Morphometric MRI analysis improves detection of focal cortical dysplasia type II
Morphometric MRI analysis improves detection of focal cortical dysplasia type II
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DOI：
10.1093/brain/awr204
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发表时间：
2011-10-01
期刊：
影响因子：
14.5
通讯作者：
Huppertz, Hans-Juergen
中科院分区：
文献类型：
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作者：
Wagner, Jan;Weber, Bernd;Huppertz, Hans-Juergen
局灶性皮质发育不良II型（FCD II）是一种高度致痫性病变，常引起药物耐药性癫痫。在MRI上检测这些病变仍然具有挑战性，因为FCD在外观上可能非常微妙，并且可能逃脱常规的视觉分析。形态测量MRI分析是一种基于统计参数映射软件（SPM 5）算法的基于体素的后处理方法。它创建三维特征图，突出显示具有模糊的灰白质连接和异常回转的大脑区域，从而可以帮助检测FCD。在这项研究中，我们评估了在形态测量分析程序中实施的形态测量分析的潜在诊断价值，并与2000年至2010年期间在波恩大学医院接受组织学证实的FCD II手术的91例患者（FCD IIa，n = 17; IIb，n = 74）中经验丰富的神经放射科医生进行的传统视觉分析进行了比较。所有术前MRI扫描均独立评价（i）由经验丰富的神经放射科医生根据常规目视分析和（ii）使用形态测量分析。两名评价者具有相同的临床信息（脑电图和症状学），但对彼此的结果不知情。在FCD IIa亚组中，使用形态测量分析的FCD检出率上级优于传统视觉分析（82%对65%），而在FCD IIb亚组中没有发现差异（92%对91%）。然而，传统的视觉分析和形态分析的结合提供了补充信息，并检测到89个所有91 FCD（98%）。在两个亚组中，该组合显著上级单独的传统视觉分析，导致更高的诊断灵敏度（FCD IIa为94% vs 65%，P = 0.031; FCD IIb为99% vs 91%，P = 0.016）。总之，与单独的常规视觉分析相比，形态测量MRI分析的额外应用增加了FCD II的诊断灵敏度。由于术前评估期间MRI上FCD的检测显著提高了术后无癫痫发作的机会，因此我们对所有在我们中心进行常规视觉分析后MRI阴性的患者进行了形态学分析。
Focal cortical dysplasias type II (FCD II) are highly epileptogenic lesions frequently causing pharmacoresistant epilepsy. Detection of these lesions on MRI is still challenging as FCDs may be very subtle in appearance and might escape conventional visual analysis. Morphometric MRI analysis is a voxel-based post-processing method based on algorithms of the statistical parametric mapping software (SPM5). It creates three dimensional feature maps highlighting brain areas with blurred grey-white matter junction and abnormal gyration, and thereby may help to detect FCD. In this study, we evaluated the potential diagnostic value of morphometric analysis as implemented in a morphometric analysis programme, compared with conventional visual analysis by an experienced neuroradiologist in 91 patients with histologically proven FCD II operated on at the University Hospital of Bonn between 2000 and 2010 (FCD IIa, n = 17; IIb, n = 74). All preoperative MRI scans were evaluated independently (i) based on conventional visual analysis by an experienced neuroradiologist and (ii) using morphometric analysis. Both evaluators had the same clinical information (electroencephalography and semiology), but were blinded to each other's results. The detection rate of FCD using morphometric analysis was superior to conventional visual analysis in the FCD IIa subgroup (82% versus 65%), while no difference was found in the FCD IIb subgroup (92% versus 91%). However, the combination of conventional visual analysis and morphometric analysis provided complementary information and detected 89 out of all 91 FCDs (98%). The combination was significantly superior to conventional visual analysis alone in both subgroups resulting in a higher diagnostic sensitivity (94% versus 65%, P = 0.031 for FCD IIa; 99% versus 91%, P = 0.016 for FCD IIb). In conclusion, the additional application of morphometric MRI analysis increases the diagnostic sensitivity for FCD II in comparison with conventional visual analysis alone. Since detection of FCDs on MRI during the presurgical evaluation markedly improves the chance of becoming seizure free postoperatively, we apply morphometric analysis in all patients who are MRI-negative after conventional visual analysis at our centre.