Optimizing MR Imaging Detection of Type 2 Focal Cortical Dysplasia: Best Criteria for Clinical Practice

Mellerio, Charles; Labeyrie, Marc‐Antoine; Chassoux, Francine; Daumas-Duport, Cathérine; Landré, Elisabeth; Turak, B.; Fx, Roux; Méder, Jean-François; Devaux, Bertrand; Oppenheim, Catherine

doi:10.3174/ajnr.a3081

Cited by 75 publications

(70 citation statements)

References 35 publications

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“…14,16,17,19 None of these studies used a resection region-specific analysis such as used in our evaluation, and some include patients with hippocampal sclerosis and, presumably, Type IIIa CD, which was specifically excluded in this study. In a recent study, Mellerio et al, 22 utilizing a detailed evaluation approach in 71 adults and children (median age 20 years) with Type II CD, demonstrated an MRI abnormality in 59% of the patients, which was more similar to the 68% of patients identified in our study with Type II CD.…”

Section: Discussionsupporting

confidence: 55%

“…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%

“…16,17 This could relate to the exclusion of Type I CD associated with hippocampal sclerosis (now denoted as Type IIIa) in our study; however, evaluation of localized volume loss is also highly subjective. 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.…”

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: Discussionsupporting

confidence: 55%

Section: Comparison Of Mri Features and Pathological Findingsmentioning

confidence: 99%

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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“…A precise localization of the epileptogenic lesions in the brain cortex is an important step in selecting the appropriate treatment or intervention for these patients [16]. The most common way of visualizing these lesions is by performing a standard control using high-resolution 3D magnetic resonance imaging (MRI) [13].…”

Section: Introductionmentioning

confidence: 99%

Epileptogenic Lesion Quantification in MRI Using Contralateral 3D Texture Comparisons

Toro

Foncubierta–Rodríguez

Gómez

et al. 2013

Advanced Information Systems Engineering

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Abstract. Epilepsy is a disorder of the brain that can lead to acute crisis and if possible an intervention can help patients. The exact localization of epileptogenic lesions influences the outcome of epilepsy surgery. Magnetic resonance (MR) imaging is clinically used for lesion detection and treatment planning, mainly through simple visual analysis. However, visual inspection in MR imaging can be highly subjective and subtle 3D structural abnormalities can be missclassified or not resected completely during the surgery. In this paper, a measurement of the differences in texture of the cerebral cortex between brain hemispheres is proposed. The 3D Riesz wavelet transform and the Hausdorff distance are used in MR T1 weighted images of the brain. A classification accuracy of 85% is obtained with 10 healthy control subjects and 8 patients with various types of epileptogenic lesions. The proposed quantitative measure of the texture alterations of these lesions allows an objective pre-surgical evaluation of patients undergoing epilepsy surgery.

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Normal cognitive outcome in a PEX6 deficient girl despite neonatal multisystem presentation

Witters

Régal

Waterham

et al. 2016

American J of Med Genetics Pt A

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Optimizing MR Imaging Detection of Type 2 Focal Cortical Dysplasia: Best Criteria for Clinical Practice

Cited by 75 publications

References 35 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

Epileptogenic Lesion Quantification in MRI Using Contralateral 3D Texture Comparisons

Normal cognitive outcome in a PEX6 deficient girl despite neonatal multisystem presentation

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