Seven tesla MRI improves detection of focal cortical dysplasia in patients with refractory focal epilepsy.
Seven tesla MRI improves detection of focal cortical dysplasia in patients with refractory focal epilepsy.
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DOI：
10.1002/epi4.12041
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发表时间：
2017-06
期刊：
影响因子：
3
通讯作者：
Braun KPJ
中科院分区：
文献类型：
--
作者：
Veersema TJ;Ferrier CH;van Eijsden P;Gosselaar PH;Aronica E;Visser F;Zwanenburg JM;de Kort GAP;Hendrikse J;Luijten PR;Braun KPJ
本研究的目的是确定在临床实践中使用7特斯拉（T）MRI是否会导致癫痫手术可能候选人中局灶性皮质发育不良的检出率更高。在我们的中心，如果怀疑病灶性局灶性癫痫，但在一次或多次先前的、足够质量的低场MRI扫描中未检测到异常，或者当怀疑隐藏的病理与MR可见的近中颞叶硬化-双重病理相结合时，则将患者转诊接受7 T MRI。我们评估了40名癫痫患者，他们接受了7 T MRI进行术前评估，并在多学科癫痫手术会议期间讨论了扫描（7 T和低场），其中包括专门的癫痫神经放射科医生。我们比较了7 T和低场MRI扫描的多学科目视评估的结论。在我们的40例患者系列中，7 T MRI的多学科评价在9例患者（23%）中发现了低场MRI未观察到的其他病变。这些发现可指导手术计划。到目前为止，6例患者接受了手术，组织学证实为局灶性皮质发育不良或皮质发育轻度畸形。7 T MRI可提高难治性癫痫患者的细微局灶性皮质发育不良和皮质发育轻度畸形的检出率，因此可能有助于识别手术候选人和完全切除致癫痫病灶，从而提高术后癫痫发作的自由度。
The aim of this study is to determine whether the use of 7 tesla (T) MRI in clinical practice leads to higher detection rates of focal cortical dysplasias in possible candidates for epilepsy surgery. In our center patients are referred for 7 T MRI if lesional focal epilepsy is suspected, but no abnormalities are detected at one or more previous, sufficient‐quality lower‐field MRI scans, acquired with a dedicated epilepsy protocol, or when concealed pathology is suspected in combination with MR‐visible mesiotemporal sclerosis—dual pathology. We assessed 40 epilepsy patients who underwent 7 T MRI for presurgical evaluation and whose scans (both 7 T and lower field) were discussed during multidisciplinary epilepsy surgery meetings that included a dedicated epilepsy neuroradiologist. We compared the conclusions of the multidisciplinary visual assessments of 7 T and lower‐field MRI scans. In our series of 40 patients, multidisciplinary evaluation of 7 T MRI identified additional lesions not seen on lower‐field MRI in 9 patients (23%). These findings were guiding in surgical planning. So far, 6 patients underwent surgery, with histological confirmation of focal cortical dysplasia or mild malformation of cortical development. Seven T MRI improves detection of subtle focal cortical dysplasia and mild malformations of cortical development in patients with intractable epilepsy and may therefore contribute to identification of surgical candidates and complete resection of the epileptogenic lesion, and thus to postoperative seizure freedom.