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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Neurol. | doi: 10.3389/fneur.2018.01013

Application of MRI Post-processing in Presurgical Evaluation of Nonlesional Cingulate Epilepsy

 Shan Wang1, Bo Jin1, Thandar Aung2, Masaya Katagiri2,  Stephen E. Jones2, Balu Krishnan2,  Jorge Gonzalez-Martinez2, Richard Prayson2,  Imad M. Najm2, Andreas Alexopoulos2, Shuang Wang1,  Meiping Ding1 and  Irene Wang2*
  • 1Second Affiliated Hospital, Zhejiang University School of Medicine, China
  • 2Cleveland Clinic, United States

Background and purpose: Surgical management of patients with cingulate epilepsy (CE) is highly challenging, especially when the MRI is nonlesional. We aimed to use a voxel-based MRI post-processing technique, implemented in a morphometric analysis program (MAP), to facilitate detection of subtle epileptogenic lesions in CE, thereby improving surgical evaluation of patients with CE with nonlesional MRI by visual inspection.

Methods: Included in this retrospective study were 9 patients with CE (6 with negative MRI and 3 with subtly lesional MRI) who underwent surgery and became seizure-free or had marked seizure improvement with at least 1-year follow-up. MRI post-processing was applied to pre-surgical T1-weighted volumetric sequence using MAP, which was then co-registered with other imaging modalities. Patients were further studied in terms of their presurgical evaluation tests and surgical pathology.

Results: Single MAP+ abnormalities were found in 6 patients, including 3 patients with negative MRI and 3 patients with subtly lesional MRI. Out of these 6 MAP+ patients, 4 patients became seizure-free after complete resection of the MAP+ abnormalities; 2 patients didn’t become seizure-free following laser ablation that only partially overlapped with the MAP+ abnormalities. All MAP+ foci were concordant with intracranial EEG when performed. The localization value of FDG-PET, SPECT and MEG was limited. FCD was identified in all patients’ surgical pathology except for two cases of laser ablation with no tissue available.

Conclusion: MAP provided helpful information for identifying subtle epileptogenic abnormalities in patients with nonlesional cingulate epilepsy. MRI postprocessing should be considered to add to the presurgical evaluation test battery of nonlesional cingulate epilepsy.

Keywords: Epilepsy, Surgery, cingulate, MRI postprocessing, Nonlesional, focal cortical dysplasia

Received: 31 Aug 2018; Accepted: 09 Nov 2018.

Edited by:

Fernando Cendes, Universidade Estadual de Campinas, Brazil

Reviewed by:

Marino M. Bianchin, Universidade Federal do Rio Grande do Sul (UFRGS), Brazil
Xiaorong Liu, Guangzhou Medical University, China  

Copyright: © 2018 Wang, Jin, Aung, Katagiri, Jones, Krishnan, Gonzalez-Martinez, Prayson, Najm, Alexopoulos, Wang, Ding and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Prof. Irene Wang, Cleveland Clinic, Cleveland, United States, wangi2@ccf.org