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MRI volumetric analysis in rasmussen encephalitis: a longitudinal study
Masanori Takeoka1, Francine Kim, Verne S Caviness
1Department of Neurology, Children's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A. maxtakeoka@aol.com
Purpose:
Rasmussen encephalitis is a progressive inflammatory process with difficult-to-control focal or lateralized seizure activity, leading to hemispheric dysfunction and atrophy in advanced stages. Anatomic changes of atrophy may be subtle in earlier phases of the disease, and progressive changes on serial scans may be difficult to detect. We report a case of early-stage Rasmussen encephalitis with a relatively stable clinical course in whom we performed magnetic resonance imaging (MRI)-based volumetric analysis over an interval of 1 year, to assess for volumetric changes.
Methods:
Volumetric analysis was performed on two successive MRI scans obtained at age 5 and 6 years, by using the CARDVIEWS program (J Cogn Neurosci, 1996). The images were segmented into gray- and white-matter structures according to signal intensity of their borders semiautomatically, with manual corrections. The cerebral cortex was further subdivided into smaller parcellation units according to anatomic landmarks identifiable on MRI.
Results:
Stable left cerebral hemispheric atrophy and progressive atrophy in the left precentral gyrus, left inferior frontal gyrus, and left cerebellar atrophy were detected over the 1-year interval.
Conclusions:
Volumetric analysis enables early detection and quantification of anatomic changes, identification of focal involvement, and assists in determining the severity of disease and timing for surgical interventions such as hemispherectomy.
Insights
Magnetic resonance imaging (MRI)-based volumetric analysis detected early-stage Rasmussen encephalitis atrophy. This method aids in quantifying changes and guiding surgical decisions like hemispherectomy.
Area of Science:
- Neurology
- Neuroimaging
- Pediatric Neurology
Background:
- Rasmussen encephalitis is a progressive inflammatory brain condition causing severe seizures.
- Early diagnosis is challenging due to subtle or slowly progressing anatomical changes.
Purpose of the Study:
- To assess the utility of MRI-based volumetric analysis in detecting early-stage Rasmussen encephalitis.
- To quantify anatomical changes over a one-year interval in a pediatric patient.
Main Methods:
- Volumetric analysis was performed on serial MRI scans using the CARDVIEWS program.
- Image segmentation identified gray and white matter structures with manual corrections.
- Cerebral cortex was parcellated into smaller anatomical units.
Main Results:
- The study detected stable left cerebral hemispheric atrophy over one year.
- Progressive atrophy was identified in the left precentral gyrus, left inferior frontal gyrus, and left cerebellum.
Conclusions:
- Volumetric analysis facilitates early detection and quantification of anatomical changes in Rasmussen encephalitis.
- This technique aids in identifying focal disease involvement and assessing severity.
- It supports timely surgical intervention decisions, such as hemispherectomy.
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