Preoperative evaluation of dynamic contrast‑enhanced MRI‑guided lesion identification using morphometric and textural analysis for patients with epilepsy

Abstract

Diagnosing epilepsy at the early stages is pivotal in the prevention and subsequent treatment of major epileptic events. MRI has been previously demonstrated to be beneficial in optimizing diagnostic efficacy and the subsequent treatment of epilepsy. In the present study, morphometric and textural analysis was performed pre-operatively on dynamic contrast-enhanced (Dce)-magnetic resonance imaging (MRI)-guided lesions in patients with epilepsy. The diagnostic efficacies of MRI and Dce-MRI were evaluated in 280 patients with epilepsy. The performance of Dce-MRI (n=140) was compared with that of classic MRI (n=140) in the analysis of the morphometric and textural features of the lesions, and the accuracy of mapping to regions of the brain that were potentially associated with the region of seizure onset was also investigated. Diagnostic quality was evaluated by comparing the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the hippocampus, the grey-white matter contrast and the morphometric and textural analysis of epileptogenic lesions. Data from the present study demonstrated that the regions of suspected epileptic activity in the brain were mapped more successfully using Dce-MRI compared with MRI. Image quality obtained by Dce-MRI was adequate for the detection of epileptic lesions, including those of focal cortical dysplasia or periventricular nodular heterotopia (PNH). The diagnostic value of Dce-MRI for subtle lesions such as PNH was found to be more efficient compared with that of MRI due to the significantly increased SNR and CNR. In addition, Dce-MRI exhibited higher accuracy compared with MRI for the identification of cortical lesions and for the mapping to the zone of suspected seizure onset. Dce-MRI also exhibited higher sensitivity and specificity in the diagnosis of patients with epilepsy and mapping to the lesions associated with epilepsy compared with MRI. These findings indicate that Dce-MRI is a feasible technique that may be beneficial in the diagnosis and subsequent management of patients with epilepsy.

Blood–brain barrier damage and new onset refractory status epilepticus: An exploratory study using dynamic contrast‐enhanced magnetic resonance imaging

“…47 In two human studies, DCE-MRI has been shown to provide additional value in the preoperative localization of epileptic foci in patients with epilepsy. 48,49 However, BBB permeability was not measured in either study, and the exact value of BBB permeability in human epileptic foci was unknown. The range of median Ktrans is .6-2.3 × 10 −3 /min in stroke lesions, 15 .7-.9 × 10 −3 / min in normal-appearing white matter, .3-2.1 × 10 −3 / min in lesions of multiple sclerosis patients, 16 and 10-39 × 10 −3 /min in brain tumors.…”

“…DCE‐MRI has been used to localize and quantify the BBB dysfunction in canine epileptic seizures 47 . In two human studies, DCE‐MRI has been shown to provide additional value in the preoperative localization of epileptic foci in patients with epilepsy 48,49 . However, BBB permeability was not measured in either study, and the exact value of BBB permeability in human epileptic foci was unknown.…”