasia on histopathology. We analyzed the initial radiology report, preoperative MRI interpretation at multidisciplinary epilepsy conference and subsequent retrospective MRI review with knowledge of the resection site. We recorded additional electrophysiological data and the presence of lobar concordance with the MRI findings. RESULTS Of 78 children (44 MRI lesional) evaluated, 18 had initially overlooked MRI findings. Comparing 2007-2010 to 2011-2014, there was improvement in the rate of overlooked findings on the initial radiology report (54% vs. 13% of lesional cases, respectively; P = 0.008). The majority (72%) were identified at a multidisciplinary conference with lobar concordance of findings with at least one additional electrophysiological investigation in 89%. CONCLUSION Awareness of current classification schemes of cortical dysplasia and image review in the context of a multidisciplinary conference can lead to improved MRI detection of cortical dysplasia in children.
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Affiliation(s)
- Rupa Radhakrishnan
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., ML 5031, Cincinnati, OH, 45229, USA.
| | - James L Leach
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., ML 5031, Cincinnati, OH, 45229, USA
| | - Francesco T Mangano
- Department of Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Michael J Gelfand
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., ML 5031, Cincinnati, OH, 45229, USA
| | - Leonid Rozhkov
- Department of Neurology, Comprehensive Epilepsy Treatment Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Lili Miles
- Department of Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Hansel M Greiner
- Department of Neurology, Comprehensive Epilepsy Treatment Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Mellerio C, Lapointe MN, Roca P, Charron S, Legrand L, Meder JF, Oppenheim C, Cachia A. Identification of Reliable Sulcal Patterns of the Human Rolandic Region. Front Hum Neurosci 2016; 10:410. [PMID: 27582700 PMCID: PMC4987365 DOI: 10.3389/fnhum.2016.00410] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 08/02/2016] [Indexed: 11/13/2022] Open
Abstract
A major feature of the human cortex is its huge morphological variability. Although a comprehensive literature about the sulco-gyral pattern of the central region is available from post-mortem data, a reliable and reproducible characterization from in vivo data is still lacking. The aim of this study is to test the reliability of morphological criteria of the central region sulci used in post-mortem data, when applied to in vivo magnetic resonance imaging (MRI) data. Thirty right-handed healthy individuals were included in the study. Automated segmentation and three dimensional (3D) surface-based rendering were obtained from clinical 3D T1-weighted MRI. Two senior radiologists labeled the three sulci composing the central region (precentral [PreCS], central [CS] and postcentral [PostCS]) and analyzed their morphological variations using 47 standard criteria derived from Ono's atlas based on post-mortem data. For each criterion, inter-rater concordance and comparison with the occurrence frequency provided in Ono's atlas were estimated. Overall, the sulcal pattern criteria derived from MRI data were highly reproducible between the raters with a high mean inter-rater concordance in the three sulci (CS: κ = 0.92 in left hemisphere/κ = 0.91 in right hemisphere; PreCS: κ = 0.91/κ = 0.93; PostCS: κ = 0.84/0.79). Only a very limited number of sulcal criteria significantly differed between the in vivo and the post-mortem data (CS: 2 criteria in the left hemisphere/3 criteria in the right hemisphere; PreCS: 3 in the left and right hemispheres; PostCS: 3 in the left hemisphere and 5 in the right hemisphere). Our study provides a comprehensive description of qualitative sulcal patterns in the central region from in vivo clinical MRI with high agreement with previous post-mortem data. Such identification of reliable sulcal patterns of the central region visible with standard clinical MRI data paves the way for the detection of subtle variations of the central sulcation associated with variations of normal or pathological functioning.
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Affiliation(s)
- Charles Mellerio
- Department of Neuroradiology, Centre Hospitalier Sainte-AnneParis, France; University Paris DescartesParis, France; Imaging Biomarkers of Brain Development and Disorders, INSERM, UMR 894Paris, France
| | - Marie-Noël Lapointe
- Department of Radiology, Hôpital de l'Enfant-Jésus, CHU de Québec Ville de Québec, QC, Canada
| | - Pauline Roca
- Department of Neuroradiology, Centre Hospitalier Sainte-AnneParis, France; Imaging Biomarkers of Brain Development and Disorders, INSERM, UMR 894Paris, France
| | - Sylvain Charron
- Department of Neuroradiology, Centre Hospitalier Sainte-AnneParis, France; University Paris DescartesParis, France
| | - Laurence Legrand
- Department of Neuroradiology, Centre Hospitalier Sainte-AnneParis, France; University Paris DescartesParis, France
| | - Jean-François Meder
- Department of Neuroradiology, Centre Hospitalier Sainte-AnneParis, France; University Paris DescartesParis, France; Imaging Biomarkers of Brain Development and Disorders, INSERM, UMR 894Paris, France
| | - Catherine Oppenheim
- Department of Neuroradiology, Centre Hospitalier Sainte-AnneParis, France; University Paris DescartesParis, France; Imaging Biomarkers of Brain Development and Disorders, INSERM, UMR 894Paris, France
| | - Arnaud Cachia
- University Paris DescartesParis, France; Imaging Biomarkers of Brain Development and Disorders, INSERM, UMR 894Paris, France; Laboratory for the Psychology of Child Development and Education, CNRS, UMR 8240Paris, France; Institut Universitaire de FranceParis, France
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Computational analysis in epilepsy neuroimaging: A survey of features and methods. NEUROIMAGE-CLINICAL 2016; 11:515-529. [PMID: 27114900 PMCID: PMC4833048 DOI: 10.1016/j.nicl.2016.02.013] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 02/11/2016] [Accepted: 02/22/2016] [Indexed: 12/15/2022]
Abstract
Epilepsy affects 65 million people worldwide, a third of whom have seizures that are resistant to anti-epileptic medications. Some of these patients may be amenable to surgical therapy or treatment with implantable devices, but this usually requires delineation of discrete structural or functional lesion(s), which is challenging in a large percentage of these patients. Advances in neuroimaging and machine learning allow semi-automated detection of malformations of cortical development (MCDs), a common cause of drug resistant epilepsy. A frequently asked question in the field is what techniques currently exist to assist radiologists in identifying these lesions, especially subtle forms of MCDs such as focal cortical dysplasia (FCD) Type I and low grade glial tumors. Below we introduce some of the common lesions encountered in patients with epilepsy and the common imaging findings that radiologists look for in these patients. We then review and discuss the computational techniques introduced over the past 10 years for quantifying and automatically detecting these imaging findings. Due to large variations in the accuracy and implementation of these studies, specific techniques are traditionally used at individual centers, often guided by local expertise, as well as selection bias introduced by the varying prevalence of specific patient populations in different epilepsy centers. We discuss the need for a multi-institutional study that combines features from different imaging modalities as well as computational techniques to definitively assess the utility of specific automated approaches to epilepsy imaging. We conclude that sharing and comparing these different computational techniques through a common data platform provides an opportunity to rigorously test and compare the accuracy of these tools across different patient populations and geographical locations. We propose that these kinds of tools, quantitative imaging analysis methods and open data platforms for aggregating and sharing data and algorithms, can play a vital role in reducing the cost of care, the risks of invasive treatments, and improve overall outcomes for patients with epilepsy. We introduce common epileptogenic lesions encountered in patients with drug resistant epilepsy. We discuss state of the art computational techniques used to detect lesions. There is a need for multi-institutional studies that combine these techniques. Clinically validated pipelines alongside the advances in imaging and electrophysiology will improve outcomes.
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Key Words
- DRE, drug resistant epilepsy
- DTI, diffusion tensor imaging
- DWI, diffusion weighted imaging
- Drug resistant epilepsy
- Epilepsy
- FCD, focal cortical dysplasia
- FLAIR, fluid-attenuated inversion recovery
- Focal cortical dysplasia
- GM, gray matter
- GW, gray-white junction
- HARDI, high angular resolution diffusion imaging
- MEG, magnetoencephalography
- MRS, magnetic resonance spectroscopy imaging
- Machine learning
- Malformations of cortical development
- Multimodal neuroimaging
- PET, positron emission tomography
- PNH, periventricular nodular heterotopia
- SBM, surface-based morphometry
- T1W, T1-weighted MRI
- T2W, T2-weighted MRI
- VBM, voxel-based morphometry
- WM, white matter
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Roca P, Mellerio C, Chassoux F, Rivière D, Cachia A, Charron S, Lion S, Mangin JF, Devaux B, Meder JF, Oppenheim C. Sulcus-based MR analysis of focal cortical dysplasia located in the central region. PLoS One 2015; 10:e0122252. [PMID: 25822985 PMCID: PMC4378936 DOI: 10.1371/journal.pone.0122252] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 02/10/2015] [Indexed: 11/29/2022] Open
Abstract
Objective Focal cortical dysplasias (FCDs) are mainly located in the frontal region, with a particular tropism for the central sulcus. Up to 30% of lesions are undetected (magnetic resonance [MR]-negative FCD patients) or belatedly diagnosed by visual analysis of MR images. We propose an automated sulcus-based method to analyze abnormal sulcal patterns associated with central FCD, taking into account the normal interindividual sulcal variability. Methods We retrospectively studied 29 right-handed patients with FCD in the central region (including 12 MR negative histologically-confirmed cases) and 29 right-handed controls. The analysis of sulcal abnormalities from T1-weighted MR imaging (MRI) was performed using a graph-based representation of the cortical folds and an automated sulci recognition system, providing a new quantitative criterion to describe sulcal patterns, termed sulcus energy. Results Group analysis showed that the central sulcus in the hemisphere ipsilateral to the FCD exhibited an abnormal sulcal pattern compared with controls (p = 0.032). FCDs were associated with abnormal patterns of the central sulci compared with controls (p = 0.006), a result that remained significant when MR-negative and MR-positive patients were considered separately, while the effects of sex, age and MR-field were not significant. At the individual level, sulcus energy alone failed to detect the FCD lesion. We found, however, a significant association between maximum z-scores and the site of FCD (p = 0.0046) which remained significant in MR-negative (p = 0.024) but not in MR-positive patients (p = 0.058). The maximum z-score pointed to an FCD sulcus in four MR-negative and five MR-positive patients. Conclusions We identified abnormal sulcal patterns in patients with FCD of the central region compared with healthy controls. The abnormal sulcal patterns ipsilateral to the FCD and the link between sulcus energy and the FCD location strengthen the interest of sulcal abnormalities in FCD patients.
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Affiliation(s)
- Pauline Roca
- Department of Neuroimaging, Sainte-Anne Hospital Center, Université Paris Descartes Sorbonne Paris Cité, Center for Psychiatry & Neurosciences, UMR 894 INSERM, Paris, France
- * E-mail:
| | - Charles Mellerio
- Department of Neuroimaging, Sainte-Anne Hospital Center, Université Paris Descartes Sorbonne Paris Cité, Center for Psychiatry & Neurosciences, UMR 894 INSERM, Paris, France
| | - Francine Chassoux
- Department of Neurosurgery, Sainte-Anne Hospital Center, Université Paris Descartes Sorbonne Paris Cité, Paris, France
| | | | - Arnaud Cachia
- Center for Psychiatry & Neurosciences, Sainte-Anne Hospital Center, UMR 894 INSERM/Université Paris Descartes & Laboratory for the Psychology of Child Development and Education, UMR 8240 CNRS/Université Paris Descartes Sorbonne Paris Cité, Paris, France
| | - Sylvain Charron
- Department of Neuroimaging, Sainte-Anne Hospital Center, Université Paris Descartes Sorbonne Paris Cité, Center for Psychiatry & Neurosciences, UMR 894 INSERM, Paris, France
| | - Stéphanie Lion
- Department of Neuroimaging, Sainte-Anne Hospital Center, Université Paris Descartes Sorbonne Paris Cité, Center for Psychiatry & Neurosciences, UMR 894 INSERM, Paris, France
| | | | - Bertrand Devaux
- Department of Neurosurgery, Sainte-Anne Hospital Center, Université Paris Descartes Sorbonne Paris Cité, Paris, France
| | - Jean-François Meder
- Department of Neuroimaging, Sainte-Anne Hospital Center, Université Paris Descartes Sorbonne Paris Cité, Center for Psychiatry & Neurosciences, UMR 894 INSERM, Paris, France
| | - Catherine Oppenheim
- Department of Neuroimaging, Sainte-Anne Hospital Center, Université Paris Descartes Sorbonne Paris Cité, Center for Psychiatry & Neurosciences, UMR 894 INSERM, Paris, France
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