Improved detection of focal cortical dysplasia using a novel 3D imaging sequence: Edge-Enhancing Gradient Echo...

Epilepsy is a common neurological disorder with focal cortical dysplasia (FCD) being one of the most common lesional causes. Detection of FCD by MRI is a major determinant of surgical outcome. Evolution of MRI sequences and hardware has greatly increased the detection rate of FCD, but these gains have largely been related to the more visible Type IIb FCD, with Type I and IIa remaining elusive. While most sequence improvements have relied on increasing contrast between gray and white matter, we propose a novel imaging approach, 3D Edge-Enhancing Gradient Echo (3D-EDGE), to directly image the gray-white boundary. By acquiring images at an inversion time where gray and white matter have equal signal but opposite phases, voxels with a mixture of gray and white matter (e.g., at the gray-white boundary) will have cancellation of longitudinal magnetization producing a thin area of signal void at the normal boundary. By creating greater sensitivity for minor changes in T1 relaxation, microarchitectural abnormalities present in FCD produce greater contrast than on other common MRI sequences. 3D-EDGE had a significantly greater contrast ratio between lesion and white matter for FCD compared to MP2RAGE (98% vs 17%; p = 0.0006) and FLAIR (98% vs 19%; p = 0.0006), which highlights its potential to improve outcomes in epilepsy. We present a discussion of the framework for 3D-EDGE, optimization strategies, and analysis of a series of FCDs to highlight the benefit of 3D-EDGE in FCD detection compared to commonly used sequences in epilepsy.