Voxel-Based Morphometric MRI Postprocessing in Nonlesional Pediatric Epilepsy Patients Using Pediatric Normal Databases
Abstract number :
1.232
Submission category :
5. Neuro Imaging / 5A. Structural Imaging
Year :
2017
Submission ID :
344710
Source :
www.aesnet.org
Presentation date :
12/2/2017 5:02:24 PM
Published date :
Nov 20, 2017, 11:02 AM
Authors :
Wei Wang, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China; Yicong Lin, Xuanwu Hospital, Capital Medical University, Beijing, China; Stephen Jones, Cleveland Clinic; Richard Prayson, Department of Anatomic Pathology, Clevel
Rationale: Presurgical evaluation of pediatric patients with drug-resistant focal epilepsy and negative MRI is particularly challenging. Focal cortical dysplasia (FCD), a frequent epileptogenic substrate in such setting may be subtle on MRI and may evade detection. The aim of this study was to use voxel-based MRI post-processing to improve detection of subtle FCD in pediatric surgical candidates with a negative MRI by visual analysis. Methods: We included a consecutive cohort of pediatric patients from the Cleveland Clinic surgical series from 2002 to 2015. MRI postprocessing was retrospectively performed using a 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. Results: A total of 78 nonlesional patients were included in the study. Forty-four patients (56%) had positive MAP regions, with a sensitivity of 0.95 and specificity of 0.64. Complete resection of the MAP-positive regions positively correlated with seizure-free outcome, when 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 50%, 77%, 63%, and 40% in the 3-5, 5-10, 10-15 and 15-21 year-old age groups, respectively. In subgroup analysis, MAP-positive rate was 45% in patients with temporal resection and 63% in patients with extratemporal resection. Complete resection of the MAP-positive regions positively correlated with seizure-free outcome in the extratemporal resection group (p= 0.003) but not in the temporal resection group (p = 0.078). Conclusions: MAP is a useful tool for detecting subtle and potentially epileptogenic lesions in children with drug-resistant, MRI-negative epilepsy. MAP positive rate is higher in the pediatric cohort compared with the positive rate previously reported in adult cohorts, suggesting the importance of using MRI postprocessing in the presurgical evaluation process of pediatric epilepsy patients with apparently normal MRI. Funding: None
Neuroimaging