Zampeli Ariadne, Hansson Boel, Bloch Karin Markenroth, Englund Elisabet, Källén Kristina, Strandberg Maria Compagno, Björkman-Burtscher Isabella M
Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden.
Clinical Sciences Lund, Diagnostic Radiology, Lund University, Sweden.
Seizure. 2022 Oct;101:177-183. doi: 10.1016/j.seizure.2022.08.008. Epub 2022 Aug 20.
To analyze structural characteristics of malformations of cortical development (MCD) at 7T and 3T MRI.
Twenty-five patients were examined with a 7T MRI-scanner in addition to 3T examinations performed for epilepsy evaluation. 7T sequences included a 3D-T1-weighted (T1w) MPRAGE, 3D-T2w FLAIR, and heavily T2w axial and coronal high-resolution (0.5 × 0.5 × 0.75-1.0 mm) 2D-TSE sequences. Images were reviewed for 7T MRI imaging characteristics of MCD, visibility and frequency of identified lesions on 7T and on 3T (original reports and second reading).
In 25 patients 112 lesions were identified (57 gray matter (GM) heterotopia, 37 focal cortical dysplasia (FCD), and 18 other MCD). Imaging characteristics of the 37 FCD were cortical thickening (n = 11); GM-WM border blurring (n = 30); GM signal intensity changes (n = 18); juxtacortical WM signal intensity changes (n = 18); and transmantle WM signal intensity changes (n = 11). None of the 7T MRI sequences was sufficient to detect all types of lesions. Heterotopia were in general isointense to normal GM. Structural associations between 36 heterotopia and overlaying cortex were observed, composed either of a direct connection, vessel-like structures, or GM-like bridges. FCD were mentioned in 30% (11 of 37) of the original reports at 3T, and in 57% (21 of 37) after second reading. FCD connections to subcortical heterotopia were clinically not reported at all.
7T MRI revealed subtle connections between heterotopia and previous unidentified pathology in overlaying cortex. These findings may be significant for the understanding of the anatomical seizure origin and propagation pathways.
分析7T和3T磁共振成像（MRI）下皮质发育畸形（MCD）的结构特征。
25例患者除了接受用于癫痫评估的3T检查外，还接受了7T MRI扫描仪检查。7T序列包括3D-T1加权（T1w）MPRAGE序列、3D-T2w FLAIR序列以及重T2w轴位和冠状位高分辨率（0.5×0.5×0.75 - 1.0毫米）2D-TSE序列。对图像进行回顾，以分析MCD的7T MRI成像特征、7T和3T上已识别病变的可见性及频率（原始报告和二次读片）。
25例患者共识别出112个病变（57个灰质（GM）异位、37个局灶性皮质发育不良（FCD）和18个其他MCD）。37个FCD的成像特征包括皮质增厚（n = 11）；GM-白质（WM）边界模糊（n = 30）；GM信号强度改变（n = 18）；皮质下WM信号强度改变（n = 18）；以及穿通WM信号强度改变（n = 11）。没有一个7T MRI序列能够检测出所有类型病变。异位灶通常与正常GM等信号。观察到36个异位灶与覆盖皮质之间存在结构关联，表现为直接连接、血管样结构或GM样桥接。3T时的原始报告中提及30%（37个中的11个）的FCD，二次读片后提及率为57%（37个中的21个）。临床上完全没有报告FCD与皮质下异位灶的连接情况。
7T MRI揭示了异位灶与覆盖皮质中先前未识别的病变之间的细微连接。这些发现对于理解解剖学上的癫痫起源和传播途径可能具有重要意义。
