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MRI of focal cortical dysplasia
Horst Urbach1, Elias Kellner2, Nico Kremers3
1Dept. of Neuroradiology, Medical Center - University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany. horst.urbach@uniklinik-freiburg.de.
Abstract:
Focal cortical dysplasia (FCD) are histopathologically categorized in ILAE type I to III. Mild malformations of cortical development (mMCD) including those with oligodendroglial hyperplasia (MOGHE) are to be integrated into this classification yet. Only FCD type II have distinctive MRI and molecular genetics alterations so far. Subtle FCD including FCD type II located in the depth of a sulcus are often overlooked requiring the use of dedicated sequences (MP2RAGE, FLAWS, EDGE) and/or voxel (VBM)- or surface-based (SBM) postprocessing. The added value of 7 Tesla MRI has to be proven yet.
Insights
Focal cortical dysplasia (FCD) classification needs to include mild malformations. Subtle FCD type II, especially in sulci, requires advanced MRI and postprocessing for detection.
Area of Science:
- Neuroscience
- Neuropathology
- Radiology
Background:
- Focal cortical dysplasia (FCD) is histopathologically classified into ILAE types I-III.
- Mild malformations of cortical development (mMCD), including MOGHE, require integration into current FCD classifications.
- Currently, only FCD type II exhibits distinct MRI and molecular genetic alterations.
Purpose of the Study:
- To discuss the integration of mMCD into FCD classification.
- To highlight the diagnostic challenges of subtle FCD type II.
- To explore advanced MRI techniques and postprocessing for detecting subtle FCD.
Main Methods:
- Review of current FCD classification systems.
- Discussion of advanced MRI sequences (MP2RAGE, FLAWS, EDGE).
- Consideration of voxel-based morphometry (VBM) and surface-based morphometry (SBM) postprocessing.
Main Results:
- Subtle FCD, particularly type II within sulci, is frequently overlooked.
- Dedicated MRI sequences and advanced postprocessing methods are crucial for detecting subtle FCD.
- The diagnostic value of 7 Tesla MRI for FCD requires further investigation.
Conclusions:
- Integrating mMCD into the FCD classification framework is necessary.
- Advanced neuroimaging techniques are essential for identifying subtle FCD lesions.
- Further research is needed to establish the role of 7 Tesla MRI in FCD diagnosis.
