Jeon Tae Yeon, Kim Ji Hye, Lee Jeehun, Yoo So-Young, Hwang Sook Min, Lee Munhyang
Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.
Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.
Korean J Radiol. 2017 Jul-Aug;18(4):729-738. doi: 10.3348/kjr.2017.18.4.729. Epub 2017 May 19.
To evaluate the value of repeat brain magnetic resonance imaging (MRI) in identifying potential epileptogenic lesions in children with initial MRI-negative focal epilepsy.
Our Institutional Review Board approved this retrospective study and waived the requirement for informed consent. During a 15-year period, 257 children (148 boys and 109 girls) with initial MRI-negative focal epilepsy were included. After re-evaluating both initial and repeat MRIs, positive results at repeat MRI were classified into potential epileptogenic lesions (malformation of cortical development and hippocampal sclerosis) and other abnormalities. Contributing factors for improved lesion conspicuity of the initially overlooked potential epileptogenic lesions were analyzed and classified into lesion factors and imaging factors.
Repeat MRI was positive in 21% (55/257) and negative in 79% cases (202/257). Of the positive results, potential epileptogenic lesions comprised 49% (27/55) and other abnormalities comprised 11% of the cases (28/257). Potential epileptogenic lesions included focal cortical dysplasia (n = 11), hippocampal sclerosis (n = 10), polymicrogyria (n = 2), heterotopic gray matter (n = 2), microlissencephaly (n = 1), and cortical tumor (n = 1). Of these, seven patients underwent surgical resection. Contributing factors for new diagnoses were classified as imaging factors alone (n = 6), lesion factors alone (n = 2), both (n = 18), and neither (n = 1).
Repeat MRI revealed positive results in 21% of the children with initial MRI-negative focal epilepsy, with 50% of the positive results considered as potential epileptogenic lesions. Enhanced MRI techniques or considering the chronological changes of lesions on MRI may improve the diagnostic yield for identification of potential epileptogenic lesions on repeat MRI.
评估重复脑磁共振成像（MRI）在识别初次MRI检查为阴性的局灶性癫痫患儿潜在致痫性病变中的价值。
本机构审查委员会批准了这项回顾性研究，并免除了知情同意的要求。在15年期间，纳入了257例初次MRI检查为阴性的局灶性癫痫患儿（148例男孩和109例女孩）。在重新评估初次和重复MRI后，将重复MRI的阳性结果分为潜在致痫性病变（皮质发育畸形和海马硬化）和其他异常。分析了最初被忽视的潜在致痫性病变的病变显示改善的相关因素，并将其分为病变因素和影像因素。
重复MRI检查中，21%（55/257）的病例为阳性，79%（202/257）的病例为阴性。在阳性结果中，潜在致痫性病变占49%（27/55），其他异常占11%（28/257）。潜在致痫性病变包括局灶性皮质发育不良（n = 11）、海马硬化（n = 10）、多小脑回（n = 2）、灰质异位（n = 2）、微小脑回畸形（n = 1）和皮质肿瘤（n = 1）。其中，7例患者接受了手术切除。新诊断的相关因素分类为仅影像因素（n = 6）、仅病变因素（n = 2）、两者皆有（n = 18）和两者皆无（n = 1）。
重复MRI检查显示，21%的初次MRI检查为阴性的局灶性癫痫患儿结果为阳性，其中50%的阳性结果被认为是潜在致痫性病变。增强MRI技术或考虑MRI上病变的时间变化可能会提高重复MRI检查中潜在致痫性病变的诊断率。
