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Updated: Jun 23, 2025
A Multimodal Imaging- and Stimulation-based Method of Evaluating Connectivity-related Brain Excitability in Patients with Epilepsy
Published on: November 13, 2016
[Differential diagnosis of epileptogenic substrates of unknown etiology using a modification of the routine MRI
V S Khalilov1,2, A N Kislyakov3, N A Medvedeva4
1Federal Research and Clinical Center for Children and Adolescents, Moscow, Russia.
Objective:
To evaluate the diagnostic capabilities of modifying the standard MRI protocol as part of an interdisciplinary presurgical examination of patients with epileptogenic substrates of unknown etiology.
Material And Methods:
The results of dynamic MRI of 8 patients with a referral diagnosis of focal cortical dysplasia (FCD) were analyzed. In 7 patients, epilepsy was the reason for a standard MRI of the brain; in another patient with myasthenia, MRI was performed as part of a comprehensive examination. All patients, in addition to standard MRI, underwent a modification of the real-time scanning protocol to include contrast, tractography (DTI), and perfusion techniques (ASL/DSC). In 1 case, with questionable results, the results of a modification of the standard MRI protocol, high-resolution MRI (HR MRI) and hybrid positron emission CT with 11C-methionine (PET/CT with 11C-MET) were combined.
Results:
Seven patients underwent epileptic surgery and 1 patient was operated on for a tumor. In 4 out of 8 patients, based on the results of a modification of the standard MRI protocol, radiological signs of a neoplastic process were identified, which suggested a low-grade tumor. One of them needed PET/CT to confirm the assumption. The results of pathomorphological examination correlated with the direct diagnosis for surgical treatment. One of the 4 patients was suspected to have dysembryoplastic neuroepithelial tumor (DNET) based on the results of the protocol modification, which was also confirmed by pathological examination. In another 4 patients in whom it was possible to narrow the differential between FCD type II and DNET based on the results of the modification, FCD IIb was pathomorphologically verified.
Conclusion:
The proposed modification of the standard MRI protocol can significantly facilitate the differential diagnosis between the neoplastic and dysplastic origin of an epileptogenic substrate of unknown etiology, which in turn affects the patient's management tactics.
Insights
Modified MRI protocols aid in differentiating neoplastic from dysplastic causes of epilepsy. This enhanced diagnostic approach improves presurgical evaluation for unknown epileptogenic substrates.
Area of Science:
- Neuroimaging
- Neuroradiology
- Epileptology
Context:
- Epileptogenic substrates of unknown etiology pose diagnostic challenges.
- Accurate presurgical evaluation is crucial for effective epilepsy management.
Purpose:
- To assess the diagnostic utility of a modified MRI protocol in differentiating neoplastic from dysplastic brain lesions in epilepsy patients.
- To evaluate the role of advanced MRI techniques (contrast, DTI, ASL/DSC) in presurgical diagnosis.
Summary:
- A modified MRI protocol integrating dynamic scanning, contrast, diffusion tensor imaging (DTI), and perfusion techniques was applied to 8 patients with suspected focal cortical dysplasia (FCD).
- The modified protocol successfully identified neoplastic processes in 4 patients, including a dysembryoplastic neuroepithelial tumor (DNET), and helped differentiate FCD type IIb from DNET in others.
- High-resolution MRI and PET/CT with 11C-methionine were used in one complex case for confirmation.
Impact:
- The modified MRI protocol enhances differential diagnosis between neoplastic and dysplastic epileptogenic substrates.
- Improved diagnostic accuracy influences patient management strategies and surgical planning for epilepsy.
- This approach offers a more refined presurgical assessment for complex epilepsy cases.
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