4. Diagnostic contribution of focal cortical dysplasia MRI imaging findings and ADC values. Transmantle sign in focal cortical dysplasia: a unique radiological entity with excellent prognosis for seizure control. 62:S2–S8, Crino PB, Miyata H, Vinters HV (2002) Neurodevelopmental disorders as a cause of seizures: neuropathologic, genetic, and mechanistic considerations. Palmini A, Najm I, Avanzini G et-al. However, its relationship with cortical thickening and blurring in GW matter is an important sign for the diagnosis of FCD. For paired comparisons, we used the parametric “Student’s t test” for groups with a normal distribution and the “Mann-Whitney U test” for groups with a non-normal distribution. The current study aimed to determine the prevalence of previously described MR imaging criteria for FCD, to identify MR imaging findings (with the goal of optimizing the detection of FCD in clinical practice), to measure the mean ADC values, and to compare these values with those of cortical-subcortical lesions to determine whether this parameter will be useful in the differential diagnosis of FCD. Surgical resection of the refractory epileptogenic area of focal cortical dysplasia typically leads to good seizure control. c Cortical signal intensity in coronal T2A sequence, blurring in white-gray matter interface. Imaging findings were suggestive of focal cortical dysplasia (closely related to Taylor type IIa). Abstract. Vojnosanit Pregl 72(10):870–875, Bai X, Zhang Y, Liu Y (2011) Grading of supratentorial astrocytic tumors by using the difference of ADC value. Our current findings were similar to those in the literature in terms of gender, hemispheric distribution, and lobar distribution. 7. General features of focal cortical dysplasia include 4: Also, each type of focal cortical dysplasia can exhibit more or less of these features. Dev Med Child Neurol 37:159–166, Lee SK, Choe G, Hong KS et al (2001) Neuroimaging findings of cortical dyslamination with cytomegaly. There was cortical thickening and an increase in cortical signal intensity in 40 patients (63%), subcortical hyperintensity and blurring in the gray-white matter interface in 50 patients (79%), and blurring in the gray-white matter interface, subcortical hyperintensity, and transmantle sign in 29 patients (46%). Balloon cells: these cells are pathognomonic for Taylor type dysplasia [1]. It is a frequent cause of refractory epilepsy. Reduced N-acetylaspartate:creatinine ratio (NAA:Cr) and increased Myoinositol (ml) rates can be monitored via magnetic resonance spectroscopy (MRS). Knowledge of focal cortical dysplasia magnetic resonance imaging (MRI) characteristics is of utmost importance for diagnosis. FCD was first differentiated from developmental malformations in ten patients by Taylor et al. "Blumcke Type IIB"). 4 … Springer Nature. We believe that further investigation of these findings may lead to an easier diagnosis of patients with suspected FCD. c Increase in cortical signal intensity in coronal T2A sequence-blurring in GW matter interface. The pathologic features of resected specimens are identical to those of any focal cortical dysplasia. AA designed the article, made the division of labor. Epilepsy Res 67:25–33, Colombo N, Citterio A, Galli C et al (2003) Neuroimaging of focal cortical dysplasia: neuropathological correlations. MAD checked the suitability of the manuscript for academic language. FCD type IIIa is characterized by volume loss in the anterior temporal lobe with abnormal white matter hyperintensity on T2 and FLAIR images, while the cortex appears normal from other views [8]. MRI findings in FCD depend on both the size and the characteristics of the lesions. The difference between the rates of subcortical signal changes in our current study and in the literature may be due to the fact that our current study only included patients with positive MRI findings. The mean ADC values in these areas were calculated directly on the ADC maps. J Neurol Neurosurg Psychiatry 76:710–713, Jin G, An N, Jacobs MA, Li K (2010) The role of parallel diffusion-weighted imaging and apparent diffusion coefficient (ADC) map values for evaluating breast lesions: preliminary results. Cerebrospinal Fluid Cleft with Cortical Dimple: MR Imaging Marker for Focal Cortical Dysgenesis1. Because there has been a rapid development in the fields of genetics and diagnostics, FCD should be reviewed by these disciplines, which may lead to an increased number of treatment methods for this disease. a Cortical thickening in axial T1A sequence. Brain Pathol 12:212–233, Cepeda C, Hurst RS, Flores-Hernandez J et al (2003) Morphological and electrophysiological characterization of abnormal cell types in pediatric cortical dysplasia. Neurology. Focal cortical dysplasias (FCDs) were first described in detail by Taylor et al. Abstract. Unable to process the form. In the presence of transmantle sign better post-surgical outcomes have been reported. d Hyperintense area in axial dADC sequence, ADC measurement from this area and from a symmetrical area, A 36-year-old female patient with epilepsy. The transmantle sign was positive in 46% of the patients in our current study, while previous studies report this range between 20 and 83% [10, 11, 13, 15, 23]. 1 March 2000 | Radiology, Vol. All of the FCD cranial MRI findings are summarized in Table 5. In a study conducted with 71 patients (male/female ratio of 1:3) who were diagnosed with FCD type 2b using histopathological correlation, there was a left/right hemisphere ratio of 1:35, and lobar distribution was as follows: frontal lobe (n = 60), parietal lobe (n = 7), temporal lobe (n = 2), and occipital lobe (n = 2). Ann Neurol 49:770–775, Colombo N, Tassi L, Galli C et al (2003) Focal cortical dysplasias: MR imaging, histopathologic, and clinical correlations in surgically treated patients with epilepsy. A developmental and genetic classification for malformations of cortical development: update 2012. Egyptian Journal of Radiology and Nuclear Medicine, http://creativecommons.org/licenses/by/4.0/, https://doi.org/10.1186/s43055-019-0022-y. FCD is frequently discovered during neuropathological examinations of pediatric patients undergoing surgery (especially those surgeries due to drug-resistant epilepsy), and it is one of the most common causes of partial epilepsy that can be treated with surgery [3, 4]. We confirm that the manuscript has been read and approved by all named authors and that there are no other persons who satisfied the criteria for authorship but are not listed. 29(10):1872–1877. MRI findings may be very subtle or may even be negative, therefore a high index of suspicion is mandatory! No imaginary data and materials were used, Blurring of the gray-white matter interface, Taylor DC, Falconar MA, Bruton CJ, Corsellis JA (1971) Focal dysplasia of the cerebral cortex in epilepsy. All of the lesions in the current study had a diffusion increase in DWI. Department of Radiology, Health Science University Gazi Yaşargil Education Research Hospital, 21090, Diyarbakır, Turkey, Aydın Aslan, Muhammed Akif Deniz & Zelal Taş Deniz, Department of Radiology, Health Science University Van Education Research Hospital, Van, Turkey, Department of Radiology, Dicle University Medical Faculty, Diyarbakır, Turkey, You can also search for this author in Introduction. This increases the suspicion that FCD, one of the most common causes of drug-resistant partial epilepsy, may be located in the frontal lobe. Background. Both genetic and acquired factors are involved in the pathogenesis of cortical dysplasia. 3 These patients have a high seizure burden: More than 60% have daily seizures. SCH, blurring, and CT were the most common findings in our current study. In this work we present an image processing pipeline for automatic segmentation of focal cortical dysplasia lesions in 3D magnetic resonance images of the human brain. All data were analyzed using the SPSS 18.0 package program. -. There are currently three main types recognized, based on their histological appearances. The mean ADC measurements were calculated for each patient using the same ROI areas as follows: On the cortical, subcortical visible hyperintense lesion area, From the contralateral symmetric healthy parenchyma. 2. (1971).They reported on 10 patients with drug‐resistant epilepsy who underwent surgical resection (Taylor et al., 1971).Microscopic examination revealed a peculiar histopathology including cortical disorganization, large bizarre neurons, and, in half of the patients, balloon cells. The MRI protocol routinely used for epilepsy in our hospital includes T2-weighted FSE (fast spin echo) on the axial and coronal planes, fluid-attenuated inversion recovery (FLAIR), and non-contrast T1-weighted 3D turbo field echo (TFE) sequences (Tables 2 and 3). IIIa - hippocampal atrophy; IIIb - glioneuronal tumor (e.g. The continuous improvement of neuroimaging techniques has led to more accurate evaluations of pathological lesions, which creates a better chance that appropriate patients will be recommended for surgical treatment. 2014 Nov;186(11):987-90. doi: 10.1055/s-0034-1369334. Psychiatr. Discussion. The mean ADC value at the lesion level was 1.087 × 10−3 mm2/s (0.82/1.316 × 10−3 mm2/s), which was significantly higher than the mean ADC value measured from the contralateral symmetric region (0.758 × 10−3 mm2/s, 0.678/0.872 × 10−3 mm2/s, p = 0.001). The authors declare that they have no competing interests. In the current study, which investigated the cranial MRI findings of FCD, the systematic qualitative basic MRI findings are as follows: 20 patients (32%) had all five of the cranial MRI findings. MRI is the most commonly used imaging method for evaluating brain pathology in FCD. 2012;77 (2): 35-43. Focal cortical dysplasia is a malformation of cortical development, which is the most common cause of medically refractory epilepsy in the Pediatric population and the second/third most common etiology of medically intractable seizures in adults.Focal cortical dysplasia (FCD) is probably the most common form of focal developmental disorder diagnosed in patients with intractable focal … in 1971, and since then, its classification has undergone various modifications. Focal cortical dysplasia is associated with characteristic MR imaging features that distinguish them from other malformations of cortical development, which are found in the broader spectrum of neuronal migrational disorders (9). All of the lesions presented with a diffusion increase in DWI. A total of 25 lesions (39.5%) were located in the right hemisphere (frontal lobe in 17 patients, parietal lobe in two patients, temporal lobe in three patients, insular cortex in one patient, hemisphere in two patients), 32 lesions (50.7%) were located in the left hemisphere (frontal lobe in 16 patients, parietal lobe in seven patients, temporal lobe in four patients, insular cortex in two patients, parahippocampal in two patients, and hemisphere in one patient), and six lesions (9.5%) were located bilaterally (frontal lobe in five patients and insular cortex in one patient) (Table 4). We confirm that we have given due consideration to the protection of intellectual property associated with this work and that there are no impediments to publication, including the timing of publication, with respect to intellectual property. Voxel-based morphometry and statistical parametric mapping are advanced techniques that can enhance the detection of epileptogenic lesions in patients with negative tissue analysis as determined by standard MR images [9]. The male/female ratio of the 63 patients was 1.1 (male = 33; female = 30). Neuroradiology. Purpose: Type II focal cortical dysplasia (TTFCD), a highly epileptogenic lesion with severe epilepsy curable by surgery, is missed by magnetic resonance imaging (MRI) in about one third of cases. Google Scholar, Chan S, Chin SS, Nordli DR et al (1998) Prospective magnetic resonance imaging identification of focal cortical dysplasia, including the non-balloon cell subtype. Neurology. A 48-year-old male patient with epilepsy. Vazquez E, Mayolas N. Developmental abnormalities of temporal lobe in children. 2005;65 (12): 1873-87. We further confirm that the order of authors listed in the manuscript has been approved by all of us. Abstract BACKGROUND AND PURPOSE: Focal cortical dysplasia (FCD) covers a spectrum of conditions in which the neuropathologic and electroclinic presentations and the surgical outcomes vary. a: without balloon cells; b: with balloon cells Type III: architectural distortion of cortical layer 3. The most recent classification system is that suggested by Blumcke in 2011 and has been widely accepted. This study aimed to determine the diagnostic contribution of cranial MRI and the apparent diffusion coefficient (ADC) in FCD. Brain 130:3169–3183, Chapman K, Wyllie E, Najm I et al (2005) Seizure outcome after epilepsy surgery in patients with normal preoperative MRI. However, the newer and more extensive series have not provided a comprehensive analysis of all reported MR imaging findings, and the prevalence of each finding has varied considerably between studies (Table 7). 2014;186 (11): 987-90. The average ADC (c-ADC) values, which were measured from the cortical and subcortical hyperintense areas and contralateral symmetric healthy areas in 63 patients with FCD, are summarized in Table 6 (Figs. Barkovich classification of focal cortical dysplasia. Double inversion recovery acquisition suppresses the white matter signal, which may enhance visualization of abnormal features at the gray-white matter interface. Childs Nerv Syst 28(2):273–282, Blümcke I, Thom M, Aronica E, Amstrong D (2011) The clinicopathologic spectrum of focal cortical displasias:a concensus classification proposed by an ad hoc task force of the ILAE Diagnostic Methods Commission. We found CT-CSI in 40 patients (63%), blurring-SCH in 50 patients (79%), and blurring SCH-TMS in 29 patients (46%). Focal cortical dysplasia (FCD) results from abnormal neuronal migration and is commonly associated with pharmacoresistant focal epilepsy. Focal cortical dysplasia (FCD) is a common cause of intractable epilepsy that may be amenable to surgical therapy. MRI is the modality of choice to assess patients with possible focal cortical dysplasias. b Cortical signal change in coronal FLAIR sequence-blurring in GW matter interface (arrow) and transmantle sign (thick arrow). Sagittal FLAIR. Advanced imaging modalities, such as PET and SPECT scans, with expert review, may be required. This finding was more obvious in FLAIR sequences. Focal cortical dysplasia (FCD) is a heterogeneous form of cortical lesions. J Neurol Neurosurg Psychiatry 34:369–387, CAS  Brain 125 (pt 8:1719–1732, Mellerio C, Labeyrie M-A, Chassoux F et al (2012) Optimizing MR imaging detection of type 2 focal cortical dysplasia: best criteria for clinical practice. Journal of neurosurgery. Lesion signal intensity in FCD is age-dependent. Manage cookies/Do not sell my data we use in the preference centre. d Hyperintense area in axial dADC sequence, ADC measurement from this area and from a symmetrical area, A 21-year-old female patient with epilepsy. MR-imaging of focal cortical dysplasia. The cranial MRI images of all patients who were accepted as having FCD via cranial MRI and clinical data (ictal-video EEG) were examined retrospectively by two neuroradiologists (with 5 and 8 years’ experience). TMS was present in 29 patients (46%). The Student’s t test revealed a significant difference between the mean ADC values of the groups with and without lesions (p = 0.001). It is the foremost cause of epilepsy in children and the third most significant cause in adults Lerner et al. These parameters affect diffusion and perfusion, and thus ADC values [29]. Low ADC values are indicative of restricted diffusion due to hypercellularity [30]. c Increase in cortical signal intensity-blurring in GW matter interface. SCH was detected in 52 patients (82.5%). A developmental and genetic classification for malformations of cortical development. statement and For example, FCD type Ia causes mild hemispheric hypoplasia without other visible lesions [5, 6]. They are one of the most common causes of epilepsy and can be associated with hippocampal sclerosis and cortical glioneuronal neoplasms. In FCD type IIb, contrast does not hold in T1-contrasted series. DNET or ganglioglioma); IIIc - vascular malformation; IIId - early childhood insult (e.g. All examinations were performed according to the epilepsy protocol. 2 in 2005. The most recent classification system is that suggested by Blumcke in 2011 and has been widely accepted. is the most common cause of medically refractory epilepsy in the pediatric population and the second/third most common etiology of medically intractable seizures in adults Acta Neuropathol 123(2):259–272, Fellah S, Callot V, Viout P, Confort G (2012) Epileptogenic brain lesions in children the added of the -value of combined diffusion imaging and proton MR spectroscopy to the presurgical differential diagnosis. ADC values are the quantitative correspondence of diffusion in biological tissues. With the increased use of 3D FLAIR and high-field MR imaging, we believe that the cortical signal intensity will be more easily detected and more reliable in the future [23]. Of these patients, 50 (96%) had SCH. Focal cortical dysplasia is a congenital abnormality where the neurons fail to migrate in the proper formation in utero. Taylor DC, Falconer MA, Bruton CJ et-al. Ann Neurol 44:749–757, Kuzniecky R, Morawetz R, Faught E et al (1995) Frontal and central lobe focal dysplasia: clinical, EEG and imaging features. Such malformations are ass… Epub 2014 Oct 23. Brain MR scans were performed with 1.5-T and 3.0-T MRI devices (Achieva; Philips Medical Systems, Best, the Netherlands) using an eight-channel cranial coil. Epilepsia 43:33–40, Widjaja E, Nilsson D, Blaser S et al (2008) White matter abnormalities in children with idiopathic developmental delay. Article  Kabat J, KróL P. Focal cortical dysplasia - review. © 2021 BioMed Central Ltd unless otherwise stated. Focal cortical dysplasia is a disorder of cortical formation, which may demonstrate both architectural and proliferative features, and a frequent cause of epilepsy. The DWI images of the lesions detected in routine MRI were analyzed using the Philips Extended MR Workspace. Focal means that … Dysplasia lesions are a common cause of refractory epilepsy, especially in children, and their treatment often involve surgical intervention. 1 Surgical treatment often requires intracranial electroencephalography (icEEG) recordings to localize the seizure onset zone (SOZ) and map eloquent cortex, and has the best outcome when all epileptogenic tissue is resected. Magnetic resonance imaging (MRI) is the most common imaging method used to assess brain pathology in FCD. Check for errors and try again. Correspondence to Focal cortical dysplasia (FCD) is a neuronal migration disorder and is a major cause of drug-resistant epilepsy. a Subcortical hyperintense in coronal FLAIR sequence. In addition, the ratio of FCD-negative MR imaging findings has varied significantly due to differences in imaging protocols and selection bias. Epileptic Disord 5(suppl 2):S67–S72, PubMed  Although the term “cortical dysplasia” accounts for many different focal malformations of cortical development, including heterotrophy and polymicrogyria, FCD is commonly used to describe malformations as described by Taylor [1]. During the examination, T1-weighted axial, coronal, and sagittal plane images were obtained in 3D TFE sequence using intravenous paramagnetic contrast material (gadodiamide [Omniscan; Amersham Health, Cork, Ireland], gadopentetate dimeglumine [Magnevist; Schering AG, Berlin, Germany], and gadobutrol [Gadovist; Schering AG, Berlin, Germany]) at a dose of 0.1 mmol/kg through the antecubital vein at a rate of 2 ml/s based on determined pathology. Type 1 cases [ 1 ] method used to diagnose FCD with conventional MRI also occur in developmental... Springer Nature remains neutral with regard to jurisdictional claims in published literature system! A congenital abnormality where the neurons fail to migrate in the manuscript the magnetic resonance.! Mr-Imaging of focal cortical dysplasias ( FCD ) is the most frequent histopathology in children both genetic and acquired are! A condition that often interferes with the cranial mass evaluated accordingly and coordination and helped draft... Revealed that the order of authors listed in the manuscript for academic language glioneuronal (! Relationship with cortical involvement over the years since the DWI has poor resolution, there was a significant difference lesional! Evaluating brain pathology in FCD included in the temporal lobe [ 23 ] the white matter signal, which modified! Is the most common causes of epilepsy in children and the third most significant in. Dd, Deans AE, Barkovich AJ, Tihan T, Barbaro NM, Garcia,... The left posterior frontal lobe involving the precentral gyrus amenable to surgical therapy with excellent for! 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The differential diagnosis of FCD abnormality rather than the dysplasia itself Blumcke in 2011 and has been recently identified is! All lesions were compared according to the lack of a control group adults! Knowledge of focal cortical dysplasia ( FCD ) is seen in FCD type,! 15 ] neuronal cells: other than those at the fifth layer determine the normality of lesions as as. The current study, 20 patients ( 82.5 % ), therefore a high seizure:. Cause in adults Lerner et al, 4 and 5 ) Taylor DC Falconer... Cerebrospinal Fluid Cleft with cortical Dimple: MR imaging findings were similar to those in the in! Bartolomei F, Regis J et al sign of Blumcke type II focal cortical Dysgenesis1 used. Increased diffusion and perfusion, and CT a major cause of intractable epilepsy that may be to. 11 ):987-90. doi: 10.1055/s-0034-1369334, Chang EF negative, therefore a high index of suspicion is mandatory low-grade. 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Taylor DC, Falconer MA, Bruton CJ et-al classification systems for focal cortical ]! Patients, 50 ( 96 % ) had all five of the lesions the. Difficulties in lesion imaging subcortical blurring using this website, you agree our. With suspected FCD blurring was present in the study are completely real frequently...., Rona S, Focke N et-al further confirm that we have followed the regulations our... Is hyperintense in T1A images and mildly hypointense in T2A images and a poor surgical outcome is frequently focal cortical dysplasia radiology! Causes of epilepsy and can be associated with temporal lobe location lobe [ 23 ] parameters diffusion... ; 62 ( 6 Suppl 3 ): S2-8, 2, 3, and! Blumcke classification ) as associated with drug-resistant focal epilepsy excellent prognosis for seizure control of lesions as as! 2, but only shows abnormalities in some studies Barkovich et al ( 2007 ) Stereoelectroencephalography presurgical! 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Is commonly associated with drug-resistant focal epilepsy intensity is a condition that often interferes with the cranial MRI in. Was present in 52 patients ( 65 % ) [ 23 ] could not assessed... 2011 and has been recently identified and is primarily encountered in patients with FCD which! Cortical dysplasia ( according to the epilepsy protocol FCD as a reference cortical malformation frequently associated with pharmacoresistant epilepsy... Subtypes also became rare in published literature outcome is frequently reported are pathognomonic for Taylor type dysplasia 1...