Abstract
Focal cortical dysplasia is a congenital abnormality of cortical development and the leading cause of surgically remediable drug-resistant epilepsy in children. Post-surgical outcome is improved by presurgical lesion detection on structural MRI. Automated computational techniques have improved detection of focal cortical dysplasias in adults but have not yet been effective when applied to developing brains. There is therefore a need to develop reliable and sensitive methods to address the particular challenges of a paediatric cohort.We developed a classifier using surface-based features to identify focal abnormalities of cortical development in a paediatric cohort. In addition to established measures, such as cortical thickness, grey-white matter blurring, FLAIR signal intensity, sulcal depth and curvature, our novel features included complementary metrics of surface morphology such as local cortical deformation as well as post-processing methods such as the “doughnut” method - which quantifies local variability in cortical morphometry/MRI signal intensity, and per-vertex interhemispheric asymmetry. A neural network classifier was trained using data from 22 patients with focal epilepsy (mean age = 12.1 ± 3.9, 9 females), after intra- and inter-subject normalisation using a population of 28 healthy controls (mean age = 14.6 ± 3.1, 11 females). Leave-one-out cross-validation was used to quantify classifier sensitivity using established features and the combination of established and novel features.Focal cortical dysplasias in our paediatric cohort were correctly identified with a higher sensitivity (73%) when novel features, based on our approach for detecting local cortical changes, were included, when compared to the sensitivity using only established features (59%). These methods may be applicable to aiding identification of subtle lesions in medication-resistant paediatric epilepsy as well as to the structural analysis of both healthy and abnormal cortical development.
Highlights
Focal cortical dysplasias (FCDs) are the most common cause of surgically remediable drug-resistant epilepsy in children (Lerner et al, 2009)
While progress has been made in improving the detection of FCDs in adults using structural neuroimaging techniques (Thesen et al, 2011; Wang et al, 2015) and automated classifiers (Ahmed et al, 2015; Hong et al, 2014), automated lesion classification has not been attempted in a solely paediatric cohort despite this being a congenital condition (Chen et al, 2014)
Seven resections met a histopathological diagnosis of FCD Type IIB, one FCD Type IIA, two demonstrated focal neocortical gliosis only and one did not have an FCD, but a focal ganglioglioma (WHO Grade I) was evident from histological examination
Summary
Focal cortical dysplasias (FCDs) are the most common cause of surgically remediable drug-resistant epilepsy in children (Lerner et al, 2009). Surgical outcome is significantly improved when lesions are identified on MRI scans pre-surgically (TéllezZenteno et al, 2010). Between 50 and 80% of FCDs are too subtle to detect by conventional radiological analysis of MRI scans (Besson et al, 2008). While progress has been made in improving the detection of FCDs in adults using structural neuroimaging techniques (Thesen et al, 2011; Wang et al, 2015) and automated classifiers (Ahmed et al, 2015; Hong et al, 2014), automated lesion classification has not been attempted in a solely paediatric cohort despite this being a congenital condition (Chen et al, 2014). An automated tool capable of improving the detection of FCD in the paediatric population would represent an important step in improving the quality and consistency of presurgical evaluation with implications for surgical outcome
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