Focal cortical dysplasia type IIa and IIb: MRI aspects in 118 cases proven by histopathology

Colombo, Nadia; Tassi, Laura; Deleo, Francesco; Citterio, Alberto; Bramerio, Manuela; Mai, Roberto; Sartori, Ivana; Cardinale, Francesco; Russo, Giorgio Lo; Spreafico, Roberto

doi:10.1007/s00234-012-1049-1

Cited by 134 publications

(119 citation statements)

References 27 publications

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“…Transmantle signal changes are a useful predictor of Type II CD, 22 and IIb CD specifically. 2,7 We also found transmantle signal changes to be a specific finding in Type II CD but did not distinguish Type II subtypes in our analysis. Colombo et al 7 found transmantle signal changes in 83% of Type IIb CD compared with 26% of Type IIa CD (statistically significant [p < 0.05]).…”

Section: Comparison Of Mri Features and Pathological Findingsmentioning

confidence: 47%

“…Evaluating the data reported by Krsek et al 16 also demonstrates a higher prevalence of gray matter signal changes in Type IIb (71%) than in Type IIa CD (48%) in children, but this difference was not statistically significant. Colombo et al, 7 assessing a mixed but predominately adult population, found increased gray matter signal in 20% of Type IIb, as compared with 6% of Type IIa CD (also not statistically significant). The cause for the increased prevalence in our study is uncertain; however, 3D 1-mm isotropic T2-weighted FLAIR sequences and predominately 3-T images were used and this differs from most prior studies.…”

Section: Comparison Of Mri Features and Pathological Findingsmentioning

confidence: 91%

“…The cause for the increased prevalence in our study is uncertain; however, 3D 1-mm isotropic T2-weighted FLAIR sequences and predominately 3-T images were used and this differs from most prior studies. 6,7,16,22 Interestingly, Wagner et al, 32 in a selected group of 50 predominately adult patients with Type IIb CD (82% lesional), found increased cortical signal in 90% of their patients, 40% of whom underwent 3-T imaging, some with 3D T2-weighted FLAIR sequences. The etiology of this finding is uncertain but may be related to gliosis, cell density, or potentially seizure-related edema.…”

Section: Comparison Of Mri Features and Pathological Findingsmentioning

confidence: 99%

“…5,7,19,22 These included abnormal sulcal/gyral pattern, abnormal white matter signal, abnormal gray matter signal, cortical thickening, blurred gray matter-white matter junction, "transmantle" (that is, extending to the ventricular margin) subcortical signal changes, 2,7 and localized volume loss. An MRI score was calculated for each resection region (range 0-7) giving 1 point for each MRI feature identified.…”

Section: Mri Technique and Evaluationmentioning

confidence: 99%

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Magnetic resonance imaging abnormalities in the resection region correlate with histopathological type, gliosis extent, and postoperative outcome in pediatric cortical dysplasia

Leach¹,

Miles²,

Henkel³

et al. 2014

PED

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Object The authors conducted a study to correlate histopathological features, MRI findings, and postsurgical outcomes in children with cortical dysplasia (CD) by performing a novel resection site–specific evaluation. Methods The study cohort comprised 43 children with intractable epilepsy and CD. The MR image review was blinded to pathology but with knowledge of the resection location. An MRI score (range 0–7) was calculated for each resection region based on the number of imaging features of CD and was classified as “lesional” or “nonlesional” according to all imaging features. Outcome was determined using the International League Against Epilepsy (ILAE) scale. The determination of pathological CD type was based on the ILAE 2011 consensus classification system, and the cortical gliosis pattern was assessed on GFAP staining. Results There were 89 resection regions (50 ILAE Type I, 29 Type IIa, and 10 Type IIb). Eleven (25.6%) of 43 children had more than one type of CD. The authors observed MRI abnormalities in 63% of patients, characteristic enough to direct resection (lesional) in 42%. Most MRI features, MRI score ≥ 3, and lesional abnormalities were more common in patients with Type II CD. Increased cortical signal was more common in those with Type IIb (70%) rather than Type IIa (17.2%) CD (p = 0.004). A good outcome was demonstrated in 39% of children with Type I CD and 72% of those with Type II CD (61% in Type IIa and 100% in Type IIb) (p = 0.03). A lesional MRI abnormality and an MRI score greater than 3 correlated with good outcome in 78% and 90% of patients, respectively (p < 0.03). Diffuse cortical gliosis was more prevalent in Type II CD and in resection regions exhibiting MRI abnormalities. Complete surgical exclusion of the MRI abnormality was associated with a better postoperative outcome. Conclusions This study provides a detailed correlation of MRI findings, neuropathological features, and outcomes in children with intractable epilepsy by using a novel resection site–specific evaluation. Because 25% of the patients had multiple CD subtypes, a regional analysis approach was mandated. Those children with lesional MRI abnormalities, Type II CD, and surgical exclusion of the MRI abnormality had better outcomes. Type II CD is more detectable by MRI than other types, partly because of the greater extent of associated gliosis in Type II. Although MRI findings were correlated with the pathological CD type and outcome in this study, the majority of patients (58%) did not have MRI findings that could direct surgical therapy, underscoring the need for improved MRI techniques for detection and for the continued use of multimodal evaluation methods in patient selection.

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Section: Comparison Of Mri Features and Pathological Findingsmentioning

confidence: 47%

Section: Comparison Of Mri Features and Pathological Findingsmentioning

confidence: 91%

Section: Comparison Of Mri Features and Pathological Findingsmentioning

confidence: 99%

Section: Mri Technique and Evaluationmentioning

confidence: 99%

See 2 more Smart Citations

Magnetic resonance imaging abnormalities in the resection region correlate with histopathological type, gliosis extent, and postoperative outcome in pediatric cortical dysplasia

Leach¹,

Miles²,

Henkel³

et al. 2014

PED

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show abstract

“…1 Despite clear cytomorphologic differences, FCD subtypes cannot be reliably distinguished on conventional MRI, 2 even though qualitative studies have reported a tendency for more subtle anomalies in type IIA. 3 It has been suggested that identifying subtype-specific imaging signatures has potential clinical utility. 1,2,4 Notably, this ability may become increasingly relevant with the emergence of minimally invasive surgical procedures, 5 which do not supply specimens for histologic diagnosis.…”

mentioning

confidence: 99%

Multimodal MRI profiling of focal cortical dysplasia type II

Hong¹,

Bernhardt²,

Caldairou³

et al. 2017

Neurology

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Objective: To characterize in vivo MRI signatures of focal cortical dysplasia (FCD) type IIA and type IIB through combined analysis of morphology, intensity, microstructure, and function. Methods:We carried out a multimodal 3T MRI profiling of 33 histologically proven FCD type IIA (9) and IIB (24) lesions. A multisurface approach operating on manual consensus labels systematically sampled intracortical and subcortical lesional features. Geodesic distance mapping quantified the same features in the lesion perimeter. Logistic regression assessed the relationship between MRI and histology, while supervised pattern learning was used for individualized subtype prediction.Results: FCD type IIB was characterized by abnormal morphology, intensity, diffusivity, and function across all surfaces, while type IIA lesions presented only with increased fluid-attenuated inversion recovery signal and reduced diffusion anisotropy close to the gray-white matter interface. Similar to lesional patterns, perilesional anomalies were more marked in type IIB extending up to 16 mm. Structural MRI markers correlated with categorical histologic characteristics. A profile-based classifier predicted FCD subtypes with equal sensitivity of 85%, while maintaining a high specificity of 94% against healthy and disease controls. Conclusions:Image processing applied to widely available MRI contrasts has the ability to dissociate FCD subtypes at a mesoscopic level. Integrating in vivo staging of pathologic traits with automated lesion detection is likely to provide an objective definition of lesional boundary and assist emerging approaches, such as minimally invasive thermal ablation, which do not supply tissue specimen. Neurology ® 2017;88:734-742 GLOSSARY ALFF 5 amplitude of low-frequency fluctuations; d-MRI 5 diffusion-weighted MRI; FA 5 fractional anisotropy; FCD 5 focal cortical dysplasia; FLAIR 5 fluid-attenuated inversion recovery; FWHM 5 full width at half maximum; GM 5 gray matter; MD 5 mean diffusivity; MNI 5 Montreal Neurological Institute; ReHo 5 regional homogeneity; rs-fMRI 5 resting-state functional MRI; SVM 5 support vector machine; TE 5 echo time; TR 5 repetition time; WM 5 white matter.

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Mutations in mammalian target of rapamycin regulator DEPDC5 cause focal epilepsy with brain malformations

Scheffer

Heron

Regan

et al. 2014

Annals of Neurology

203

190

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We recently identified DEPDC5 as the gene for familial focal epilepsy with variable foci and found mutations in >10% of small families with nonlesional focal epilepsy. Here we show that DEPDC5 mutations are associated with both lesional and nonlesional epilepsies, even within the same family. DEPDC5-associated malformations include bottom-of-the-sulcus dysplasia (3 members from 2 families), and focal band heterotopia (1 individual). DEPDC5 negatively regulates the mammalian target of rapamycin (mTOR) pathway, which plays a key role in cell growth. The clinicoradiological phenotypes associated with DEPDC5 mutations share features with the archetypal mTORopathy, tuberous sclerosis, raising the possibility of therapies targeted to this pathway.

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Focal cortical dysplasia type IIa and IIb: MRI aspects in 118 cases proven by histopathology

Cited by 134 publications

References 27 publications

Magnetic resonance imaging abnormalities in the resection region correlate with histopathological type, gliosis extent, and postoperative outcome in pediatric cortical dysplasia

Magnetic resonance imaging abnormalities in the resection region correlate with histopathological type, gliosis extent, and postoperative outcome in pediatric cortical dysplasia

Multimodal MRI profiling of focal cortical dysplasia type II

Mutations in mammalian target of rapamycin regulator DEPDC5 cause focal epilepsy with brain malformations

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