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Multimodal quantitative magnetic resonance imaging analysis with individualized postprocessing in patients with drug-resistant focal epilepsy and conventional visual inspection negative for epileptogenic lesions
Abud, Lucas Giansante; Velasco, Tonicarlo Rodrigues; Salmon, Carlos Ernesto Garrido; Sakamoto, Americo Ceiki; Abud, Thiago Giansante; Pessini, Rodrigo Antonio; Abud, Daniel Giansante; Leite, João Pereira; dos Santos, Antonio Carlos.
  • Abud, Lucas Giansante; Universidade de Sao Paulo. Divisao de Neurorradiologia, Faculdade de Medicina de Ribeirao Preto. Ribeirao Preto. BR
  • Velasco, Tonicarlo Rodrigues; Universidade de Sao Paulo. Departamento de Neurologia, Faculdade de Medicina de Ribeirao Preto. Ribeirao Preto. BR
  • Salmon, Carlos Ernesto Garrido; Ciencias e Letras de Ribeirao Preto, Universidade de Sao Paulo. Departamento de Fisica e Matematica, Faculdade de Filosofia. Ribeirao Preto. BR
  • Sakamoto, Americo Ceiki; Universidade de Sao Paulo. Departamento de Neurologia, Faculdade de Medicina de Ribeirao Preto. Ribeirao Preto. BR
  • Abud, Thiago Giansante; Universidade Federal de Sao Paulo. Departamento de Diagnostico por Imagem, Escola Paulista de Medicina. Sao Paulo. BR
  • Pessini, Rodrigo Antonio; Universidade de Sao Paulo. Divisao de Ciencias da Imagem e Fisica Medica, Faculdade de Medicina de Ribeirao Preto. Ribeirao Preto. BR
  • Abud, Daniel Giansante; Universidade de Sao Paulo. Divisao de Neurorradiologia, Faculdade de Medicina de Ribeirao Preto. Ribeirao Preto. BR
  • Leite, João Pereira; Universidade de Sao Paulo. Departamento de Neurologia, Faculdade de Medicina de Ribeirao Preto. Ribeirao Preto. BR
  • dos Santos, Antonio Carlos; Universidade de Sao Paulo. Divisao de Neurorradiologia, Faculdade de Medicina de Ribeirao Preto. Ribeirao Preto. BR
Clinics ; 74: e908, 2019. tab, graf
Article in English | LILACS | ID: biblio-1011907
ABSTRACT

OBJECTIVES:

Approximately one-third of candidates for epilepsy surgery have no visible abnormalities on conventional magnetic resonance imaging. This is extremely discouraging, as these patients have a less favorable prognosis. We aimed to evaluate the utility of quantitative magnetic resonance imaging in patients with drug-resistant neocortical focal epilepsy and negative imaging.

METHODS:

A prospective study including 46 patients evaluated through individualized postprocessing of five quantitative

measures:

cortical thickness, white and gray matter junction signal, relaxation rate, magnetization transfer ratio, and mean diffusivity. Scalp video-electroencephalography was used to suggest the epileptogenic zone. A volumetric fluid-attenuated inversion recovery sequence was performed to aid visual inspection. A critical assessment of follow-up was also conducted throughout the study.

RESULTS:

In the subgroup classified as having an epileptogenic zone, individualized postprocessing detected abnormalities within the region of electroclinical origin in 9.7% to 31.0% of patients. Abnormalities outside the epileptogenic zone were more frequent, up to 51.7%. In five patients initially included with negative imaging, an epileptogenic structural abnormality was identified when a new visual magnetic resonance imaging inspection was guided by information gleaned from postprocessing. In three patients, epileptogenic lesions were detected after visual evaluation with volumetric fluid-attenuated sequence guided by video electroencephalography.

CONCLUSION:

Although quantitative magnetic resonance imaging analyses may suggest hidden structural lesions, caution is warranted because of the apparent low specificity of these findings for the epileptogenic zone. Conversely, these methods can be used to prevent visible lesions from being ignored, even in referral centers. In parallel, we need to highlight the positive contribution of the volumetric fluid-attenuated sequence.
Subject(s)


Full text: Available Index: LILACS (Americas) Main subject: Magnetic Resonance Imaging / Drug Resistant Epilepsy Type of study: Diagnostic study / Observational study / Prognostic study Limits: Adult / Female / Humans / Male Language: English Journal: Clinics Journal subject: Medicine Year: 2019 Type: Article Affiliation country: Brazil Institution/Affiliation country: Ciencias e Letras de Ribeirao Preto, Universidade de Sao Paulo/BR / Universidade Federal de Sao Paulo/BR / Universidade de Sao Paulo/BR

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Full text: Available Index: LILACS (Americas) Main subject: Magnetic Resonance Imaging / Drug Resistant Epilepsy Type of study: Diagnostic study / Observational study / Prognostic study Limits: Adult / Female / Humans / Male Language: English Journal: Clinics Journal subject: Medicine Year: 2019 Type: Article Affiliation country: Brazil Institution/Affiliation country: Ciencias e Letras de Ribeirao Preto, Universidade de Sao Paulo/BR / Universidade Federal de Sao Paulo/BR / Universidade de Sao Paulo/BR