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Manara R, Fragiacomo F, Ladogana A, Vaianella L, Camporese G, Zorzi G, Vicinanza S, Zanusso G, Pocchiari M, Cagnin A. MRI abnormalities in Creutzfeldt-Jakob disease and other rapidly progressive dementia. J Neurol 2024; 271:300-309. [PMID: 37698615 PMCID: PMC10770193 DOI: 10.1007/s00415-023-11962-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 08/21/2023] [Accepted: 08/21/2023] [Indexed: 09/13/2023]
Abstract
OBJECTIVE To investigate brain MRI abnormalities in a cohort of patients with rapidly progressive dementia (RPD) with and without a diagnosis of Creutzfeldt-Jakob disease (CJD). METHODS One hundred and seven patients with diagnosis of prion disease (60 with definite sCJD, 33 with probable sCJD and 14 with genetic prion disease) and 40 non-prion related RPD patients (npRPD) underwent brain MRI including DWI and FLAIR. MRIs were evaluated with a semiquantitative rating score, which separately considered abnormal signal extent and intensity in 22 brain regions. Clinical findings at onset, disease duration, cerebrospinal-fluid 14-3-3 and t-tau protein levels, and EEG data were recorded. RESULTS Among patients with definite/probable diagnosis of CJD or genetic prion disease, 2/107 had normal DWI-MRI: in one patient a 2-months follow-up DWI-MRI showed CJD-related changes while the other had autopsy-proven CJD despite no DWI abnormalities 282 days after clinical onset. CJD-related cortical changes were detected in all lobes and involvement of thalamus was common. In the npRPD groups, 6/40 patients showed DWI alterations that clustered in three different patterns: (1) minimal/doubtful signal alterations (limbic encephalitis, dementia with Lewy bodies); (2) clearly suggestive of alternative diagnoses (status epilepticus, Wernicke or metabolic encephalopathy); (3) highly suggestive of CJD (mitochondrial disease), though cortical swelling let exclude CJD. CONCLUSIONS In the diagnostic work-up of RPD, negative/doubtful DWI makes CJD diagnosis rather unlikely, while specific DWI patterns help differentiating CJD from alternative diagnoses. The pulvinar sign is not exclusive of the variant form.
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Affiliation(s)
- Renzo Manara
- Department of Neuroscience (DNS), University of Padova, Via Giustiniani 5, 35128, Padua, Italy
- Padova Neuroscience Center, University of Padova, Padua, Italy
| | - Federica Fragiacomo
- Department of Neuroscience (DNS), University of Padova, Via Giustiniani 5, 35128, Padua, Italy
| | - Anna Ladogana
- Department of Neuroscience, Istituto Superiore di Sanità, Rome, Italy
| | - Luana Vaianella
- Department of Neuroscience, Istituto Superiore di Sanità, Rome, Italy
| | - Giulia Camporese
- Department of Neuroscience (DNS), University of Padova, Via Giustiniani 5, 35128, Padua, Italy
| | - Giovanni Zorzi
- Department of Neuroscience (DNS), University of Padova, Via Giustiniani 5, 35128, Padua, Italy
- Padova Neuroscience Center, University of Padova, Padua, Italy
| | | | - Gianluigi Zanusso
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | | | - Annachiara Cagnin
- Department of Neuroscience (DNS), University of Padova, Via Giustiniani 5, 35128, Padua, Italy.
- Padova Neuroscience Center, University of Padova, Padua, Italy.
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2
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Selahi Ö, Kuru Bektaşoğlu P, Hakan T, Firat Z, Güngör A, Çelikoğlu E. Cingulate sulcus morphology and paracingulate sulcus variations: Anatomical and radiological studies. Clin Anat 2023; 36:256-266. [PMID: 36403099 DOI: 10.1002/ca.23981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/04/2022] [Accepted: 11/08/2022] [Indexed: 11/21/2022]
Abstract
The sulci and gyri found across the cerebrum differ in morphology between individuals. The cingulate sulcus is an important landmark for deciding the surgical approach for neighboring pathological lesions. Identifying the anatomical variations of anterior cingulate cortex morphology would help to determine the safe-entry route through neighboring lesions. In this study, magnetic resonance imaging data acquired from 149 healthy volunteers were investigated retrospectively for anatomical variations of the paracingulate sulcus. Also, human cadaveric brain hemispheres were investigated for cingulate and paracingulate sulcus anatomy. All participants had cingulate sulci in both hemispheres (n = 149, 100%). Three types of paracingulate sulcus patterns were identified: "prominent," "present," and "absent." Hemispheric comparisons indicated that the paracingulate sulcus is commonly "prominent" in the left hemisphere (n = 48, 32.21%) and more commonly "absent" in the right hemisphere (n = 73, 48.99%). Ten (6.71%) people had a prominent paracingulate sulcus in both the right and left hemispheres. Seven (4.70%) of them were male, and 3 (2.01%) of them were female. Paracingulate sulci were present in both hemispheres in 19 people (12.75%), of which 9 (6.04%) were male and 10 (6.71%) were female. There were 35 (23.49%) participants without paracingulate sulci in both hemispheres. Eleven (7.38%) were male and 24 (16.11%) were female. There were 73 (48.99%) participants without right paracingulate sulcus and 57 (38.26%) participants without left paracingulate sulcus (p = 0.019). In the examinations of the cadaver hemispheres, the paracingulate sulcus was present and prominent in 25%, and the intralimbic sulcus was present in 15%. It has been observed that the paracingulate sulcus is more prominent in the normal male brain compared to females. In females, there were more participants without paracingulate sulcus. This study shows that there are both hemispheric and sex differences in the anatomy of the paracingulate sulcus. Understanding the cingulate sulcus anatomy and considering the variations in the anterior cingulate cortex morphology during surgery will help surgeons to orient this elegant and complex area.
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Affiliation(s)
- Özge Selahi
- Department of Neurosurgery, University of Health Sciences, Fatih Sultan Mehmet Research and Training Hospital, Istanbul, Turkey
| | | | - Tayfun Hakan
- Department of Neurosurgery, University of Health Sciences, Fatih Sultan Mehmet Research and Training Hospital, Istanbul, Turkey
| | - Zeynep Firat
- Department of Radiology, Yeditepe University School of Medicine, Istanbul, Turkey
| | - Abuzer Güngör
- Department of Neurosurgery, University of Health Sciences, Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Erhan Çelikoğlu
- Department of Neurosurgery, University of Health Sciences, Fatih Sultan Mehmet Research and Training Hospital, Istanbul, Turkey
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3
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Abstract
Limbic encephalitis (LE) is a clinical syndrome defined by subacutely evolving limbic signs and symptoms with structural and functional evidence of mediotemporal damage in the absence of a better explanation than an autoimmune (or paraneoplastic) cause. There are features common to all forms of LE. In recent years, antibody(ab)-defined subtypes have been established. They are distinct regarding underlying pathophysiologic processes, clinical and magnetic resonance imaging courses, cerebrospinal fluid signatures, treatment responsivity, and likelihood of a chronic course. With immunotherapy, LE with abs against surface antigens has a better outcome than LE with abs to intracellular antigens. Diagnostic and treatment challenges are, on the one hand, to avoid overlooking and undertreatment and, on the other hand, to avoid overdiagnoses and overtreatment. LE can be conceptualized as a model disease for the consequences of new onset mediotemporal damage by different mechanisms in adult life. It may be studied as an example of mediotemporal epileptogenesis.
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Affiliation(s)
- Christian G Bien
- Department of Epileptology (Krankenhaus Mara), Bielefeld University, Bielefeld, Germany; Laboratory Krone, Bad Salzuflen, Germany.
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4
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Bizzi A, Pascuzzo R, Blevins J, Grisoli M, Lodi R, Moscatelli MEM, Castelli G, Cohen ML, Schonberger LB, Foutz A, Safar JG, Appleby BS, Gambetti P. Evaluation of a New Criterion for Detecting Prion Disease With Diffusion Magnetic Resonance Imaging. JAMA Neurol 2021; 77:1141-1149. [PMID: 32478816 DOI: 10.1001/jamaneurol.2020.1319] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance Early diagnosis is a requirement for future treatment of prion diseases. Magnetic resonance imaging (MRI) with diffusion-weighted images and improved real-time quaking-induced conversion (RT-QuIC) in cerebrospinal fluid (CSF) have emerged as reliable tests. Objectives To assess the sensitivity and specificity of diffusion MRI for the diagnosis of sporadic Creutzfeldt-Jakob disease (sCJD) with a new criterion (index test) of at least 1 positive brain region among the cortex of the frontal, parietal, temporal, and occipital lobes; the caudate; the putamen; and the thalamus. Design, Setting, and Participants This diagnostic study with a prospective and a retrospective arm was performed from January 1, 2003, to October 31, 2018. MRIs were collected from 1387 patients with suspected sCJD consecutively referred to the National Prion Disease Pathology Surveillance Center as part of a consultation service. Intervention Magnetic resonance imaging. Four neuroradiologists blinded to the diagnosis scored the MRIs of 200 randomly selected patients. One neuroradiologist scored the MRIs of all patients. Main Outcomes and Measures Sensitivity and specificity of the index test compared with currently used criteria and CSF diagnostic (improved RT-QuIC, 14-3-3, and tau CSF tests). Results A total of 872 patients matched the inclusion criteria (diffusion MRI and autopsy-confirmed diagnosis), with 619 having sCJD, 102 having other prion diseases, and 151 having nonprion disease. The primary analysis included 200 patients (mean [SD] age, 63.6 [12.9] years; 100 [50.0%] male). Sensitivity of the index test of 4 neuroradiologists was 90% to 95% and superior to sensitivity of current MRI criteria (69%-76%), whereas specificity was 90% to 100% and unchanged. Interrater reliability of the 4 neuroradiologists was high (κ = 0.81), and individual intrarater reliability was excellent (κ ≥0.87). The sensitivity of the index test of 1 neuroradiologist for 770 patients was 92.1% (95% CI, 89.7%-94.1%) and the specificity was 97.4% (95% CI, 93.4%-99.3%) compared with a sensitivity of 69.8% (95% CI, 66.0%-73.4%; P < .001) and a specificity of 98.0% (95% CI, 94.3%-99.6%; P > .99) according to the current criteria. For 88 patients, index test sensitivity (94.9%; 95% CI, 87.5%-98.6%) and specificity (100%; 95% CI, 66.4%-100%) were similar to those of improved RT-QuIC (86.1% [95% CI, 76.5%-92.8%] and 100% [95% CI, 66.4%-100%], respectively). Lower specificities were found for 14-3-3 and tau CSF tests in 452 patients. Conclusions and Relevance In this study, the diagnostic performance of diffusion MRI with the new criterion was superior to that of current standard criteria and similar to that of improved RT-QuIC. These results may have important clinical implications because MRI is noninvasive and typically prescribed at disease presentation.
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Affiliation(s)
- Alberto Bizzi
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Riccardo Pascuzzo
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Janis Blevins
- National Prion Disease Pathology Surveillance Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Marina Grisoli
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Raffaele Lodi
- Department of Biomedical and Neuromotor Sciences, Università di Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Marco E M Moscatelli
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Gianmarco Castelli
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Mark L Cohen
- National Prion Disease Pathology Surveillance Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.,Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, Ohio.,Department of Neurology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Lawrence B Schonberger
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Aaron Foutz
- National Prion Disease Pathology Surveillance Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jiri G Safar
- Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Brian S Appleby
- National Prion Disease Pathology Surveillance Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.,Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, Ohio.,Department of Neurology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio.,Department of Psychiatry, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Pierluigi Gambetti
- Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, Ohio
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5
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Goodkin O, Pemberton HG, Vos SB, Prados F, Das RK, Moggridge J, De Blasi B, Bartlett P, Williams E, Campion T, Haider L, Pearce K, Bargallό N, Sanchez E, Bisdas S, White M, Ourselin S, Winston GP, Duncan JS, Cardoso J, Thornton JS, Yousry TA, Barkhof F. Clinical evaluation of automated quantitative MRI reports for assessment of hippocampal sclerosis. Eur Radiol 2020; 31:34-44. [PMID: 32749588 PMCID: PMC7755617 DOI: 10.1007/s00330-020-07075-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 05/07/2020] [Accepted: 07/15/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Hippocampal sclerosis (HS) is a common cause of temporal lobe epilepsy. Neuroradiological practice relies on visual assessment, but quantification of HS imaging biomarkers-hippocampal volume loss and T2 elevation-could improve detection. We tested whether quantitative measures, contextualised with normative data, improve rater accuracy and confidence. METHODS Quantitative reports (QReports) were generated for 43 individuals with epilepsy (mean age ± SD 40.0 ± 14.8 years, 22 men; 15 histologically unilateral HS; 5 bilateral; 23 MR-negative). Normative data was generated from 111 healthy individuals (age 40.0 ± 12.8 years, 52 men). Nine raters with different experience (neuroradiologists, trainees, and image analysts) assessed subjects' imaging with and without QReports. Raters assigned imaging normal, right, left, or bilateral HS. Confidence was rated on a 5-point scale. RESULTS Correct designation (normal/abnormal) was high and showed further trend-level improvement with QReports, from 87.5 to 92.5% (p = 0.07, effect size d = 0.69). Largest magnitude improvement (84.5 to 93.8%) was for image analysts (d = 0.87). For bilateral HS, QReports significantly improved overall accuracy, from 74.4 to 91.1% (p = 0.042, d = 0.7). Agreement with the correct diagnosis (kappa) tended to increase from 0.74 ('fair') to 0.86 ('excellent') with the report (p = 0.06, d = 0.81). Confidence increased when correctly assessing scans with the QReport (p < 0.001, η2p = 0.945). CONCLUSIONS QReports of HS imaging biomarkers can improve rater accuracy and confidence, particularly in challenging bilateral cases. Improvements were seen across all raters, with large effect sizes, greatest for image analysts. These findings may have positive implications for clinical radiology services and justify further validation in larger groups. KEY POINTS • Quantification of imaging biomarkers for hippocampal sclerosis-volume loss and raised T2 signal-could improve clinical radiological detection in challenging cases. • Quantitative reports for individual patients, contextualised with normative reference data, improved diagnostic accuracy and confidence in a group of nine raters, in particular for bilateral HS cases. • We present a pre-use clinical validation of an automated imaging assessment tool to assist clinical radiology reporting of hippocampal sclerosis, which improves detection accuracy.
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Affiliation(s)
- Olivia Goodkin
- Centre for Medical Image Computing (CMIC), University College London, London, UK. .,Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, University College London, London, UK.
| | - Hugh G Pemberton
- Centre for Medical Image Computing (CMIC), University College London, London, UK.,Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Sjoerd B Vos
- Centre for Medical Image Computing (CMIC), University College London, London, UK.,Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, University College London, London, UK.,Epilepsy Society MRI Unit, Chalfont St Peter, UK
| | - Ferran Prados
- Centre for Medical Image Computing (CMIC), University College London, London, UK.,Universitat Oberta de Catalunya, Barcelona, Spain
| | - Ravi K Das
- Clinical, Educational and Health Psychology, University College London, London, UK
| | - James Moggridge
- Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, University College London, London, UK.,Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, London, UK
| | - Bianca De Blasi
- Department of Medical Physics and Bioengineering, University College London, London, UK
| | - Philippa Bartlett
- Epilepsy Society MRI Unit, Chalfont St Peter, UK.,Department of Clinical and Experimental Epilepsy, University College London, London, UK
| | - Elaine Williams
- Wellcome Trust Centre for Neuroimaging, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Thomas Campion
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, London, UK
| | - Lukas Haider
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria.,NMR Research Unit, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Kirsten Pearce
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, London, UK
| | - Nuria Bargallό
- Radiology Department, Hospital Clínic de Barcelona and Magnetic Resonance Image Core Facility, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Esther Sanchez
- Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Sotirios Bisdas
- Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, University College London, London, UK.,Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, London, UK
| | - Mark White
- Digital Services, University College London Hospital, London, UK
| | - Sebastien Ourselin
- Department of Medical Physics and Bioengineering, University College London, London, UK.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Gavin P Winston
- Epilepsy Society MRI Unit, Chalfont St Peter, UK.,Department of Clinical and Experimental Epilepsy, University College London, London, UK.,Department of Medicine, Division of Neurology, Queen's University, Kingston, Ontario, Canada
| | - John S Duncan
- Epilepsy Society MRI Unit, Chalfont St Peter, UK.,Department of Clinical and Experimental Epilepsy, University College London, London, UK
| | - Jorge Cardoso
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - John S Thornton
- Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, University College London, London, UK.,Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, London, UK
| | - Tarek A Yousry
- Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, University College London, London, UK.,Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, London, UK
| | - Frederik Barkhof
- Centre for Medical Image Computing (CMIC), University College London, London, UK.,Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, University College London, London, UK.,Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, London, UK.,Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
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6
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Zoccarato M, Valeggia S, Zuliani L, Gastaldi M, Mariotto S, Franciotta D, Ferrari S, Lombardi G, Zagonel V, De Gaspari P, Ermani M, Signori A, Pichiecchio A, Giometto B, Manara R. Conventional brain MRI features distinguishing limbic encephalitis from mesial temporal glioma. Neuroradiology 2019; 61:853-860. [PMID: 31028423 DOI: 10.1007/s00234-019-02212-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/04/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE Radiological hallmark of autoimmune limbic encephalitis (LE) is a hyperintense signal in MRI T2-weighted images of mesial temporal structures. We aimed to identify conventional magnetic resonance imaging (MRI) features that can help distinguish LE from temporal glioma. METHODS Brain MRIs of 25 patients affected by antibody-positive autoimmune LE, 24 patients affected by temporal glioma (tumor group), and 5 negative controls were retrospectively blindly evaluated in random order. RESULTS Ten brain MRIs from the LE group were correctly recognized; one additional patient with mesial temporal hyperintensity with anti-AK5 abs LE was wrongly diagnosed as having a tumor. The brain MRIs of the remaining 14 of the 25 patients with LE were judged negative or, in three cases, showed features not typical for LE. In the tumor group, all MRIs showed pathological alterations diagnosed as tumors in 22/24 cases and as LE in two (2/22, 9%). Unilateral lesions were more common in tumors than in neuroradiologically abnormal LE (96% vs. 18%, p < 0.001). T2/FLAIR hyperintensity of the parahippocampal gyrus was associated more with tumor than with LE (71% vs. 18%) (p = 0,009), as T2/FLAIR hyperintensity of extralimbic structures (p = 0.015), edema (p = 0.041), and mass effect (p = 0.015). Maintenance of gray/white matter distinction was strongly associated with LE (91% vs. 17%, p < 0.001). CONCLUSION Conventional brain MRI is a fundamental tool in the differential diagnosis between LE and glioma. Bilateral involvement and maintenance of gray/white matter distinction at the cortical/subcortical interface are highly suggestive of LE.
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Affiliation(s)
- Marco Zoccarato
- Neurology Unit, AULSS 6 Euganea, Padua, Italy. .,Neuroimmunology Group, Istituto di Ricerca Pediatrica, Padua, Italy.
| | | | - Luigi Zuliani
- Neuroimmunology Group, Istituto di Ricerca Pediatrica, Padua, Italy.,Department of Neurology, Ospedale San Bortolo, AULSS 8 Berica, Vicenza, Italy
| | - Matteo Gastaldi
- Neuroimmunology Laboratory, IRCSS Mondino Foundation, Pavia, Italy
| | - Sara Mariotto
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Diego Franciotta
- Neuroimmunology Laboratory, IRCSS Mondino Foundation, Pavia, Italy
| | - Sergio Ferrari
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Giuseppe Lombardi
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Vittorina Zagonel
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Piera De Gaspari
- Neuroimmunology Group, Istituto di Ricerca Pediatrica, Padua, Italy
| | - Mario Ermani
- Department of Neurosciences (DNS), Statistic and Informatics Unit, School of Medicine, University of Padua, Padua, Italy
| | - Alessio Signori
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Anna Pichiecchio
- Department of Neuroradiology, IRCSS Mondino Foundation, Pavia, Italy
| | - Bruno Giometto
- Department of Neurology, Ospedale Santa Chiara, Trento, Italy
| | - Renzo Manara
- Neuroradiology, Department of Medicine and Surgery, Sezione di Neuroscienze, University of Salerno, Salerno, Italy
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7
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Adler S, Hong SJ, Liu M, Baldeweg T, Cross JH, Bernasconi A, Bernhardt BC, Bernasconi N. Topographic principles of cortical fluid-attenuated inversion recovery signal in temporal lobe epilepsy. Epilepsia 2018; 59:627-635. [PMID: 29383717 DOI: 10.1111/epi.14017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2018] [Indexed: 01/16/2023]
Abstract
OBJECTIVE In drug-resistant temporal lobe epilepsy (TLE), relative to the large number of whole-brain morphological studies, neocortical T2 changes have not been systematically investigated. The aim of this study was to assess the anatomical principles that govern the distribution of neocortical T2-weighted fluid-attenuated inversion recovery (FLAIR) signal intensity and uncover its topographic principles. METHODS Using a surface-based sampling scheme, we mapped neocortical FLAIR intensity of 61 TLE patients relative to 38 healthy controls imaged at 3 T. To address topographic principles of the susceptibility to FLAIR signal changes in TLE, we assessed associations with normative data on tissue composition using 2 complementary approaches. First, we evaluated whether the degree of TLE-related FLAIR intensity changes differed across cytoarchitectonic classes as defined by Von Economo-Koskinas taxonomy. Second, as a proxy to map regions with similar intracortical composition, we carried out a FLAIR intensity covariance paradigm in controls by seeding systematically from all cortical regions, and identified those networks that were the best spatial predictors of the between-group FLAIR changes. RESULTS Increased intensities were observed in bilateral limbic and paralimbic cortices (hippocampus, parahippocampus, cingulate, temporopolar, insular, orbitofrontal). Effect sizes were highest in periallocortical limbic and insular classes as defined by the Von Economo-Koskinas cytoarchitectonic taxonomy. Furthermore, systematic FLAIR intensity covariance analysis in healthy controls revealed that similarity patterns characteristic of limbic cortices, most notably the hippocampus, served as sensitive predictors for the topography of FLAIR hypersignal in patients. FLAIR intensity findings were robust against correction for morphological confounds. Patients with a history of febrile convulsions showed more marked signal changes in parahippocampal and retrosplenial cortices, known to be strongly connected to the hippocampus. SIGNIFICANCE FLAIR intensity mapping and covariance analysis provide a model of TLE gray matter pathology based on shared vulnerability of periallocortical and limbic cortices.
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Affiliation(s)
- Sophie Adler
- NeuroImaging of Epilepsy Laboratory, McConnell Brain Imaging Center, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada.,Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Seok-Jun Hong
- NeuroImaging of Epilepsy Laboratory, McConnell Brain Imaging Center, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Min Liu
- NeuroImaging of Epilepsy Laboratory, McConnell Brain Imaging Center, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Torsten Baldeweg
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - J Helen Cross
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Andrea Bernasconi
- NeuroImaging of Epilepsy Laboratory, McConnell Brain Imaging Center, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Boris C Bernhardt
- NeuroImaging of Epilepsy Laboratory, McConnell Brain Imaging Center, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada.,Multimodal Imaging and Connectome Analysis Laboratory, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Neda Bernasconi
- NeuroImaging of Epilepsy Laboratory, McConnell Brain Imaging Center, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
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8
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Dadar M, Maranzano J, Misquitta K, Anor CJ, Fonov VS, Tartaglia MC, Carmichael OT, Decarli C, Collins DL. Performance comparison of 10 different classification techniques in segmenting white matter hyperintensities in aging. Neuroimage 2017; 157:233-249. [PMID: 28602597 DOI: 10.1016/j.neuroimage.2017.06.009] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 05/30/2017] [Accepted: 06/02/2017] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION White matter hyperintensities (WMHs) are areas of abnormal signal on magnetic resonance images (MRIs) that characterize various types of histopathological lesions. The load and location of WMHs are important clinical measures that may indicate the presence of small vessel disease in aging and Alzheimer's disease (AD) patients. Manually segmenting WMHs is time consuming and prone to inter-rater and intra-rater variabilities. Automated tools that can accurately and robustly detect these lesions can be used to measure the vascular burden in individuals with AD or the elderly population in general. Many WMH segmentation techniques use a classifier in combination with a set of intensity and location features to segment WMHs, however, the optimal choice of classifier is unknown. METHODS We compare 10 different linear and nonlinear classification techniques to identify WMHs from MRI data. Each classifier is trained and optimized based on a set of features obtained from co-registered MR images containing spatial location and intensity information. We further assess the performance of the classifiers using different combinations of MRI contrast information. The performances of the different classifiers were compared on three heterogeneous multi-site datasets, including images acquired with different scanners and different scan-parameters. These included data from the ADC study from University of California Davis, the NACC database and the ADNI study. The classifiers (naïve Bayes, logistic regression, decision trees, random forests, support vector machines, k-nearest neighbors, bagging, and boosting) were evaluated using a variety of voxel-wise and volumetric similarity measures such as Dice Kappa similarity index (SI), Intra-Class Correlation (ICC), and sensitivity as well as computational burden and processing times. These investigations enable meaningful comparisons between the performances of different classifiers to determine the most suitable classifiers for segmentation of WMHs. In the spirit of open-source science, we also make available a fully automated tool for segmentation of WMHs with pre-trained classifiers for all these techniques. RESULTS Random Forests yielded the best performance among all classifiers with mean Dice Kappa (SI) of 0.66±0.17 and ICC=0.99 for the ADC dataset (using T1w, T2w, PD, and FLAIR scans), SI=0.72±0.10, ICC=0.93 for the NACC dataset (using T1w and FLAIR scans), SI=0.66±0.23, ICC=0.94 for ADNI1 dataset (using T1w, T2w, and PD scans) and SI=0.72±0.19, ICC=0.96 for ADNI2/GO dataset (using T1w and FLAIR scans). Not using the T2w/PD information did not change the performance of the Random Forest classifier (SI=0.66±0.17, ICC=0.99). However, not using FLAIR information in the ADC dataset significantly decreased the Dice Kappa, but the volumetric correlation did not drastically change (SI=0.47±0.21, ICC=0.95). CONCLUSION Our investigations showed that with appropriate features, most off-the-shelf classifiers are able to accurately detect WMHs in presence of FLAIR scan information, while Random Forests had the best performance across all datasets. However, we observed that the performances of most linear classifiers and some nonlinear classifiers drastically decline in absence of FLAIR information, with Random Forest still retaining the best performance.
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Affiliation(s)
- Mahsa Dadar
- NeuroImaging and Surgical Tools Laboratory, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada.
| | - Josefina Maranzano
- Magnetic Resonance Studies Laboratory, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada.
| | - Karen Misquitta
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada.
| | - Cassandra J Anor
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada.
| | - Vladimir S Fonov
- NeuroImaging and Surgical Tools Laboratory, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada.
| | - M Carmela Tartaglia
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada.
| | | | | | - D Louis Collins
- NeuroImaging and Surgical Tools Laboratory, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada.
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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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Shiee N, Bazin PL, Cuzzocreo JL, Ye C, Kishore B, Carass A, Calabresi PA, Reich DS, Prince JL, Pham DL. Reconstruction of the human cerebral cortex robust to white matter lesions: method and validation. Hum Brain Mapp 2013; 35:3385-401. [PMID: 24382742 DOI: 10.1002/hbm.22409] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 09/09/2013] [Accepted: 09/15/2013] [Indexed: 11/08/2022] Open
Abstract
Cortical atrophy has been reported in a number of diseases, such as multiple sclerosis and Alzheimer's disease, that are also associated with white matter (WM) lesions. However, most cortical reconstruction techniques do not account for these pathologies, thereby requiring additional processing to correct for the effect of WM lesions. In this work, we introduce CRUISE(+), an automated process for cortical reconstruction from magnetic resonance brain images with WM lesions. The process extends previously well validated methods to allow for multichannel input images and to accommodate for the presence of WM lesions. We provide new validation data and tools for measuring the accuracy of cortical reconstruction methods on healthy brains as well as brains with multiple sclerosis lesions. Using this data, we validate the accuracy of CRUISE(+) and compare it to another state-of-the-art cortical reconstruction tool. Our results demonstrate that CRUISE(+) has superior performance in the cortical regions near WM lesions, and similar performance in other regions.
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Affiliation(s)
- Navid Shiee
- Image Analysis and Communication Laboratory, Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, Maryland; Center for Neuroscience and Regenerative Medicine, Henry M. Jackson Foundation for Advancement of Military Medicine, Bethesda, Maryland
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11
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Doyle-Thomas KAR, Kushki A, Duerden EG, Taylor MJ, Lerch JP, Soorya LV, Wang AT, Fan J, Anagnostou E. The effect of diagnosis, age, and symptom severity on cortical surface area in the cingulate cortex and insula in autism spectrum disorders. J Child Neurol 2013; 28:732-9. [PMID: 22832774 DOI: 10.1177/0883073812451496] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Functional activity in the anterior cingulate cortex and insula has been reported to be abnormal during social tasks in autism spectrum disorders. However, few studies have examined surface morphometry in these regions and how this may be related to autism spectrum disorder symptomatology. In this study, 27 individuals with autism spectrum disorders and 25 controls between the ages of 7 to 39 years underwent structural magnetic resonance imaging. Our primary analysis examined differences in surface area in the cingulate and insula, between individuals with and without autism spectrum disorders, as well as age-related changes and associations with social impairments. Surface area in the right cingulate was significantly different between groups and decreased more rapidly with age in autism spectrum disorder participants. In addition, greater surface area in the insula and isthmus was associated with poorer social behaviors. Results suggest atypical surface morphometry in brain regions involved in social function, which appeared to be related to poorer social ability scores.
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Affiliation(s)
- Krissy A R Doyle-Thomas
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
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12
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Letourneau-Guillon L, Wada R, Kucharczyk W. Imaging of prion diseases. J Magn Reson Imaging 2012; 35:998-1012. [PMID: 22499277 DOI: 10.1002/jmri.23504] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Prion diseases are caused by self-replicating proteins that induce lethal neurodegenerative disorders. In the last decade, the understanding of the different clinical, pathological, and neuroimaging phenotypes of this group of disorders has evolved paralleling the advances in prion molecular biology. From an imaging standpoint, the implementation of diffusion-weighted imaging in routine practice has markedly facilitated the detection of prion diseases, especially Creutzfeldt-Jakob. Less frequent prion-related disorders, including genetic diseases, may also benefit from progresses in the field of quantitative diffusion-weighted imaging, MR spectroscopy or molecular imaging. Herein, we present a review of the neuroimaging features of the prion disorders known to affect humans emphasizing the important contribution of MRI in the diagnosis of this group of disorders.
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Affiliation(s)
- Laurent Letourneau-Guillon
- Department of Diagnostic Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada.
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13
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14
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Willemse RB, Pouwels PJW, Barkhof F, Vandertop WP. Localisation of the central sulcus region in glioma patients with three-dimensional fluid-attenuated inversion recovery and volume rendering: comparison with functional and conventional magnetic resonance. Br J Neurosurg 2010; 25:210-7. [PMID: 20979436 DOI: 10.3109/02688697.2010.522742] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Volume rendering (VR) of three-dimensional (3D) fluid-attenuated inversion recovery (FLAIR) magnetic resonance (MR) images shows regional intensity differences, reflecting the central sulcus (CS) region and occipital cortex. The purpose of this study was to determine whether 3D FLAIR with VR could be used as an alternative method to localise the CS region in comparison with functional and conventional MR-imaging in patients with perirolandic glioma. METHODS Eleven patients with intracranial gliomas were studied with single-slab 3D FLAIR including VR and conventional T1-weighted imaging. In all patients, preoperative functional magnetic resonance imaging (fMRI) was performed with a motor paradigm of the hand. The hypo-intense central gyri on 3D FLAIR with VR were interpreted as the CS area. Localisation of the motor hand knob on anatomical images and fMRI results were used for identification of the primary motor cortex. RESULTS Anatomical localisation of the motor hand knob on T1-weighted images was possible in 91% of both hemispheres. In 73% of the affected hemispheres (AH) and 91% of the unaffected hemispheres (UH) the hand knob and CS region could be identified on 3D FLAIR axial and VR images, respectively. With one exception, fMRI activation confirmed the CS region as observed with 3D FLAIR with VR. CONCLUSIONS Volume rendering of 3D FLAIR MR images shows central hypo-intensities frequently corresponding with the CS region. Two-dimensional localisation of the CS region on conventional T1-weighted images and fMRI seems favourable compared to 3D FLAIR. However, in selected cases, especially where fMRI is not possible or feasible, volume rendering with 3D FLAIR may enhance the 3D visualisation of gliomas in relation to the CS region which can be used as an alternative method in the presurgical structural and functional evaluation of neurosurgical patients.
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Affiliation(s)
- Ronald B Willemse
- Department of Neurosurgery, VU University Medical Centre, Amsterdam, The Netherlands.
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15
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Machino Y, Nakayama S, Takashima S, Tomimoto H. [A case of superficial siderosis with repeated episodes of epilepsy]. Rinsho Shinkeigaku 2010; 50:108-10. [PMID: 20196493 DOI: 10.5692/clinicalneurol.50.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report a patient with superficial siderosis that repeated episodes of epilepsy. The patient was a 62-year-old male, and underwent an operation for the tumor of the spinal cord at 22 years of age. He had become deaf at 50 years of age, and repeated loss of consciousness at 59 years of age and later. Neurological examination revealed cerebellar ataxia and bilateral sensorineural deafness in addition to paraplegia, which was caused by the spinal cord tumor. Brain MRI showed low intensity rim around the brain stem, cerebellar hemisphere, and inferior aspects of the temporal and frontal lobes, being consistent with superficial siderosis. Hemosiderin deposition for an extended period was considered to contribute to the pathogenesis of epilepsy.
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16
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Clinical MRI in children and adults with focal epilepsy: a critical review. Epilepsy Behav 2009; 15:40-9. [PMID: 19236945 DOI: 10.1016/j.yebeh.2009.02.032] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Accepted: 02/19/2009] [Indexed: 11/21/2022]
Abstract
Hippocampal sclerosis in adults and focal cortical dysplasia in children with epilepsy are frequent lesions, but they are overlooked on standard MRI. Errors in the interpretation of MRI in epilepsy can be attributed mainly to poor technique and perceptual misses, but incomplete knowledge and poor judgment are also possible sources. This review covers what to expect in structural MRI of an adult patient with mesial temporal lobe epilepsy (TLE) and how to find hippocampal sclerosis (HS). It also covers the clinical MRI-based detection of focal cortical dysplasia (FCD) in extratemporal lobe epilepsy, mainly in children. In a stepwise approach, first, a typical epilepsy MRI protocol at 1.5 T includes axial and coronal fluid-attenuated inversion recovery (FLAIR) imaging, T2- and T2 *-weighted images, and a T1-weighted, three-dimensional volume acquisition. Advanced MR techniques (quantitation, new contrasts like diffusion, MR spectroscopy, high-contrast high-resolution imaging on high-field MR scanners > or = 3 T) are used to increase the method's sensitivity to detect a lesion in an individual patient. Exploiting increased sensitivity, we can avoid false-positive results in the light of a clinical hypothesis, possibly isolating a localized brain area by seizure semiology and EEG prior to MR reading.
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17
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Signal intensity of motor and sensory cortices on T2-weighted and FLAIR images: intraindividual comparison of 1.5T and 3T MRI. Eur Radiol 2008; 18:2949-55. [DOI: 10.1007/s00330-008-1069-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2006] [Revised: 04/29/2008] [Accepted: 05/03/2008] [Indexed: 11/25/2022]
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Fulbright RK, Hoffmann C, Lee H, Pozamantir A, Chapman J, Prohovnik I. MR imaging of familial Creutzfeldt-Jakob disease: a blinded and controlled study. AJNR Am J Neuroradiol 2008; 29:1638-43. [PMID: 18635614 DOI: 10.3174/ajnr.a1217] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The E200K mutation of the PRNP (prion protein) gene is the most common cause of familial Creutzfeldt-Jakob disease (fCJD), which has imaging and clinical features that are similar to the sporadic form. The purpose of this study was to conduct a controlled and blinded evaluation of the sensitivity and specificity of MR imaging in this unique population. MATERIALS AND METHODS We compared the MR imaging characteristics of 15 early stage familial CJD patients (age, 60 +/- 7 years) with a group of 22 healthy subjects from the same families (age, 61 +/- 8 years). MR imaging included diffusion-weighted imaging (DWI), T2-weighted fast spin-echo imaging, and a fluid-attenuated inversion recovery (FLAIR) sequence. The scans were rated for abnormalities by an experienced neuroradiologist blind to diagnosis, group assignment, age, and sex. RESULTS Thirteen of 15 fCJD subjects had abnormal MR imaging. FLAIR signal intensity abnormality in the caudate or putamen nuclei demonstrated a sensitivity of 87% and specificity of 91%. DWI abnormality in the caudate nucleus showed a sensitivity of 73% and a specificity of 100%. Abnormalities in the thalamus (6 patients), cingulate gyrus (6 patients), frontal lobes (4 patients), and occipital lobes (3 patients) were best detected with DWI. No signal intensity abnormalities were demonstrated in the cerebellum. T2-weighted and T1-weighted sequences were uninformative. CONCLUSIONS FLAIR and DWI abnormalities in the caudate nucleus and putamen offer the best sensitivity and specificity for diagnosing fCJD. Our findings support recent recommendations that MR imaging should be added to the diagnostic evaluation of CJD.
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Affiliation(s)
- R K Fulbright
- Department of Radiology, Yale University School of Medicine, New Haven, CT 06520- 8043, USA.
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19
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Roosendaal SD, Moraal B, Vrenken H, Castelijns JA, Pouwels PJ, Barkhof F, Geurts JJ. In vivo MR imaging of hippocampal lesions in multiple sclerosis. J Magn Reson Imaging 2008; 27:726-31. [DOI: 10.1002/jmri.21294] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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20
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Asao C, Hirai T, Yoshimatsu S, Matsukawa T, Imuta M, Sagara K, Yamashita Y. Human cerebral cortices: signal variation on diffusion-weighted MR imaging. Neuroradiology 2007; 50:205-11. [PMID: 18058093 DOI: 10.1007/s00234-007-0327-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2007] [Accepted: 10/05/2007] [Indexed: 11/29/2022]
Abstract
INTRODUCTION We have often encountered high signal intensity (SI) of the cingulate gyrus and insula during diffusion-weighted magnetic resonance imaging (DW-MRI) on neurologically healthy adults. To date, cortical signal heterogeneity on DW images has not been investigated systematically. The purpose of our study was to determine whether there is regional signal variation in the brain cortices of neurologically healthy adults on DW-MR images. METHODS The SI of the cerebral cortices on DW-MR images at 1.5 T was evaluated in 50 neurologically healthy subjects (34 men, 16 women; age range 33-84 years; mean age 57.6 years). The cortical SI in the cingulate gyrus, insula, and temporal, occipital, and parietal lobes was graded relative to the SI of the frontal lobe. Contrast-to-noise ratios (CNRs) on DW-MR images were compared for each cortical area. Diffusion changes were analyzed by visually assessment of the differences in appearance among the cortices on apparent diffusion coefficient (ADC) maps. RESULTS Increased SI was frequently seen in the cingulate gyrus and insula regardless of patient age. There were no significant gender- or laterality-related differences. The CNR was significantly higher in the cingulate gyrus and insula than in the other cortices (p< .01) , and significant differences existed among the cortical regions (p< .001). There were no apparent ADC differences among the cortices on ADC maps. CONCLUSION Regional signal variation of the brain cortices was observed on DW-MR images of healthy subjects, and the cingulate gyrus and insula frequently manifested high SI. These findings may help in the recognition of cortical signal abnormalities as visualized on DW-MR images.
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Affiliation(s)
- Chiaki Asao
- Department of Radiology, Kumamoto Regional Medical Center, 5-16-10 Honjo, Kumamoto 860-0811, Japan.
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Tschampa HJ, Kallenberg K, Kretzschmar HA, Meissner B, Knauth M, Urbach H, Zerr I. Pattern of cortical changes in sporadic Creutzfeldt-Jakob disease. AJNR Am J Neuroradiol 2007; 28:1114-8. [PMID: 17569970 PMCID: PMC8134134 DOI: 10.3174/ajnr.a0496] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE High cortical signal intensity on diffusion-weighted (DW) or fluid-attenuated inversion recovery (FLAIR) images is increasingly described in sporadic Creutzfeldt-Jakob disease (sCJD). The aim of this study was to assess the extent and location of high cortical signal intensity, to investigate whether DW or FLAIR is superior in showing changes in cortical signal intensity, and to find out whether the distribution of the signal intensity changes is random or follows a common pattern. MATERIALS AND METHODS We analyzed FLAIR and DW MR imaging scans of 39 patients with sCJD for hyperintense cortical signal intensity. We compared the sensitivity of the DW and FLAIR scans. We correlated the extent and location of the cortical signal intensity changes with concomitant changes in deep gray matter and the genotype of codon 129 of the prion protein gene. RESULTS There was high signal intensity in the insula, the cingulate gyrus, and the superior frontal gyrus in 95%. The cortical areas near the midline also frequently showed the abnormal signal intensity (precuneus 87%, paracentral lobe 77%). The precentral and postcentral gyri were affected less frequently (41% and 28%, respectively). The DW MR imaging showed the cortical changes more effectively than FLAIR. There was no correlation between the distribution of changes and additional signal alterations in deep gray matter or the genotype of codon 129. CONCLUSION The distribution of cortical signal intensity abnormalities in patients with sCJD follows a common pattern, affecting mainly the cortical areas near the midline, the insula, cingulum, and the superior frontal cortex. DW imaging is superior to FLAIR in the detection of cortical high signal intensity.
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Affiliation(s)
- H J Tschampa
- Department of Radiology, Friedrich-Wilhelms University of Bonn, Germany.
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Schneider JF, Vergesslich K. Maturation of the limbic system revealed by MR FLAIR imaging. Pediatr Radiol 2007; 37:351-5. [PMID: 17325825 DOI: 10.1007/s00247-007-0415-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2006] [Revised: 01/08/2007] [Accepted: 01/11/2007] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cortical signal intensity (SI) of the limbic system in adults is known to be higher than in neocortical structures, but time-related changes in SI during childhood have not been described. OBJECTIVE To detect maturation-related SI changes within the limbic system using a fluid-attenuated inversion recovery (FLAIR) MR sequence. MATERIALS AND METHODS Twenty children (10 boys, 10 girls; age 3.5-18 years, mean 11.2 years) with no neurological abnormality and normal MR imaging examination were retrospectively selected. On two coronal FLAIR slices, ten regions of interest (ROI) with a constant area of 10 mm2 were manually placed in the archeocortex (hippocampus), periarcheocortex (parahippocampal gyrus, subcallosal area, cingulate gyrus) and in the neocortex at the level of the superior frontal gyrus on both sides. RESULTS Significant SI gradients were observed with a higher intensity in the archeocortex, intermediate intensity in the periarcheocortex and low intensity in the neocortex. Significant higher SI values in hippocampal and parahippocampal structures were detected in children up to 10 years of age. CONCLUSION These differences mainly reflected differences in cortical structure and myelination state. Archeocortical structures especially showed significant age-related intensity progression suggesting ongoing organization and/or myelination until early adolescence.
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Affiliation(s)
- Jacques Frédéric Schneider
- Department of Paediatric Radiology, University Children's Hospital UKBB, Römergasse 8, Basel, 4058, Switzerland.
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Affiliation(s)
- V Rajmohan
- Elite Mission Hospital, Trichur, Kerala, India
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Tschampa HJ, Zerr I, Urbach H. Radiological assessment of Creutzfeldt-Jakob disease. Eur Radiol 2006; 17:1200-11. [PMID: 17093966 DOI: 10.1007/s00330-006-0456-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2006] [Revised: 07/26/2006] [Accepted: 08/25/2006] [Indexed: 11/30/2022]
Abstract
Creutzfeldt-Jakob disease is a rare fatal neurodegenerative disorder, characterized by rapidly progressive dementia and neurological signs. There is a need for early and accurate clinical diagnosis in order to exclude any treatable disorder. Additionally, it is of public interest to differentiate the sporadic form of the disease from the variant CJD type (vCJD), which is probably transmitted from cattle infected with bovine spongiform encephalopathy (BSE). High signal in the striatum on T2-weighted, FLAIR and diffusion weighted (DW) MRI as well as cortical high signal in FLAIR and DW MRI are the classical findings in sCJD. The "pulvinar sign", defined as high signal in the pulvinar thalami that is brighter than potential additional high signal in the basal ganglia, is considered pathognomonic for vCJD.
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Affiliation(s)
- Henriette J Tschampa
- Department of Radiology, University of Bonn, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany.
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Pouwels PJW, Kuijer JPA, Mugler JP, Guttmann CRG, Barkhof F. Human gray matter: feasibility of single-slab 3D double inversion-recovery high-spatial-resolution MR imaging. Radiology 2006; 241:873-9. [PMID: 17053197 DOI: 10.1148/radiol.2413051182] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The purpose of this study was to develop and prospectively evaluate the feasibility of a single-slab three-dimensional (3D) double inversion-recovery, or DIR, sequence for magnetic resonance imaging at 1.5 T. The study was approved by the local ethics committee, and informed consent was obtained from six healthy control subjects (one woman, five men; age range, 26-47 years) and two patients with multiple sclerosis (one woman, aged 39; one man, aged 56). Gray matter (GM)-only images were obtained by selectively suppressing cerebrospinal fluid (CSF) and white matter (WM) signals. Whole-brain high-spatial-resolution 3D images (1.2 x 1.2 x 1.3 mm) were acquired within 10 minutes. Cortical and deep GM structures were clearly delineated from WM and CSF, and there were regional differences in GM signal intensity. No flow artifacts from blood or CSF were observed. These GM images with high spatial resolution are suitable to identify cortical pathologic conditions and can potentially be used for segmentation purposes to determine cortical thickness or volume.
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Affiliation(s)
- Petra J W Pouwels
- MS Research Center, Department of Physics and Medical Technology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands.
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Vattipally VR, Bronen RA. MR Imaging of Epilepsy: Strategies for Successful Interpretation. Magn Reson Imaging Clin N Am 2006; 14:225-47. [PMID: 16873012 DOI: 10.1016/j.mric.2006.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
MR imaging plays a pivotal role in the evaluation of patients with epilepsy. With its high spatial resolution, excellent inherent soft tissue contrast, multiplanar imaging capability, and lack of ionizing radiation, MR imaging has emerged as a versatile diagnostic tool in the evaluation of patients with epilepsy. MR imaging not only identifies specific epileptogenic substrates but also determines specific treatment and predicts prognosis. Employing appropriate imaging protocols and reviewing the images in a systematic manner helps in the identification of subtle epileptogenic structural abnormalities. With future improvements in software, hardware, and post-processing methods, MR imaging should be able to throw more light on epileptogenesis and help physicians to better understand its structural basis.
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Urbach H, Soeder BM, Jeub M, Klockgether T, Meyer B, Bien CG. Serial MRI of limbic encephalitis. Neuroradiology 2006; 48:380-6. [PMID: 16586118 DOI: 10.1007/s00234-006-0069-0] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2005] [Accepted: 01/11/2006] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The aim of the study was to analyze serial magnetic resonance imaging (MRI) scans in patients with various forms of limbic encephalitis (LE) in order to evaluate whether, and at what time point, MRI findings support the diagnosis of LE. METHODS Serial MRI scans (1 day to 15 years after the onset of symptoms) of 20 patients with LE were retrospectively evaluated. Of these 20 patients, 16 had definite LE (histopathological limbic inflammation, n=6; onconeural antibodies, n=5; voltage-gated potassium channel antibodies, n=3; malignant tumors, n=5), and 4 possible LE because they met the clinical criteria but had no typical antibodies or tumors. RESULTS Of 13 patients who were studied with MRI within 3 months after the onset of symptoms, 11 had swollen temporomesial structures (unilateral, n=7; bilateral, n=4). After up to 9 months, the swelling had resolved in nine of ten re-evaluated patients. Of seven patients who were initially studied with MRI more than 3 months after disease onset, three had swollen temporomesial structures, one had a hyperintense, normal-sized hippocampus, and three had hyperintense and atrophic temporomesial structures. CONCLUSION LE starts as an acute disease with uni- or bilateral swollen temporomesial structures that are hyperintense on fluid attenuation inversion recovery and T2-weighted sequences. Swelling and hyperintensity may persist over months to years, but in most cases progressive temporomesial atrophy develops.
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Affiliation(s)
- Horst Urbach
- Department of Radiology, University of Bonn Medical Center, Sigmund Freud Str. 25, 53105 Bonn, Germany.
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Asao C, Hirai T, Imuta M, Okuda T, Goto Y, Hamaguchi M, Sagara K, Korogi Y, Yamashita Y. Signal intensity of the normal pontine tegmentum on T2-weighted MR imaging. Neuroradiology 2006; 48:166-70. [PMID: 16463031 DOI: 10.1007/s00234-005-0035-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2005] [Accepted: 10/28/2005] [Indexed: 11/24/2022]
Abstract
On T2-weighted MR images, the pontine tegmentum frequently shows a signal of high intensity in neurologically healthy individuals. We examined whether the signal intensity of the pontine tegmentum normally differs from that of the pontine base. We evaluated the signal intensity of the pontine tegmentum and pontine base on T2-weighted images from 38 neurologically healthy subjects. The subjects included 29 adults (16 males and 13 females, age range 23-48 years, mean age 39.5 years) and 9 children (4 boys and 5 girls (age range 4-9 years mean age 6.5 years). We compared the contrast-to-noise ratio (CNR) between the tegmentum and the base in the upper pons, midpons and lower pons, and evaluated the signal intensity ratio of the tegmentum to the base. The CNR was significantly higher for the tegmentum than the base at each level of the pons (P<0.0001), and the signal intensity ratio of the tegmentum to the base in the upper pons was significantly higher in children than in adults (P<0.005). On T2-weighted images, a high signal intensity of the pontine tegmentum is frequently seen in neurologically healthy subjects. This finding should not be considered abnormal, particularly in children.
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Affiliation(s)
- Chiaki Asao
- Department of Radiology, Kumamoto Regional Medical Center, Japan.
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Abstract
Imaging of epilepsy patients is challenging, since epileptogenic lesions (defined as structural lesions causally related to the epilepsy syndrome) may be small and often do not change during life. Prior clinical information about the epilepsy syndrome and the semiology of the seizures is needed in order to plan the examination properly. The effort to detect an epileptogenic lesion is directed to partial (focal) epilepsy syndromes whereas--by definition--no lesion is identified in idiopathic epilepsies. Most patients with partial epilepsies suffer from mesial temporal lobe epilepsies. In these patients, 2- to 3-mm-thick T2-weighted and fluid-attenuated inversion-recovery (FLAIR) fast spin echo slices along or perpendicular to the temporal lobe length axis have the highest diagnostic efficacy. In contrast, in patients with extratemporal lobe epilepsies perpendicular FLAIR slices through the anatomic region, from which, due to clinical and EEG criteria, the seizures are likely to originate, are preferred. The imaging features of common epileptogenic lesions (hippocampal sclerosis, long-term epilepsy-associated tumours, focal cortical dysplasias, vascular malformations, encephalitis including limbic and Rasmussen's encephalitis, gyral scarring including ulegyria) are detailed in the second section of this paper.
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Affiliation(s)
- H Urbach
- Department of Radiology/Neuroradiology, University of Bonn Medical Center, Sigmund Freud Str. 25, 53105, Bonn, Germany.
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Karaarslan E, Arslan A. ROI measurement of the signal intensity of precentral cortex in the normal brain. Eur J Radiol 2004; 52:221-3. [PMID: 15544898 DOI: 10.1016/j.ejrad.2004.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2004] [Revised: 04/05/2004] [Accepted: 04/08/2004] [Indexed: 12/13/2022]
Abstract
OBJECTIVE It has recently been described that perirolandic cortex generally had a low signal intensity (SI) in neurologically normal brain. The aim of this study was to confirm this finding by an objective quantitative study. MATERIALS AND METHODS Turbo fluid attenuated inversion recovery (FLAIR) magnetic resonance (MR) images of 24 neurologically normal patients were evaluated retrospectively. Signal intensity measurements of the precentral and superior frontal cortices (SFCs) were obtained at a manually traced irregular region-of-interest (ROI). t-Test for paired samples was used to evaluate the significance of differences between signal intensity measurements. RESULTS Mean signal intensities of precentral and superior frontal cortices were 349.5 and 380.7, respectively, on the right, and 351.7 and 374.1 on the left hemisphere. The difference between the mean signal intensities of the side-matched precentral and superior frontal cortices was statistically significant (P < 0.001). CONCLUSION Low signal intensity of the precentral cortex (PCC) in normal brain on turbo FLAIR images is an objective finding, confirmed by ROI measurement.
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Vattipally VR, Bronen RA. MR imaging of epilepsy: strategies for successful interpretation. Neuroimaging Clin N Am 2004; 14:349-72. [PMID: 15324853 DOI: 10.1016/j.nic.2004.04.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
MR imaging plays a pivotal role in the evaluation of patients with epilepsy. With its high spatial resolution, excellent inherent soft tissue contrast,multiplanar imaging capability, and lack of ionizing radiation, MR imaging has emerged as a versatile diagnostic tool in the evaluation of patients with epilepsy. MR imaging not only identifies specific epileptogenic substrates but also determines specific treatment and predicts prognosis. Employing appropriate imaging protocols and reviewing the images ina systematic manner helps in the identification of subtle epileptogenic structural abnormalities. With future improvements in software, hardware, and post-processing methods, MR imaging should be able to throw more light on epileptogenesis and help physicians to better understand its structural basis.
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Bendersky M, Rugilo C, Kochen S, Schuster G, Sica REP. Magnetic resonance imaging identifies cytoarchitectonic subtypes of the normal human cerebral cortex. J Neurol Sci 2003; 211:75-80. [PMID: 12767501 DOI: 10.1016/s0022-510x(03)00086-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Magnetic Resonance Imaging (MRI) allows a detailed "in vivo" macroscopic study of the human brain; previously, it has been demonstrated that Fluid Attenuated Inversion Recovery (FLAIR) sequence shows higher signal intensity of cortices belonging to limbic structures. PURPOSE To measure and compare signal intensities (SI) of cytoarchitectonically different cortical regions. METHODS In 22 adult subjects, without psychiatric or neurological diseases, FLAIR sequence was performed in coronal slices, perpendicular to the main hippocampal axis. Signal intensity was measured, with a region-of-interest (ROI) function, in 12 different cortical regions. We compared these values and grouped the cortices into five groups: (1) limbic cortices, (2) paralimbic agranular cortices, (3) paralimbic granular cortices, (4) parietal-type neopallium, (5) frontal-type neopallium. A t-test for comparison of paired samples was performed, considering p</=0.05 as statistically significant. RESULTS We found statistically significant differences amongst the different groups, with the exception of groups 1 and 2, which did not show differences between them. No statistically significant differences were found among cortices belonging to the same group. CONCLUSION Structural characteristics of the cerebral cortex cause changes in its signal intensity. Magnetic resonance imaging (FLAIR sequence) allows discrimination of different cytoarchitectonic areas of the human cerebral cortex.
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Affiliation(s)
- Mariana Bendersky
- Science and Technology Department, (UBACYT) Buenos Aires University, Paraguay 2155, Buenos Aires, Argentina.
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Karaarslan E, Arslan A. Perirolandic cortex of the normal brain: low signal intensity on turbo FLAIR MR images. Radiology 2003; 227:538-41. [PMID: 12663824 DOI: 10.1148/radiol.2272020311] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the signal intensity (SI) characteristics of the perirolandic cortex (PRC) in the neurologically normal population on turbo fluid-attenuated inversion-recovery (FLAIR) magnetic resonance (MR) images. MATERIALS AND METHODS Turbo FLAIR MR images of 112 neurologically normal patients were evaluated retrospectively. SI of the PRC was graded by consensus of both authors as isointense (grade 0), mildly hypointense (grade 1), or definitely hypointense (grade 2) when compared to the SI of the superior frontal cortex. Kolmogorov-Smirnov and Kruskal-Wallis one-way analysis of variance tests were used for the statistical analysis of the differences in grades between the two sexes and between the age groups, respectively. RESULTS PRC was isointense (grade 0) in six (5%) and hypointense (grade 1 or 2) in 106 (95%) of 112 patients. The difference in grades was statistically significant between age groups (P <.001). Grade 0 was encountered most often in older patients and grade 2 in younger patients. There was no significant difference in grades between age-matched groups of male and female patients (P =.66). CONCLUSION On turbo FLAIR images the PRC generally has a low SI in the neurologically normal brain, and this helps as an additional landmark in identifying the sensorimotor cortex.
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Affiliation(s)
- Ercan Karaarslan
- Department of Radiology, Intermed Medical Center, Istanbul, Turkey.
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Jack CR, O'Brien PC, Rettman DW, Shiung MM, Xu Y, Muthupillai R, Manduca A, Avula R, Erickson BJ. FLAIR histogram segmentation for measurement of leukoaraiosis volume. J Magn Reson Imaging 2001; 14:668-76. [PMID: 11747022 PMCID: PMC2755497 DOI: 10.1002/jmri.10011] [Citation(s) in RCA: 135] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The purposes of this study were to develop a method to measure brain and white matter hyperintensity (leukoaraiosis) volume that is based on the segmentation of the intensity histogram of fluid-attenuated inversion recovery (FLAIR) images and to assess the accuracy and reproducibility of the method. Whole-head synthetic image phantoms with manually introduced leukoaraiosis lesions of varying severity were constructed. These synthetic image phantom sets incorporated image contrast and anatomic features that mimicked leukoaraiosis found in real life. One set of synthetic image phantoms was used to develop the segmentation algorithm (FLAIR-histoseg). A second set was used to measure its accuracy. Test retest reproducibility was assessed in 10 elderly volunteers who were imaged twice. The mean absolute error of the FLAIR-histoseg method was 6.6% for measurement of leukoaraiosis volume and 1.4% for brain volume. The mean test retest coefficient of variation was 1.4% for leukoaraiosis volume and 0.3% for brain volume. We conclude that the FLAIR-histoseg method is an accurate and reproducible method for measuring leukoaraiosis and whole-brain volume in elderly subjects.
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Affiliation(s)
- C R Jack
- Department of Radiology, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
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Abstract
Magnetic resonance imaging (MRI) is the radiological investigation of choice for the evaluation of patients with epilepsy. It is able to detect and characterize the structural origin of seizures, and significantly influences treatment planning and prognosis. The indications for MRI, protocols used for MRI in epilepsy and the relevant imaging anatomy are discussed. The major categories of epileptogenic lesions which result in chronic seizures are reviewed and illustrated. Mesial temporal sclerosis is emphasized, reflecting its major importance as a cause of medically intractable epilepsy. The role of MRI in the planning and assessment of epilepsy surgery is considered.
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Affiliation(s)
- S E Connor
- Department of Neuroradiology, King's College Hospital, London, UK.
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Okujava MV, Woermann FG. Evaluation of the human limbic lobe. Radiology 2001; 220:555-6. [PMID: 11477270 DOI: 10.1148/radiology.220.2.r01au48555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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