Abstract
PurposeTo evaluate a MRI postprocessing tool for the enhanced and rapid detection of focal cortical dysplasia (FCD).MethodsMP2RAGE sequences of 40 consecutive, so far MRI-negative patients and of 32 healthy controls were morphometrically analyzed to highlight typical FCD features. The resulting morphometric maps served as input for an artificial neural network generating a FCD probability map. The FCD probability map was inversely normalized, co-registered to the MPRAGE2 sequence, and re-transferred into the PACS system. Co-registered images were scrolled through “within a minute” to determine whether a FCD was present or not.ResultsFifteen FCD, three subcortical band heterotopias (SBH), and one periventricular nodular heterotopia were identified. Of those, four FCD and one SBH were only detected by MRI postprocessing while one FCD and one focal polymicrogryia were missed, respectively. False-positive results occurred in 21 patients and 22 healthy controls. However, true positive cluster volumes were significantly larger than volumes of false-positive clusters (p < 0.001). The area under the curve of the receiver operating curve was 0.851 with a cut-off volume of 0.05 ml best indicating a FCD.ConclusionAutomated MRI postprocessing and presentation of co-registered output maps in the PACS allowed for rapid (i.e., “within a minute”) identification of FCDs in our clinical setting. The presence of false-positive findings currently requires a careful comparison of postprocessing results with conventional MR images but may be reduced in the future using a neural network better adapted to MP2RAGE images.
Highlights
Malformations of cortical development comprise heterogeneous disorders of disrupted cerebral cortex formation caused by various genetic, infectious, vascular, or metabolic etiologies [1]
DICOM images were converted to NIfTI format; segmented into gray matter (GM), white matter (WM), and cerebrospinal fluid (CSF) maps; and normalized to the Montreal Neurological Institute (MNI) space
focal cortical dysplasia (FCD) can be detected “within a minute” when MP2RAGE data sets are postprocessed by morphometric analysis and presented together with morphometric results in the PACS, allowing for a very fast screening by scrolling through the co-registered images
Summary
Malformations of cortical development comprise heterogeneous disorders of disrupted cerebral cortex formation caused by various genetic, infectious, vascular, or metabolic etiologies [1]. Focal malformations represent an important subgroup as they may be amenable to epilepsy surgery. Focal malformations include focal cortical dysplasia (FCD) and gray matter heterotopia and focal polymicrogyria. Gray matter heterotopia are clusters of normal neurons in abnormal locations and commonly categorized into periventricular nodular heterotopia (previously designated as subependymal heterotopia), subcortical heterotopia, and. Neuroradiology subcortical band heterotopia (SBH) (previously called double cortex) [1]. Polymicrogyria means an excessive number of abnormally small cerebral gyri, most commonly in a bilateral location in the posterior parts of the Sylvian fissures. Any part of the cerebral cortex including the frontal, occipital, and temporal lobes can be affected [1]
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