title: JOURNAL CLUB: Longitudinal Qualitative Characterization of MRI Features After Laser Interstitial Thermal Therapy in Drug-Resistant Epilepsy.
abstract: OBJECTIVE
  Laser interstitial thermal therapy (LITT), a method for ablating brain tissue under real-time MR thermometry, has been used more frequently in recent years to treat nonmalignant lesions. The purpose of this study is to longitudinally characterize MRI features after LITT in patients with drug-resistant epilepsy, primarily in the setting of mesial temporal sclerosis.
  
  
  METHODS
  MR images from 23 consecutive patients who underwent LITT were retrospectively reviewed. All patients had images obtained immediately after the ablation. Multiple patients had follow-up imaging at various time points after treatment, from postoperative days 7 through 1539. A total of 54 MRI studies were reviewed.
  
  
  RESULTS
  Immediately after LITT, MR images showed a ring-enhancing lesion at the ablation site with minimal surrounding edema. Seven images showed increased enhancement of the ipsilateral choroid plexus. Images in the subacute phase showed a mild increase in edema with similar enhancement. Images in the transitional phase showed a decrease in edema with variable enhancement. Images in the chronic phase showed minimal gliosis with or without cavity formation or cavity formation alone, with either decreased or no enhancement.
  
  
  CONCLUSIONS
  This report describes the time course of the imaging findings after LITT for drug-resistant epilepsy. The typical stages include rim-enhancing lesion with minimal edema, followed by an increase in edema, to eventual gliosis and nonenhancing cavity formation. Radiologists need to be familiar with the postablation findings to minimize misdiagnosis and prevent unnecessary workup.
authors.affiliation: 1 Department of Radiology, Thomas Jefferson University, 132 S 10th St, Main Bldg, Ste 780A, Philadelphia, PA 19107.
authors.forename: Kofi-Buaku
authors.initials: KB
authors.lastname: Atsina
authors.affiliation: 2 Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA.
authors.forename: Ashwini D
authors.initials: AD
authors.lastname: Sharan
authors.affiliation: 2 Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA.
authors.forename: Chengyuan
authors.initials: C
authors.lastname: Wu
authors.affiliation: 2 Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA.
authors.forename: James J
authors.initials: JJ
authors.lastname: Evans
authors.affiliation: 3 Department of Neurology, Thomas Jefferson University, Philadelphia, PA.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Sperling
authors.affiliation: 3 Department of Neurology, Thomas Jefferson University, Philadelphia, PA.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Skidmore
authors.affiliation: 1 Department of Radiology, Thomas Jefferson University, 132 S 10th St, Main Bldg, Ste 780A, Philadelphia, PA 19107.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Gorniak
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use; D002648:Child; D004351:Drug Resistance; D004827:Epilepsy / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D053685:Laser Therapy / Q000379:methods*; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013817:Thermography / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000927:Anticonvulsants
keywords: cavity formation; edema; enhancement; gliosis; laser interstitial thermal therapy