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Published on: May 20, 2016
Voxel based morphometry of FLAIR MRI in children with intractable focal epilepsy: implications for surgical
Catherine J Riney1, William K Chong, Chris A Clark
1Neuroscience Unit, Mater Children's Hospital, Raymond Terrace, South Brisbane, Queensland 4101, Australia. c.riney@ich.ucl.ac.uk
Purpose:
Magnetic resonance imaging (MRI), in particular fluid-attenuated inversion-recovery (FLAIR), has transformed the delineation of structural brain pathology associated with focal epilepsy. However, to date there is no literature on voxel based morphometry (VBM) of FLAIR in children with epilepsy. The aim of this study was to explore the role of visual and VBM assessment of FLAIR in pre-operative investigation of children with intractable focal epilepsy.
Methods:
Children with intractable epilepsy due to focal cortical dysplasia (FCD) and children with intractable cryptogenic focal epilepsy (CFE) were investigated. FLAIR and T1-weighted MRI were acquired on a 1.5T MRI scanner (Siemens, Erlangen, Germany). VBM was performed using SPM5 (Wellcome Institute of Cognitive Neuroscience, London).
Results:
Eight children with FCD (M = 5, age 7.9-17.3 years) and 14 children with CFE (M = 8, 7.8-16.8 years) were enrolled. VBM of FLAIR detected 7/8 (88%) of FCD whilst VBM of T1-weighted MRI detected only 3/8 (38%) FCD. VBM of FLAIR detected abnormality in 4/14 children with CFE, in 2/14 (14%) the abnormality was concordant with other data on the epileptogenic zone and with visible abnormality on repeat visual inspection of MR data. VBM of T1-weighed MRI detected abnormality in 2/14 children with CFE, none of which correlated with visible abnormality.
Discussion:
This study highlights the important role that FLAIR imaging has in the pre-operative assessment of children with intractable epilepsy. VBM of FLAIR may provide important information allowing selection of children with intractable CFE who are likely to benefit from further neuroradiological or neurophysiological evaluation.
Insights
Voxel based morphometry (VBM) of fluid-attenuated inversion-recovery (FLAIR) MRI is effective for detecting epilepsy causes in children. FLAIR-VBM identified more focal cortical dysplasia than T1-weighted MRI, aiding pre-operative assessment.
Area of Science:
- Pediatric Neurology
- Neuroradiology
- Epilepsy Research
Background:
- Magnetic resonance imaging (MRI), particularly fluid-attenuated inversion-recovery (FLAIR), is crucial for identifying brain abnormalities in focal epilepsy.
- Voxel based morphometry (VBM) analysis of FLAIR MRI has not been previously studied in pediatric epilepsy.
Purpose of the Study:
- To evaluate the utility of visual and VBM analysis of FLAIR MRI in the pre-operative assessment of children with intractable focal epilepsy.
- To compare the effectiveness of VBM of FLAIR versus T1-weighted MRI in detecting epileptogenic lesions.
Main Methods:
- Investigated children with intractable focal cortical dysplasia (FCD) and cryptogenic focal epilepsy (CFE).
- Acquired FLAIR and T1-weighted MRI data on a 1.5T scanner.
- Performed VBM analysis using SPM5 software.
Main Results:
- VBM of FLAIR detected 88% of FCD cases, significantly higher than T1-weighted MRI (38%).
- FLAIR-VBM identified abnormalities in 14% of CFE cases, correlating with other diagnostic data.
- T1-weighted MRI detected abnormalities in 2 CFE cases, with no correlation to visible findings.
Conclusions:
- FLAIR imaging plays a vital role in pre-operative evaluations for pediatric intractable epilepsy.
- VBM of FLAIR can provide valuable information for selecting pediatric CFE patients who may benefit from further neuroimaging or neurophysiological studies.
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