MRI postprocessing in presurgical evaluation

Wang, Z. Irene; Alexopoulos, Andreas V.

doi:10.1097/wco.0000000000000305

Cited by 10 publications

(10 citation statements)

References 60 publications

(64 reference statements)

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“…Nevertheless, considering the cost and risk of implanting electrodes within the deep-seated and highly vascularized insula, it would be preferable to identify the subset of patients for whom insular intracerebral electrodes would best yield results. As MAP is non-invasive, low-cost and easy-handled, it can be used as a supplementary tool to other presurgical evaluation methods in the process of the detection of the seizure onset zone (39,40). Previous reports have shown MAP can help detect the FIGURE 5 | The junction z-score images, extension z-score images, and thickness z-score images of MAP-positive patients (Patient 3, 5, 6, and 7).…”

Section: Discussionmentioning

confidence: 99%

Pilot Study of Voxel-Based Morphometric MRI Post-processing in Patients With Non-lesional Operculoinsular Epilepsy

et al. 2020

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The aim of this study was to use voxel-based MRI post-processing in detection of subtle FCD in drug-resistant operculoinsular epilepsy patients with negative presurgical MRI, and by combining magnetoencephalography (MEG) to improve the localization of epileptogenic zone. Methods: Operculoinsular epilepsy patients with a negative presurgical MRI were included in this study. MRI post-processing was performed using a Morphometric Analysis Program (MAP) on T1-weighted volumetric MRI. Clinical information including semiology, MEG, scalp electroencephalogram (EEG), intracranial EEG and surgical strategy was retrospectively reviewed. The pertinence of MAP-positive areas was confirmed by surgical outcome and pathology. Results: A total of 20 patients were diagnosed with operculoinsular epilepsy had non-lesional MRI during 2010-2018, of which 11 patients with resective surgeries were included. MEG showed clusters of single equivalent current dipole (SECD) in inferior frontal regions in five patients and temporal-insular/ frontal-temporal-insular/parietal-insular regions in five patients. Four out of 11 patients had positive MAP results. The MAP positive rate was 36.4%. The positive regions were in insular in one patient and operculoinsular regions in three patients. Three of the four patients who were MAP-positive got seizure-free after successfully resect the MAP-positive and MEG-positive regions (the pathology results were FCD IIb in two patients and FCD IIa in one patient). Conclusions: MAP is a useful tool in detection the epileptogenic lesions in patients with MRI-negative operculoinsular epilepsy. Notably, in order to make a right surgical regime decision, MAP results should always be interpreted in the context of the patient's anatomo-electroclinical presentation.

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Section: Discussionmentioning

confidence: 99%

Pilot Study of Voxel-Based Morphometric MRI Post-processing in Patients With Non-lesional Operculoinsular Epilepsy

et al. 2020

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“…Automatic quantitative analysis, such as voxel-based morphometry, would possibly further increase the detection rate ( Wang et al, 2016 ). Unfortunately, the post-processing methods have not been used in routine practice and their interpretation still requires experienced readers ( Wang and Alexopoulos, 2016 ). Finally, future studies should compare the FLAWS sequence to other advanced sequences, such as the double inversion recovery sequence ( Wong-Kisiel et al, 2016 ), in which both the CSF and WM signals can be suppressed.…”

Section: Discussionmentioning

confidence: 99%

Gray-matter-specific MR imaging improves the detection of epileptogenic zones in focal cortical dysplasia: A new sequence called fluid and white matter suppression (FLAWS)

Chen

Qian

Kober

et al. 2018

NeuroImage: Clinical

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ObjectivesTo evaluate the diagnostic value and characteristic features of FCD epileptogenic zones using a novel sequence called fluid and white matter suppression (FLAWS).Materials and methodsThirty-nine patients with pathologically confirmed FCD and good surgery outcomes (class I or II, according to the Engel Epilepsy Surgery Outcome Scale) were retrospectively included in the study. All the patients underwent a preoperative whole-brain MRI examination that included conventional sequences (T2WI, T1WI, two-dimensional (2D) axial, coronal fluid-attenuated inversion recovery [FLAIR]) and FLAWS. An additional 3D-FLAIR MRI sequence was performed in 17 patients. To evaluate the sensitivity and specificity of FLAWS and investigate the cause of false-positives, 36 healthy volunteers were recruited as normal controls. Two radiologists evaluated all the image data. The detection rates of the FCD epileptogenic zone on different sequences were compared based on five criteria: abnormal cortical morphology (thickening, thinning, or abnormally deep sulcus); abnormal cortical signal intensity; blurred gray-white matter junction; abnormal signal intensity of the subcortical white matter, and the transmantle sign. The sensitivity and specificity of FLAWS for detecting the FCD lesions were calculated with the reviewers blinded to all the clinical information, i.e. to the patient identity and the location of the resected regions. To explore how many features were sufficient for the diagnosis of the epileptogenic zones, the frequency of each criterion in the resected regions and their combinations were assessed on FLAWS, according to the results of the assessment when the reviewers were aware of the location of the resected regions. Based on the findings of the 17 patients with an additional 3D-FLAIR scan when the reviewers were aware of the location of the resected regions, quantitative analysis of the regions of interest was used to compare the tissue contrast among 2D-axial FLAIR, 3D-FLAIR, and the FLAWS sequence. Visualization score analysis was used to evaluate the visualization of the five features on conventional, 3D-FLAIR, and FLAWS images. Finally, to explore the reason for false-positive results, a further evaluation of the whole brain FLAWS images was conducted for all the subjects.ResultsThe sensitivity and specificity for detecting the FCD lesions on the FLAWS sequence were 71.9% and 71.1%, respectively. When the reviewers were blinded to the location of the resected regions, the detection rate of the FLAWS sequence was significantly higher than that of the conventional sequences (P = 0.00). In the 17 patients who underwent an additional 3D FLAIR scan, no statistically significant difference was found between the FLAWS and the 3D-FLAIR (P = 0.25). All the patients had at least two imaging features, one of which was “the blurred junction of the gray-white matter.” The transmantle sign, which is widely believed to be a specific feature of FCD type II, could also be observed in type I on the FLAWS sequence. The relative ti...

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“…Post‐processing techniques may offer solutions by computationally analyzing morphological MRI features, such as sulcal depth, contrast of the gray‐white matter junction, volumes, and cortical thickness, among others. A comparison to healthy controls then provides objective metrics of structural alterations potentially providing evidence for a subtle lesion 54 . The use of artificial intelligence approaches in parallel to the visual analyses may enhance further the detection of very subtle FCDs in previously negative MRIs 55…”

Section: Diagnostic Workup Of Focal Epilepsies Neuroimagingmentioning

confidence: 99%

Focal epilepsies: Update on diagnosis and classification

Nascimento

Friedman

Peters

et al. 2023

Epileptic Disorders

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Correctly diagnosing and classifying seizures and epilepsies is paramount to ensure the delivery of optimal care to patients with epilepsy. Focal seizures, defined as those that originate within networks limited to one hemisphere, are primarily subdivided into focal aware, focal impaired awareness, and focal to bilateral tonic-clonic seizures. Focal epilepsies account for most epilepsy cases both in children and adults. In children, focal epilepsies are typically subdivided in three groups: self-limited focal epilepsy syndromes (e.g., self-limited epilepsy with centrotemporal spikes), focal epilepsy of unknown cause but which do not meet criteria for a self-limited focal epilepsy syndrome, and focal epilepsy of known cause (e.g., structural lesions-developmental or acquired). In adults, focal epilepsies are often acquired and may be caused by a structural lesion such as stroke, infection and traumatic brain injury, or brain tumors, vascular malformations, metabolic disorders, autoimmune, and/or genetic causes. In addition to seizure semiology, neuroimaging, neurophysiology, and neuropathology constitute the cornerstones of a diagnostic evaluation. Patients with focal epilepsy who become drug-resistant should promptly undergo assessment in an epilepsy center. After excluding pseudo-resistance, these patients should be considered for presurgical evaluation as a means to identify the location and extent of the epileptogenic zone and assess their candidacy for a surgical procedure. The goal of this seminar in epileptology is to summarize clinically relevant information concerning focal epilepsies. This contributes to the ILAE's mission to ensure that worldwide healthcare professionals, patients, and caregivers continue to have access to highquality educational resources concerning epilepsy.

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MRI postprocessing in presurgical evaluation

Cited by 10 publications

References 60 publications

Pilot Study of Voxel-Based Morphometric MRI Post-processing in Patients With Non-lesional Operculoinsular Epilepsy

Pilot Study of Voxel-Based Morphometric MRI Post-processing in Patients With Non-lesional Operculoinsular Epilepsy

Gray-matter-specific MR imaging improves the detection of epileptogenic zones in focal cortical dysplasia: A new sequence called fluid and white matter suppression (FLAWS)

Focal epilepsies: Update on diagnosis and classification

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