Radiologic-pathologic correlation in focal cortical dysplasia and hemimegalencephaly in 18 children
C L Woo1, S H Chuang, L E Becker
1Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Radiologic-pathologic correlation in pediatric epilepsy surgery showed MRI accuracy in 16 of 18 patients. Key findings included abnormal gyral formation, cortical thickness, and signal changes, correlating with neuronal heterotopia and abnormal cortical lamination.
Area of Science:
- Neurology
- Radiology
- Pathology
Background:
- Medically intractable epilepsy in children often requires surgical intervention.
- Focal cortical dysplasia and hemimegalencephaly are common pathologies in pediatric epilepsy.
- Accurate preoperative diagnosis is crucial for successful epilepsy surgery outcomes.
Purpose of the Study:
- To establish the radiologic-pathologic correlation in pediatric epilepsy surgery patients.
- To evaluate the accuracy of magnetic resonance imaging (MRI) in diagnosing cortical malformations.
- To correlate MRI findings with histopathological features of focal cortical dysplasia and hemimegalencephaly.
Main Methods:
- Retrospective review of MRI and pathology data from 18 children undergoing epilepsy surgery.
- Neuroradiologist reviewed preoperative MRIs blinded to radiologic diagnosis and pathology.
- Pathological examination included assessment of neuronal heterotopia, alignment, size, and cortical lamination.
Main Results:
- MRI accurately diagnosed the underlying cause in 16 out of 18 patients.
- Common MRI findings included abnormal gyral formation, cortical thickness, loss of gray-white differentiation, and T2-weighted signal abnormalities.
- Pathological findings frequently included neuronal heterotopia, neuronal misalignment, large neurons, and abnormal cortical lamination.
Conclusions:
- MRI demonstrates high accuracy in preoperative diagnosis for pediatric epilepsy surgery.
- Specific MRI characteristics correlate with underlying pathological features like neuronal heterotopia and abnormal cortical lamination.
- Understanding these radiologic-pathologic correlations can optimize surgical planning and improve outcomes in pediatric epilepsy.
Abstract:
To describe the radiologic-pathologic correlation in children who underwent epilepsy surgery for medically intractable epilepsy with pathologically confirmed focal cortical dysplasia and hemimegalencephaly, we conducted a retrospective review on the magnetic resonance imaging and pathology of 18 children (10 boys and 8 girls). The preoperative MRIs were reviewed by one neuroradiologist who did not know the radiologic diagnosis and the pathology reports. MRI revealed focal cortical dysplasia (10), hemimegalencephaly (3), hamartomas (2), polymicrogyria (1), pial hemosiderosis (1), and no abnormality (1). Pathologic examination revealed focal cortical dysplasia (9), forme fruste of tuberous sclerosis (5), hemimegalencephaly (3), and focal cortical dysplasia with mesial temporal sclerosis (1). MRI was accurate in making the preoperative diagnosis in 16 out of 18 patients. On MRI, 12 patients had abnormal gyral formation and 12 had abnormal cortical thickness. Eleven patients manifested loss of gray-white differentiation, and 11 patients had abnormal signal on T(2)-weighted image. Pathologically, 15 patients had neuronal heterotopia, 12 had misalignment or disorientation of neurons, 11 had large neurons, and 10 had abnormal cortical lamination. The presence of ectopic and large neurons and abnormal cortical lamination may be responsible for the MRI characteristics.
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