Diagnostic Accuracy of Epilepsy-dedicated MRI with Post-processing
Horst Urbach1, Christian Scheiwe2, Muskesh J Shah2
1Dept. of Neuroradiology, Medical Center, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany. horst.urbach@uniklinik-freiburg.de.
Purpose:
To evaluate the diagnostic accuracy of epilepsy-dedicated 3 Tesla MRI including post-processing by correlating MRI, histopathology, and postsurgical seizure outcomes.
Methods:
3 Tesla-MRI including a magnetization-prepared two rapid acquisition gradient echo (MP2RAGE) sequence for post-processing using the morphometric analysis program MAP was acquired in 116 consecutive patients with drug-resistant focal epilepsy undergoing resection surgery. The MRI, histopathology reports and postsurgical seizure outcomes were recorded from the patient's charts.
Results:
The MRI and histopathology were concordant in 101 and discordant in 15 patients, 3 no hippocampal sclerosis/gliosis only lesions were missed on MRI and 1 of 28 focal cortical dysplasia (FCD) type II associated with a glial scar was considered a glial scar only on MRI. In another five patients, MRI was suggestive of FCD, the histopathology was uneventful but patients were seizure-free following surgery. The MRI and histopathology were concordant in 20 of 21 glioneuronal tumors, 6 cavernomas, and 7 glial scars. Histopathology was negative in 10 patients with temporal lobe epilepsy, 4 of them had anteroinferior meningoencephaloceles. Engel class IA outcome was reached in 71% of patients.
Conclusion:
The proposed MRI protocol is highly accurate. No hippocampal sclerosis/gliosis only lesions are typically MRI negative. Small MRI positive FCD can be histopathologically missed, most likely due to sampling errors resulting from insufficient harvesting of tissue.
Insights
This study shows that 3 Tesla MRI with MP2RAGE is highly accurate for diagnosing drug-resistant focal epilepsy. While some subtle lesions may be missed, the protocol significantly aids in surgical planning and predicting seizure outcomes.
Area of Science:
- Neurology
- Radiology
- Pathology
Background:
- Drug-resistant focal epilepsy poses significant challenges in diagnosis and treatment.
- Accurate pre-surgical localization of epileptogenic foci is crucial for successful surgical outcomes.
Purpose of the Study:
- To assess the diagnostic accuracy of 3 Tesla MRI, utilizing MP2RAGE sequence and MAP post-processing, in patients with drug-resistant focal epilepsy.
- To correlate MRI findings with histopathology and postsurgical seizure outcomes.
Main Methods:
- 116 consecutive patients with drug-resistant focal epilepsy underwent 3 Tesla MRI with MP2RAGE sequence.
- Morphometric analysis program (MAP) was used for post-processing MRI data.
- MRI findings were compared with histopathology reports and postsurgical seizure outcomes.
Main Results:
- MRI and histopathology concordance was observed in 101 out of 116 patients.
- Three lesions (hippocampal sclerosis/gliosis only) were MRI-negative.
- Focal cortical dysplasia (FCD) type II was accurately identified in most cases, with one case misclassified as glial scar.
- Surgery led to seizure freedom (Engel class IA) in 71% of patients.
Conclusions:
- The 3 Tesla MRI protocol with MP2RAGE and MAP post-processing demonstrates high diagnostic accuracy for drug-resistant focal epilepsy.
- Subtle hippocampal sclerosis/gliosis lesions may not be detected by MRI.
- Discrepancies between MRI and histopathology for FCD may be attributed to tissue sampling errors.
More Related Videos
09:57Author Spotlight: Advancing Pediatric Epilepsy Surgery in Children Through Novel Biomarkers and Enhanced Localization
Published on: September 20, 2024
08:23A Multimodal Imaging- and Stimulation-based Method of Evaluating Connectivity-related Brain Excitability in Patients with Epilepsy
Published on: November 13, 2016
