Related Experiment Videos
Cerebral cortical dysplasia: assessment by MRI and SPECT
1Department of Child Neurology, National Center Hospital for Mental, Nervous and Muscular Disorders, National Center of Neurology and Psychiatry, Tokyo, Japan.
Abstract:
The objective of this study was to establish correlations between image findings and pathologic deficits in patients with cerebral cortical malformations. The results of magnetic resonance imaging (MRI) and single-photon emission computed tomography (SPECT) in addition to clinical data for 15 patients with cerebral cortical malformations were reviewed retrospectively. MRI led to the diagnoses of bilateral perisylvian syndrome, hemimegalencephaly, focal polymicrogyria, band-heterotopia, and focal cortical dysplasia (FCD). Interictal SPECT did not reveal hypoperfusion in any case of polymicrogyria. Ictal SPECT images revealed hyperperfusion of the lesion in three patients with polymicrogyria, with accompanying hyperperfusion of the basal ganglia in two of the three patients. On the other hand, interictal SPECT images demonstrated hypoperfusion of the lesion in four patients with FCD. Ictal SPECT images revealed hypoperfusion of the lesion in two patients, hyperperfusion of the lesion in one patient, and hypoperfusion of the basal ganglia in two patients with FCD. This difference in perfusion between polymicrogyria and FCD observed in this study may reflect histologically different characteristics. This relative hyperperfusion of the cortex and the basal ganglia observed on ictal SPECT, which was found in two polymicrogyria patients with complex partial seizures and partial seizures evolving to secondary generalized seizures, respectively, suggests that the cortical-subcortical interaction is related to the mechanism of loss of consciousness or seizure generation.
Insights
This study correlated neuroimaging findings with pathology in cerebral cortical malformations. Ictal SPECT revealed distinct perfusion patterns in polymicrogyria versus focal cortical dysplasia, suggesting different underlying mechanisms.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Cerebral cortical malformations are a diverse group of developmental brain disorders.
- Accurate diagnosis and understanding of pathophysiology are crucial for patient management.
Purpose of the Study:
- To establish correlations between neuroimaging findings (MRI, SPECT) and pathological deficits in patients with cerebral cortical malformations.
- To differentiate between various types of cortical malformations based on perfusion patterns.
Main Methods:
- Retrospective review of clinical data, magnetic resonance imaging (MRI), and single-photon emission computed tomography (SPECT) in 15 patients.
- Analysis of interictal and ictal SPECT findings in relation to specific malformations.
Main Results:
- MRI identified various malformations including polymicrogyria and focal cortical dysplasia (FCD).
- Ictal SPECT showed hyperperfusion in polymicrogyria lesions, sometimes involving basal ganglia.
- Interictal SPECT revealed hypoperfusion in FCD lesions, with variable ictal SPECT findings.
Conclusions:
- Distinct perfusion patterns on SPECT may reflect histological differences between polymicrogyria and FCD.
- Cortical-subcortical interactions, suggested by ictal SPECT findings, may play a role in seizure generation and consciousness.