MR imaging features of epileptogenic focal cortical dysplasia and optimization of scanning protocols

( views:532, downloads:0 )
WANG Fang(Department of Radiology,Dongguan People's Hospital, Dongguan 523059, China)
ZHANG Li(MR Room Guangzhou General Hospital of PLA , Guangzhou 510010, China)
CAO Hui-xia(MR Room Guangzhou General Hospital of PLA , Guangzhou 510010, China)
HAN Li-xin(MR Room Guangzhou General Hospital of PLA , Guangzhou 510010, China)
WANG Jun(MR Room Guangzhou General Hospital of PLA , Guangzhou 510010, China)
WANG Wei()
WANG Wei()
Journal Title:
Chinese Journal of Radiology
Volume 46, Issue 10, 2012
Key Word:
Cerebral cortex; Nervous system abnormalities; Magnetic resonance imaging

Abstract: Objective To analyze the MR imaging features of epileptogenic focal cortical dysplasia (FCD)and to optimize the scanning protocols by correlating MRI appearance with pathological findings.Methods MRI findings and the relative scanning protocols in 36 patients with surgically and pathologically proved 40 lesions of FCD were retrospectively analyzed. According to Palmini classification system,all 40 lesions were pathologically categorized as FCD type Ⅰ (including FCD Ⅰ A and FCD Ⅰ B) and FCD type Ⅱ (including FCD Ⅱ A and FCD ⅡB ). The distribution of cerebral or dual lesions accompanied hippocampal sclerosis were observed.Differences of the distribution of cerebral in FCD type Ⅰ and FCD type Ⅱ were compared by using Fisher exact probabilities. MR scans in all patients consisted of routine and optimized protocols.Axial FSE T2WI,axial SET1WI and axial FLAIR were recognized as routine scanning protocols,while adding oblique coronal FSE T2WI and FLAIR were recognized as optimization scanning protocols.Both routine and optimization scanning protocols were performed in all patients.The conspicuity of main findings of FCD on different imaging plane and sequences of each protocol were assessed.The detection of cerebral or dual lesion and the accompanied hippocampal sclerosis were compared between the routine protocol and the optimized protocol by using McNemar test.Results Forty lesions were found in 36 cases with FCD,29 had temporal lobe lesion (72.5% ),9 had frontal lobe lesion(22.5% ) and 2 had parietal lobe lesion (5.0%).According to Palmini classification system,29 lesions in 27 patients (72.5% ) were FCD type Ⅰ,11 lesions in 10 patients (27.5%) were FCD type Ⅱ lesions.There were 25 temporal lobe lesions in FCD type Ⅰ,while 4 in FCD type Ⅱ.There were statistically significant differences between FCD type Ⅰ group and FCD type Ⅱ group in the distribution of cerebral (P =0.002 ).Fourteen cases were found to have hippocampal sclerosis simultaneously,with 13 cases found in FCD type Ⅰ patients and 1 case in type Ⅱ patients.The detection rate of temporal lobe lesion was 65.5 % (19/29) and 44.8 % ( 13/29 ) respectively on optimized protocol and routine protocol.There was statistically significant difference ( x2 =4.167,P =0.031 ).The detection rate of hippocampal sclerosis was 85.7% (12/14) and 42.9% (6/14) respectively on optimized protocol and routine protocol respectively.There was statistically significant difference ( x2 =4.167,P =0.031 ).The detection rate of frontal lobe lesion showed no statistically significant difference between optimized protocols and routine protocols (x2 =0.304,P =1.000 ).Conclusions FCD was frequently involved the temporal lobe,followed by the frontal lobe.FCD type Ⅰ lesion was frequently found in the temporal lobe,with a higher incidence of concomitant hippocampal sclerosis. The optimized whole temporal lobe scanning with imaging plane perpendicular to the hippocampus long axis was a highly desired scanning protocol specifically for FCD,which is helpful for the detection of the FCD lesions.

  • [1]Sisodiya SM.Surgery for focal cortical dysplasia.Brain,2004,127(Pt 11):2383-2384.
  • [2]杨晓岚,陆钦池.局灶性皮质发育不良不同病理类型的MRI表现及预后.神经病学与神经康复学杂志,2009,6:289-292.
  • [3]胡滨,王进钢,廖卫平,等.不同病理分型局部脑皮质发育不良的MRI研究.中华神经医学杂志,2011,10:721-723.
  • [4]柳溪,孙吉林,吴晶,等.不同病理类型局灶性皮质发育不良的MRI特征.中华放射学杂志,2010,44:491-494.
  • [5]Widdess-Walsh P,Kellinghaus C,Jeha L,et al.Electro-clinical and imaging characteristics of focal cortical dysplasia:correlation with pathological subtypes.Epilepsy Res,2005,67:25-33.
  • [6]程彦昊,蔡立新,李坤成,等.局灶性脑皮质发育不良病理分型的MRI特点.中华放射学杂志,2007,41:493-495.
  • [7]Blümcke I,Thom M,Aronica E,et al.The clinicopathologic spectrum of focal cortical dysplasias:a consensus classification proposed by an ad hoc Task Force of the ILAE Diagnostic Methods Commission.Epilepsia,2011,52:158-174.
  • [8]Palmini A,Najm I,Avanzini G,et al. Terminology and classification of the cortical dysplasias.Neurology,2004,62 (6Suppl 3):S2-8.
  • [9]Colombo N,Tassi L,Galli C,et al.Focal cortical dysplasias:MR imaging,histopathologic,and clinical correlations in surgically treated patients with epilepsy.AJNR Am J Neuroradiol,2003,24:724-733.
  • [10]Bonilha L,Montenegro MA,Rorden C,et al. Voxel-based morphometry reveals excess gray matter concentration in patients with focal cortical dysplasia.Epilepsia,2006,47:908-915.
  • [11]Huppertz HJ,Wellmer J,Staack AM,et al.Voxel-based 3D MRI analysis helps to detect subtle forms of subcortical band heterotopia.Epilepsia,2008,49:772-785.
  • [12]Widjaja E,Zarei Mahmoodabadi S,Otsubo H,et al.Subcortical alterations in tissue microstructure adjacent to focal cortical dysplasia:detection at diffusion-tensor MR imaging by using magnetoencephalographic dipole cluster localization. Radiology,2009,251:206-215.
  • [13]Cepeda C,André VM,Levine MS,et al. Epileptogenesis in pediatric cortical dysplasia:the dysmature cerebral developmental hypothesis.Epilepsy Behav,2006,9:219-235.
  • [14]Colliot O,Bernasconi N,Khalili N,et al.Individual voxel-based analysis of gray matter in focal cortical dysplasia.Neuroimage,2006,29:162-171.
WanfangData CO.,Ltd All Rights Reserved
About WanfangData | Contact US
Healthcare Department, Fuxing Road NO.15, Haidian District Beijing, 100038 P.R.China
Tel:+86-010-58882616 Fax:+86-010-58882615