Wong-Kisiel Lily C, Tovar Quiroga Diego F, Kenney-Jung Daniel L, Witte Robert J, Santana-Almansa Alexandra, Worrell Gregory A, Britton Jeffrey, Brinkmann Benjamin H
Department of Neurology, Mayo Clinic, 200 First St., SW, Rochester, MN, 55905, USA.
Department of Radiology, Mayo Clinic, 200 First St., SW, Rochester, MN, 55905, USA.
Epilepsy Res. 2018 Feb;140:184-191. doi: 10.1016/j.eplepsyres.2018.01.018. Epub 2018 Jan 31.
Focal cortical dysplasia (FCD) is a common pathology in focal drug resistant epilepsy (DRE). Voxel based morphometric MRI analysis has been proposed as an adjunct to visual detection of FCD, which remains challenging given the subtle radiographic appearance of FCD. This study evaluates the diagnostic value of morphometric analysis program (MAP) in focal DRE with pathology-confirmed FCD.
Automated morphometric analysis program analysis generated z-score maps derived from T1 images, referenced to healthy adult or pediatric controls for each of 39 cases with pathology-confirmed FCD. MAP identified abnormal extension of gray matter into white matter (MAP-E) and blurring of the gray-white matter junction (MAP-J), independently of clinical data and other imaging modalities. MRI was visually reviewed by neuroradiologists as part of usual clinical care, and independently re-reviewed retrospectively by a neuroradiologist with >10-years' experience in epilepsy MRI. Sensitivity and specificity were calculated for MRI, MAP, scalp-EEG, PET and SISCOM compared to resection area (RA).
In this cohort of 39 histologically proven FCD cases, the sensitivity and specificity of MAP-J [64% (95% CI 48%-77%) and 96% (95% CI 93%-0.98%)] and MAP-E [74% (95% CI 59%-86%) and 94% (95% CI 91%-97%)] were higher than qualitative MRI review, SISCOM, and FDG-PET. Initial MRI review detected FCD in 17, expert review identified 26. Among cases not detected by initial MRI review, MAP-J correctly identified FCD in 12 additional cases and MAP-E in 13 cases. Among cases not detected by expert MRI review, MAP-J correctly identified 6 and MAP-E 8 cases. Excellent surgical outcome was achieved in 76% of patients.
MAP showed favorable sensitivity compared to visual inspection and other non-invasive imaging modalities. MAP complements non-invasive imaging evaluation for detection of FCD in focal DRE patients.
局灶性皮质发育不良（FCD）是局灶性药物难治性癫痫（DRE）的常见病理表现。基于体素的形态计量学MRI分析已被提议作为视觉检测FCD的辅助手段，鉴于FCD的影像学表现较为细微，视觉检测仍具有挑战性。本研究评估形态计量分析程序（MAP）在病理确诊为FCD的局灶性DRE中的诊断价值。
自动形态计量分析程序分析从T1图像生成z评分图，以39例病理确诊为FCD的病例中的每一例的健康成人或儿童对照为参考。MAP可独立于临床数据和其他成像方式识别灰质向白质的异常延伸（MAP-E）以及灰白质交界模糊（MAP-J）。神经放射科医生在常规临床护理过程中对MRI进行视觉评估，并由一位在癫痫MRI方面有超过10年经验的神经放射科医生进行回顾性独立复查。将MRI、MAP、头皮脑电图、PET和SISCOM与切除区域（RA）进行比较，计算其敏感性和特异性。
在这组39例经组织学证实的FCD病例中，MAP-J[64%（95%CI 48%-77%）和96%（95%CI 93%-0.98%）]和MAP-E[74%（95%CI 59%-86%）和94%（95%CI 91%-97%）]的敏感性和特异性高于定性MRI评估、SISCOM和FDG-PET。初始MRI评估检测出17例FCD，专家评估识别出26例。在初始MRI评估未检测出的病例中，MAP-J又正确识别出12例FCD，MAP-E正确识别出13例。在专家MRI评估未检测出的病例中，MAP-J正确识别出6例，MAP-E正确识别出8例。76%的患者手术效果良好。
与视觉检查和其他非侵入性成像方式相比，MAP显示出良好的敏感性。MAP可补充非侵入性成像评估，用于检测局灶性DRE患者的FCD。
