Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.
Epilepsy Center, Cleveland Clinic Foundation (CCF), Cleveland, OH, USA.
Eur J Neurol. 2019 Jul;26(7):969-e71. doi: 10.1111/ene.13916. Epub 2019 Mar 12.
Pre-surgical evaluation of pediatric patients with drug-resistant focal epilepsy and negative (non-lesional) magnetic resonance imaging (MRI) is particularly challenging. Focal cortical dysplasia (FCD), a frequent pathological substrate in such setting, may be subtle on MRI and evade detection. The aim of this study was to use voxel-based MRI postprocessing to improve the detection of subtle FCD in pediatric surgical candidates.
A consecutive cohort of pediatric patients undergoing pre-surgical evaluation with a negative MRI by visual analysis was included. MRI postprocessing was performed using a voxel-based morphometric analysis program (MAP) on T1-weighted volumetric MRI, with comparison to an age-specific normal pediatric database. The pertinence of MAP-positive areas was confirmed by surgical outcome and pathology.
A total of 78 patients were included. Forty-four patients (56%) had positive MAP regions. Complete resection of the MAP-positive regions was positively associated with seizure-free outcome compared with the no/partial resection group (P < 0.001). Patients with no/partial resection of the MAP-positive regions had worse seizure outcomes than the MAP-negative group (P = 0.002). The MAP-positive rate was 100%, 77%, 63% and 40% in the 3-5, 5-10, 10-15 and 15-21 year age groups, respectively. MAP-positive rates were 45% in patients with temporal resection and 63% in patients with extratemporal resection. Complete resection of the MAP-positive regions was positively associated with seizure-free outcome in the extratemporal group (P = 0.001) but not in the temporal group (P = 0.070).
Our data suggest the importance of using MRI postprocessing in the pre-surgical evaluation process of pediatric epilepsy patients with apparently normal MRI.
耐药性局灶性癫痫且磁共振成像（MRI）结果为阴性（无病变）的儿科患者的术前评估极具挑战性。此类情况下常见的病理基础为局灶性皮质发育不良（FCD），其在 MRI 上可能表现不明显，从而导致漏诊。本研究旨在通过基于体素的 MRI 后处理来提高对儿科手术候选者中隐匿性 FCD 的检测能力。
纳入了一组连续的接受术前评估且 MRI 结果为阴性的儿科患者。通过基于体素的形态计量分析程序（MAP）对 T1 加权容积 MRI 进行 MRI 后处理，并与年龄匹配的正常儿科数据库进行比较。通过手术结果和病理证实 MAP 阳性区域的相关性。
共纳入 78 例患者。44 例（56%）患者的 MAP 阳性区域。与无/部分切除组相比，MAP 阳性区域完全切除与无癫痫发作的结果呈正相关（P＜0.001）。无/部分切除 MAP 阳性区域的患者比 MAP 阴性组的癫痫发作结局更差（P=0.002）。3-5 岁、5-10 岁、10-15 岁和 15-21 岁年龄组的 MAP 阳性率分别为 100%、77%、63%和 40%。颞叶切除患者的 MAP 阳性率为 45%，而颞叶外切除患者的 MAP 阳性率为 63%。MAP 阳性区域完全切除与颞叶外切除患者的无癫痫发作结果呈正相关（P=0.001），但与颞叶切除患者无相关性（P=0.070）。
我们的数据表明，在 MRI 结果正常的儿科癫痫患者的术前评估过程中，使用 MRI 后处理非常重要。
