Prospective detection of cortical dysplasia on clinical MRI in pediatric intractable epilepsy.
BACKGROUND
Cortical dysplasia is the most common cause of pediatric refractory epilepsy. MRI detection of epileptogenic lesion is associated with good postsurgical outcome. Additional electrophysiological information is suggested to be helpful in localization of cortical dysplasia. Educational measures were taken to increase the awareness of cortical dysplasia at our institution in the context of a recent International League Against Epilepsy (ILAE 2011) classification of cortical dysplasia.


OBJECTIVE
To determine changes in the rate of prospective identification of cortical dysplasia on an initial radiology report and also evaluate the benefit of MRI review as part of a multidisciplinary epilepsy conference in identifying previously overlooked MRI findings.


METHODS
We retrospectively evaluated surgically treated children with refractory epilepsy from 2007 to 2014 with cortical dysplasia on histopathology. We analyzed the initial radiology report, preoperative MRI interpretation at multidisciplinary epilepsy conference and subsequent retrospective MRI review with knowledge of the resection site. We recorded additional electrophysiological data and the presence of lobar concordance with the MRI findings.


RESULTS
Of 78 children (44 MRI lesional) evaluated, 18 had initially overlooked MRI findings. Comparing 2007-2010 to 2011-2014, there was improvement in the rate of overlooked findings on the initial radiology report (54% vs. 13% of lesional cases, respectively; P = 0.008). The majority (72%) were identified at a multidisciplinary conference with lobar concordance of findings with at least one additional electrophysiological investigation in 89%.


CONCLUSIONS
Awareness of current classification schemes of cortical dysplasia and image review in the context of a multidisciplinary conference can lead to improved MRI detection of cortical dysplasia in children.
Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., ML 5031, Cincinnati, OH, 45229, USA. rupa.radhakrishnan@cchmc.org.
Rupa
R
Radhakrishnan
Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., ML 5031, Cincinnati, OH, 45229, USA.
James L
JL
Leach
Department of Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Francesco T
FT
Mangano
Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., ML 5031, Cincinnati, OH, 45229, USA.
Michael J
MJ
Gelfand
Department of Neurology, Comprehensive Epilepsy Treatment Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Leonid
L
Rozhkov
Department of Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Lili
L
Miles
Department of Neurology, Comprehensive Epilepsy Treatment Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Hansel M
HM
Greiner
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D000069279:Drug Resistant Epilepsy / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D004569:Electroencephalography; D005260:Female; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D054220:Malformations of Cortical Development / Q000000981:diagnostic imaging* / Q000473:pathology*; D011446:Prospective Studies; D012189:Retrospective Studies; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D055815:Young Adult
Brain; Cerebral cortex; Children; Cortical dysplasia; Magnetic resonance imaging; Seizures