Visual analysis of automated segmentation in the diagnosis of focal cortical dysplasias with magnetic resonance imaging.

Focal cortical dysplasias (FCDs) are a frequent cause of epilepsy. It has been reported that up to 40% of them cannot be visualized with conventional magnetic resonance imaging (MRI). The main objective of this work was to evaluate by means of a retrospective descriptive observational study whether the automated brain segmentation is useful for detecting FCD. One hundred and fifty-five patients, who underwent surgery between the years 2009 and 2016, were reviewed. Twenty patients with FCD confirmed by histology and a preoperative segmentation study, with ages ranging from 3 to 43 years (14 men), were analyzed. Three expert neuroradiologists visually analyzed conventional and advanced MRI with automated segmentation. They were classified into positive and negative concerning visualization of FCD by consensus. Of the 20 patients evaluated with conventional MRI, 12 were positive for FCD. Of the negative studies for FCD with conventional MRI, 2 (25%) were positive when they were analyzed with automated segmentation. In 13 of the 20 patients (with positive segmentation for FCD), cortical thickening was observed in 5 (38.5%), while pseudothickening was observed in the rest of patients (8, 61.5%) in the anatomical region of the brain corresponding to the dysplasia. This work demonstrated that automated brain segmentation helps to increase detection of FCDs that are unable to be visualized in conventional MRI images.

White matter abnormalities in patients with focal cortical dysplasia revealed by diffusion tensor imaging analysis in a voxelwise approach.

BACKGROUND: Diffusion tensor imaging (DTI) allows the analysis of changes in microstructure, through the quantification of the spread and direction of water molecules in tissues. We used fractional anisotropy (FA) maps to compare the integrity of WM between patients and controls. The objective of the present study was to investigate WM abnormalities in patients with frontal lobe epilepsy secondary to focal cortical dysplasia (FCD). MATERIALS AND METHODS: We included 31 controls (12 women, 33.1 ± 9.6 years, mean ± SD) and 22 patients (11 women, 30.4 ± 10.0 years), recruited from our outpatient clinic. They had clinical and EEG diagnosis of frontal lobe epilepsy, secondary to FCD detected on MRI. Patients and controls underwent 3T MRI, including the DTI sequence, obtained in 32 directions and b value of 1000 s/mm(2). To process the DTI we used the following softwares: MRIcroN and FSL/TBSS (tract-based spatial statistics). We used a threshold-free cluster enhancement with significance at p < 0.05, fully corrected for multiple comparisons across space. RESULTS: Areas with FA reduction in patients were identified in both hemispheres, mainly in the frontal lobes, cingulum, and forceps minor (p = 0.014), caudate e anterior thalamic radiation (p = 0.034), superior longitudinal fasciculus (p = 0.044), uncinate fasciculus, and inferior fronto-occipital fasciculus (p = 0.042). CONCLUSION: Our results showed a widespread pattern of WM microstructural abnormalities extending beyond the main lesion seen on MRI (frontal lobe), which may be related to frequent seizures or to the extent of MRI-invisible portion of FCD.