Luc Rubinger1, Carol Chan1, Felice D'Arco2, Rahim Moineddin3, Osama Muthaffar4,5, James T Rutka6, O Carter Snead4, Mary Lou Smith7, Elysa Widjaja2,4. 1. Neuroscience and Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada. 2. Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada. 3. Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada. 4. Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada. 5. Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia. 6. Department of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada. 7. Department of Psychology, University of Toronto, Toronto, Ontario, Canada.
Abstract
OBJECTIVE: Since 2008, we have changed our presurgical diagnostic imaging evaluation for medically refractory focal epilepsy to include high-resolution epilepsy protocol on 3 T magnetic resonance imaging (MRI), and combined magnetoencephalography and 18-fluorodeoxyglucose-positron emission tomography (FDG-PET) in selected patients with normal or subtle changes on MRI or discordant diagnostic tests. The aim of this study was to evaluate the effectiveness of the change in imaging practice on epilepsy surgery outcome in a tertiary pediatric epilepsy surgery center. METHODS: The change in practice occurred in early 2008, and patients were classified based on old or new practice. The patient characteristics, surgical variables, and seizure-free surgical outcome were compared, and the trend in seizure-free outcome over time was assessed. RESULTS: There was a trend for increased abnormal MRI (92% vs. 86%, respectively, p = 0.062), and increased utilization of FDG-PET (34% vs. 3% respectively, p < 0.001) with new relative to old practice. There were no statistically significant differences in invasive monitoring, location, and type of surgery and histology between the two periods (all p > 0.05). During the old practice, there was no statistically significant change in yearly trend of seizure-free outcome (odds ratio [OR] 0.960, 95% confidence interval [CI] 0.875-1.053, p = 0.386). The change in practice in 2008 was associated with a significant improvement in seizure-free outcome (OR 1.535, 95% CI 1.100-2.142, p = 0.012). During the new practice, there was a significant positive trend in yearly seizure-free outcome (OR 1.219, 95% CI 1.053-1.411, p = 0.008), after adjusting for age at seizure onset, invasive monitoring, location and type of surgery, histology, MRI, magnetoencephalography, and FDG-PET. SIGNIFICANCE: We have found an improvement in seizure-free surgical outcome following the change in imaging practice. This study highlights the importance of optimizing and improving presurgical diagnostic imaging evaluation to improve surgical outcome. Wiley Periodicals, Inc.
OBJECTIVE: Since 2008, we have changed our presurgical diagnostic imaging evaluation for medically refractory focal epilepsy to include high-resolution epilepsy protocol on 3 T magnetic resonance imaging (MRI), and combined magnetoencephalography and 18-fluorodeoxyglucose-positron emission tomography (FDG-PET) in selected patients with normal or subtle changes on MRI or discordant diagnostic tests. The aim of this study was to evaluate the effectiveness of the change in imaging practice on epilepsy surgery outcome in a tertiary pediatric epilepsy surgery center. METHODS: The change in practice occurred in early 2008, and patients were classified based on old or new practice. The patient characteristics, surgical variables, and seizure-free surgical outcome were compared, and the trend in seizure-free outcome over time was assessed. RESULTS: There was a trend for increased abnormal MRI (92% vs. 86%, respectively, p = 0.062), and increased utilization of FDG-PET (34% vs. 3% respectively, p < 0.001) with new relative to old practice. There were no statistically significant differences in invasive monitoring, location, and type of surgery and histology between the two periods (all p > 0.05). During the old practice, there was no statistically significant change in yearly trend of seizure-free outcome (odds ratio [OR] 0.960, 95% confidence interval [CI] 0.875-1.053, p = 0.386). The change in practice in 2008 was associated with a significant improvement in seizure-free outcome (OR 1.535, 95% CI 1.100-2.142, p = 0.012). During the new practice, there was a significant positive trend in yearly seizure-free outcome (OR 1.219, 95% CI 1.053-1.411, p = 0.008), after adjusting for age at seizure onset, invasive monitoring, location and type of surgery, histology, MRI, magnetoencephalography, and FDG-PET. SIGNIFICANCE: We have found an improvement in seizure-free surgical outcome following the change in imaging practice. This study highlights the importance of optimizing and improving presurgical diagnostic imaging evaluation to improve surgical outcome. Wiley Periodicals, Inc.
Authors: D Mata-Mbemba; Y Iimura; L-N Hazrati; A Ochi; H Otsubo; O C Snead; J Rutka; E Widjaja Journal: AJNR Am J Neuroradiol Date: 2018-11-15 Impact factor: 3.825
Authors: Marko Wilke; Samuel Groeschel; Anna Lorenzen; Sabine Rona; Martin U Schuhmann; Ulrike Ernemann; Ingeborg Krägeloh-Mann Journal: Ann Clin Transl Neurol Date: 2018-09-27 Impact factor: 4.511