Radiology Department, Clínica Alemana de Santiago, Vitacura, Chile.
Facultad de Medicina, Clínica Alemana - Universidad del Desarrollo, Santiago, Chile.
Epilepsia Open. 2021 Jan 13;6(1):235-238. doi: 10.1002/epi4.12456. eCollection 2021 Mar.
To report our initial experience using an adult-template MAP in drug-resistant focal epilepsy in five children with apparently normal MRI.
Patients selected were highly suspicious of harboring focal structural lesions and had negative brain MRI studies. MAP was performed using a locally obtained adult database as a template. Results were reviewed by two neuroradiologists. Pertinence of MAP-positive areas was confirmed by the focal epileptic hypothesis or by pathology when possible (, 39, 2012, 87). Visual analysis was performed using Mango Software. MRI studies were reanalyzed at the workstation with knowledge of the clinical suspicion to confirm or discard the possibility of FCD.
Five patients aged 19-48 months were studied, all with initial 3T MRI studies interpreted as normal. All had focal epileptic hypothesis with coherence of clinical seizure characterization and electroencephalographic findings. In two patients, histology showed type 1 FCD. Due to the age of our subjects, the junction map always highlighted the subcortical white matter in relationship to maturity differences. FCD was identified as asymmetric U-shaped highlighted regions in the junction map.
FCD is the most frequent pathology reported in pediatric epilepsy surgery series (, 18, 2016, 240). Significant number of FCDs may be overlooked on MRIs, reducing the odds of seizure freedom after surgery (, 89, 2010, 310). MAP is an image postprocessing method for enhanced visualization of FCD; however, when using an adult template in developing brains, normal subcortical regions may be highlighted as pathological. Creating a pediatric template is difficult, due to the need for general anesthesia to acquire the MRI database. Here, we were able to show that MAP identified FCDs as asymmetric "U-" shaped highlighted regions in the junction maps of all five patients, which may indicate that obtaining childhood databases for this purpose may not be necessary and that adult ones suffice for diagnosis of FCD.
报告我们在五例 MRI 未见明显异常的耐药性局灶性癫痫儿童中，应用成人模板磁共振波谱分析（MAP）的初步经验。
选择高度怀疑存在局灶性结构性病变且脑 MRI 检查结果阴性的患者。使用局部获取的成人数据库作为模板进行 MAP。由两名神经放射科医生对结果进行评估。根据局灶性癫痫假说或可能的病理结果（n = 39，2012 年，87）来验证 MAP 阳性区域的相关性。使用 Mango 软件进行视觉分析。在工作站上重新分析 MRI 研究，结合临床怀疑，以确认或排除 FCD 的可能性。
研究了 5 例年龄 19-48 个月的患者，所有患者的初始 3T MRI 研究均解释为正常。所有患者均具有局灶性癫痫假说，临床发作特征和脑电图发现具有一致性。在 2 例患者中，组织学显示为 1 型 FCD。由于研究对象的年龄，交界图始终突出显示与成熟度差异相关的皮质下白质。交界图中识别出 FCD 为不对称 U 形高亮区域。
FCD 是儿科癫痫手术系列中最常见的病理（n = 18，2016 年，240）。MRI 上可能会忽略大量的 FCD，从而降低手术后无癫痫发作的几率（n = 89，2010 年，310）。MAP 是一种增强 FCD 可视化的图像后处理方法；然而，在发育中的大脑中使用成人模板时，正常的皮质下区域可能会被突出显示为病理性。由于需要全身麻醉来获取 MRI 数据库，因此很难创建儿科模板。在这里，我们能够表明 MAP 在所有 5 例患者的交界图中识别出 FCD 为不对称的“U”形高亮区域，这可能表明为此目的获取儿童数据库可能不是必需的，而使用成人数据库即可诊断 FCD。
