W Wang1,2, Y Lin1,2, S Wang2,3, S Jones4, R Prayson5, A N V Moosa2, A McBride6, J Gonzalez-Martinez7, W Bingaman7, I Najm2, A Alexopoulos2, Z I Wang2. 1. Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China. 2. Epilepsy Center, Cleveland Clinic Foundation (CCF), Cleveland, OH, USA. 3. Epilepsy Center, Second Affiliated Hospital of Zhejiang University, Hangzhou, China. 4. Imaging Institute, CCF, Cleveland, OH, USA. 5. Department of Anatomic Pathology, CCF, Cleveland, OH, USA. 6. Cleveland Clinic Lerner College of Medicine, CCF, Cleveland, OH, USA. 7. Department of Neurosurgery, CCF, Cleveland, OH, USA.
Abstract
BACKGROUND AND PURPOSE: Pre-surgical evaluation of pediatric patients with drug-resistant focal epilepsy and negative (non-lesional) magnetic resonance imaging (MRI) is particularly challenging. Focal cortical dysplasia (FCD), a frequent pathological substrate in such setting, may be subtle on MRI and evade detection. The aim of this study was to use voxel-based MRI postprocessing to improve the detection of subtle FCD in pediatric surgical candidates. METHODS: A consecutive cohort of pediatric patients undergoing pre-surgical evaluation with a negative MRI by visual analysis was included. MRI postprocessing was performed using a voxel-based morphometric analysis program (MAP) on T1-weighted volumetric MRI, with comparison to an age-specific normal pediatric database. The pertinence of MAP-positive areas was confirmed by surgical outcome and pathology. RESULTS: A total of 78 patients were included. Forty-four patients (56%) had positive MAP regions. Complete resection of the MAP-positive regions was positively associated with seizure-free outcome compared with the no/partial resection group (P < 0.001). Patients with no/partial resection of the MAP-positive regions had worse seizure outcomes than the MAP-negative group (P = 0.002). The MAP-positive rate was 100%, 77%, 63% and 40% in the 3-5, 5-10, 10-15 and 15-21 year age groups, respectively. MAP-positive rates were 45% in patients with temporal resection and 63% in patients with extratemporal resection. Complete resection of the MAP-positive regions was positively associated with seizure-free outcome in the extratemporal group (P = 0.001) but not in the temporal group (P = 0.070). CONCLUSION: Our data suggest the importance of using MRI postprocessing in the pre-surgical evaluation process of pediatric epilepsy patients with apparently normal MRI.
BACKGROUND AND PURPOSE: Pre-surgical evaluation of pediatric patients with drug-resistant focal epilepsy and negative (non-lesional) magnetic resonance imaging (MRI) is particularly challenging. Focal cortical dysplasia (FCD), a frequent pathological substrate in such setting, may be subtle on MRI and evade detection. The aim of this study was to use voxel-based MRI postprocessing to improve the detection of subtle FCD in pediatric surgical candidates. METHODS: A consecutive cohort of pediatric patients undergoing pre-surgical evaluation with a negative MRI by visual analysis was included. MRI postprocessing was performed using a voxel-based morphometric analysis program (MAP) on T1-weighted volumetric MRI, with comparison to an age-specific normal pediatric database. The pertinence of MAP-positive areas was confirmed by surgical outcome and pathology. RESULTS: A total of 78 patients were included. Forty-four patients (56%) had positive MAP regions. Complete resection of the MAP-positive regions was positively associated with seizure-free outcome compared with the no/partial resection group (P < 0.001). Patients with no/partial resection of the MAP-positive regions had worse seizure outcomes than the MAP-negative group (P = 0.002). The MAP-positive rate was 100%, 77%, 63% and 40% in the 3-5, 5-10, 10-15 and 15-21 year age groups, respectively. MAP-positive rates were 45% in patients with temporal resection and 63% in patients with extratemporal resection. Complete resection of the MAP-positive regions was positively associated with seizure-free outcome in the extratemporal group (P = 0.001) but not in the temporal group (P = 0.070). CONCLUSION: Our data suggest the importance of using MRI postprocessing in the pre-surgical evaluation process of pediatric epilepsypatients with apparently normal MRI.
Authors: T Demerath; L Rubensdörfer; R Schwarzwald; A Schulze-Bonhage; D-M Altenmüller; C Kaller; T Kober; H-J Huppertz; H Urbach Journal: AJNR Am J Neuroradiol Date: 2020-06-04 Impact factor: 3.825
Authors: Irene Wang; Sehong Oh; Ingmar Blümcke; Roland Coras; Balu Krishnan; Sanghoon Kim; Aaron McBride; Olesya Grinenko; Yicong Lin; Margit Overmyer; Tin Tun Aung; Mark Lowe; Mykol Larvie; Andreas V Alexopoulos; William Bingaman; Jorge A Gonzalez-Martinez; Imad Najm; Stephen E Jones Journal: Epilepsia Date: 2020-09-19 Impact factor: 5.864