title: SUrface-PRojected FLuid-Attenuation-Inversion-Recovery Analysis: A Novel Tool for Advanced Imaging of Epilepsy.
abstract: OBJECTIVE
  The objective of this pilot retrospective study is to describe the SUrface-PRojected FLuid-Attenuation-Inversion-Recovery (SUPR-FLAIR) analysis, a novel method mainly aimed at revealing cortical areas with subtle signal hyperintensity.
  
  
  METHODS
  Images from 101 healthy controls and 10 patients suffering from drug-resistant partial epilepsy were retrospectively postprocessed. The brain surface was reconstructed from a 3-dimensional (3D) T1-weighted fast field echo (T1W-FFE) magnetic resonance imaging (MRI) scan. A turbo spin echo fluid attenuated inversion recovery axial scan was registered to the 3D T1W-FFE scan, and its intensity values were normalized. The cortical intensity signal was projected onto the brain surface, and surface-based analysis was performed, comparing each patient against the 101 controls. The localizations of the first positive lower P value cluster (PLPC) peak and the resection zone (RZ) were compared. We studied 5 patients with focal cortical dysplasia (3 of them with negative MRI) and 5 with hippocampal sclerosis.
  
  
  RESULTS
  SUPR-FLAIR analysis localized the first PLPC peak in the RZ in all cases. Because all patients have been seizure free since surgery, it can be assumed that the epileptogenic zone (EZ) was included in the RZ. Therefore, SUPR-FLAIR analysis correctly aligned with the EZ, with 100% sensitivity.
  
  
  CONCLUSIONS
  SUPR-FLAIR analysis is a noninvasive technique that could be helpful for the definition of the EZ, especially when MRI is negative. Its use could reduce the indications for invasive electroencephalography or could provide essential data to refine the strategy of intracerebral electrode implantation in the most challenging cases.
authors.affiliation: "Claudio Munari" Center for Epilepsy Surgery, Niguarda Hospital, Milano, Italy. Electronic address: francesco.cardinale@ospedaleniguarda.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Cardinale
authors.affiliation: "Claudio Munari" Center for Epilepsy Surgery, Niguarda Hospital, Milano, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Francione
authors.affiliation: Department of Neuroradiology, Niguarda Hospital, Milano, Italy.
authors.forename: Luciana
authors.initials: L
authors.lastname: Gennari
authors.affiliation: Department of Neuroradiology, Niguarda Hospital, Milano, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Citterio
authors.affiliation: Department of Neuroradiology, Niguarda Hospital, Milano, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Sberna
authors.affiliation: "Claudio Munari" Center for Epilepsy Surgery, Niguarda Hospital, Milano, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Tassi
authors.affiliation: "Claudio Munari" Center for Epilepsy Surgery, Niguarda Hospital, Milano, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Mai
authors.affiliation: "Claudio Munari" Center for Epilepsy Surgery, Niguarda Hospital, Milano, Italy.
authors.forename: Ivana
authors.initials: I
authors.lastname: Sartori
authors.affiliation: "Claudio Munari" Center for Epilepsy Surgery, Niguarda Hospital, Milano, Italy.
authors.forename: Lino
authors.initials: L
authors.lastname: Nobili
authors.affiliation: "Claudio Munari" Center for Epilepsy Surgery, Niguarda Hospital, Milano, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Cossu
authors.affiliation: "Claudio Munari" Center for Epilepsy Surgery, Niguarda Hospital, Milano, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Castana
authors.affiliation: "Claudio Munari" Center for Epilepsy Surgery, Niguarda Hospital, Milano, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Lo Russo
authors.affiliation: Department of Neuroradiology, Niguarda Hospital, Milano, Italy.
authors.forename: Nadia
authors.initials: N
authors.lastname: Colombo
mesh_terms: D000293:Adolescent; D000328:Adult; D001927:Brain Diseases / Q000150:complications / Q000473:pathology; D001931:Brain Mapping / Q000379:methods; D016022:Case-Control Studies; D002648:Child; D004351:Drug Resistance; D004569:Electroencephalography / Q000379:methods; D004827:Epilepsy / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D005260:Female; D006624:Hippocampus / Q000473:pathology; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012189:Retrospective Studies; D012598:Sclerosis / Q000150:complications / Q000473:pathology; D012984:Software; D055815:Young Adult
keywords: Epilepsy surgery; Epileptogenic zone; FLAIR intensity; Freesurfer; MRI-negative epilepsy; Postprocessing; SUPR-FLAIR; Stereoelectroencephalography; Surface-based analysis; Temporal lobe epilepsy