The Power Button Sign: A Newly Described Central Sulcal Pattern on Surface Rendering MR Images of Type 2 Focal Cortical Dysplasia

Mellerio, Charles; Roca, Pauline; Chassoux, Francine; Danière, Florian; Cachia, Arnaud; Lion, Stéphanie; Naggara, Olivier; Devaux, Bertrand; Méder, Jean-François; Oppenheim, Catherine

doi:10.1148/radiol.14140773

Cited by 33 publications

(26 citation statements)

References 33 publications

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“…A combination of cortical thickening, gray–white blurring, and transmantle sign was found in all 59% of patients with FCD II who had a positive MRI . A specific aspect of the central sulcus appearance named “power button sign” was found in 62% of FCD II patients in a case‐control study and was considered highly specific for this type of dysplasia . Our results support a study that analyzed pathologic specimens from 13 patients with FCD who had en bloc resection with a 7T magnet; 85% of patients had ETLE.…”

Section: Discussionsupporting

confidence: 82%

“…32 A specific aspect of the central sulcus appearance named "power button sign" was found in 62% of FCD II patients in a case-control study and was considered highly specific for this type of dysplasia. 33 Our results support a study 34 that analyzed pathologic specimens from 13 patients with FCD who had en bloc resection with a 7T magnet; 85% of patients had ETLE. The authors found isolated gray-white blurring in the four patients who had FCD IIa and hypothesized a less severe neuroradiologic feature when compared to FCD IIb, owing to the absence of edema, balloon cells, and myelin alteration.…”

Section: Explanation and Importance Of Temporal Tip Abnormalitiessupporting

confidence: 84%

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Temporal lobe epilepsy and focal cortical dysplasia in children: A tip to find the abnormality

Bartolini

Whitehead

et al. 2016

Epilepsia

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SUMMARYObjective: To demonstrate an association between magnetic resonance imaging (MRI) findings and pathologic characteristics in children who had surgery for medically refractory epilepsy due to focal cortical dysplasia (FCD). Methods: We retrospectively studied 110 children who had epilepsy surgery. Twentyseven patients with FCD were included. Thirteen had temporal lobe epilepsy (TLE) and 14 had extra-temporal lobe epilepsy (ETLE). Three patients had associated mesial temporal sclerosis. Preoperative 3T MRIs interleaved with nine controls were blindly re-reviewed and categorized according to signal alteration. Pathologic specimens were classified according to the 2011 International League Against Epilepsy (ILAE) classification and compared to MRI studies. Results: Rates of pathology subtypes differed between TLE and ETLE (v 2 (3) = 8.57, p = 0.04). FCD type I was more frequent in TLE, whereas FCD type II was more frequent in ETLE. In the TLE group, nine patients had temporal tip abnormalities. They all exhibited gray-white matter blurring with decreased myelination and white matter hyperintense signal. Blurring involved the whole temporal tip, not just the area of dysplasia. These patients were less likely to demonstrate cortical thickening compared to those without temporal tip findings (v 2 (1) = 9.55, p = 0.002). Three of them had FCD Ib, three had FCD IIa, two had FCD IIIa, and one had FCD IIb; MRI features could not entirely distinguish between FCD subtypes. TLE patients showed more pronounced findings than ETLE on MRI (v 2 (1) = 11.95, p = 0.003, odds ratio [OR] 18.00). In all cases of FCD, isolated blurring was more likely to be associated with FCD II, whereas blurring with decreased myelination was seen with FCD I (v 2 (6) = 13.07, p = 0.042). Significance: Our study described associations between MRI characteristics and pathology in children with FCD and offered a detailed analysis of temporal lobe tip abnormalities and FCD subtypes in children with TLE. These findings may contribute to the presurgical evaluation of patients with refractory epilepsy.

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Section: Discussionsupporting

confidence: 82%

Section: Explanation and Importance Of Temporal Tip Abnormalitiessupporting

confidence: 84%

Temporal lobe epilepsy and focal cortical dysplasia in children: A tip to find the abnormality

Bartolini

Whitehead

et al. 2016

Epilepsia

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“…Subtle signal changes can be obvious in one plane but completely obscured by the cortical anatomy in another plane. In some cases, even, the sole identifier can be an abnormal gyration pattern, only recognizable in high‐quality 3D image sets …”

Section: Discussionmentioning

confidence: 99%

Seven tesla MRI improves detection of focal cortical dysplasia in patients with refractory focal epilepsy

et al. 2017

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SummaryObjectiveThe aim of this study is to determine whether the use of 7 tesla (T) MRI in clinical practice leads to higher detection rates of focal cortical dysplasias in possible candidates for epilepsy surgery.MethodsIn our center patients are referred for 7 T MRI if lesional focal epilepsy is suspected, but no abnormalities are detected at one or more previous, sufficient‐quality lower‐field MRI scans, acquired with a dedicated epilepsy protocol, or when concealed pathology is suspected in combination with MR‐visible mesiotemporal sclerosis—dual pathology. We assessed 40 epilepsy patients who underwent 7 T MRI for presurgical evaluation and whose scans (both 7 T and lower field) were discussed during multidisciplinary epilepsy surgery meetings that included a dedicated epilepsy neuroradiologist. We compared the conclusions of the multidisciplinary visual assessments of 7 T and lower‐field MRI scans.ResultsIn our series of 40 patients, multidisciplinary evaluation of 7 T MRI identified additional lesions not seen on lower‐field MRI in 9 patients (23%). These findings were guiding in surgical planning. So far, 6 patients underwent surgery, with histological confirmation of focal cortical dysplasia or mild malformation of cortical development.SignificanceSeven T MRI improves detection of subtle focal cortical dysplasia and mild malformations of cortical development in patients with intractable epilepsy and may therefore contribute to identification of surgical candidates and complete resection of the epileptogenic lesion, and thus to postoperative seizure freedom.

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“…A recent study by Mellerio et al, using a post-processing tool for 3D visualization of brain sulci, assessed central sulcus variants and particularly a sulcal pattern “power button sign” (defined as the interposition of a precentral sulcal segment between the central sulcus and one of its hook-shaped anterior ascending branches) in 37 patients with histologically proven FCD type II of the central region and 44 healthy control subjects [42]. Their data suggest that central sulcus with the FCD type II patient group present with significantly more side branches and connections with the precentral sulcus and sylvian fissure.…”

Section: Mri Post-processing For Sulcal Morphologymentioning

confidence: 99%

MRI postprocessing in presurgical evaluation

Wang

Alexopoulos

2016

Current Opinion in Neurology

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Purpose of Review Advanced MRI post-processing techniques are increasingly used to complement visual analysis and elucidate structural epileptogenic lesions. This review summarizes recent developments in MRI post-processing in the context of epilepsy pre-surgical evaluation, with the focus on patients with unremarkable MRI by visual analysis (i.e., “nonlesional” MRI). Recent Findings Various methods of MRI post-processing have been reported to show additional clinical values in the following areas: (1) lesion detection on an individual level; (2) lesion confirmation for reducing the risk of over reading the MRI; (3) detection of sulcal/gyral morphologic changes that are particularly difficult for visual analysis; and (4) delineation of cortical abnormalities extending beyond the visible lesion. Future directions to improve performance of MRI post-processing include using higher magnetic field strength for better signal and contrast to noise ratio, adopting a multi-contrast frame work, and integration with other noninvasive modalities. Summary MRI post-processing can provide essential value to increase the yield of structural MRI and should be included as part of the presurgical evaluation of nonlesional epilepsies. MRI post-processing allows for more accurate identification/delineation of cortical abnormalities, which should then be more confidently targeted and mapped.

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The Power Button Sign: A Newly Described Central Sulcal Pattern on Surface Rendering MR Images of Type 2 Focal Cortical Dysplasia

Abstract: Given its excellent reproducibility and specificity, the PBS, when present, could become a useful qualitative diagnostic MR criterion of FCD2 in the central region.

Cited by 33 publications

References 33 publications

Temporal lobe epilepsy and focal cortical dysplasia in children: A tip to find the abnormality

Temporal lobe epilepsy and focal cortical dysplasia in children: A tip to find the abnormality

Seven tesla MRI improves detection of focal cortical dysplasia in patients with refractory focal epilepsy

MRI postprocessing in presurgical evaluation

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