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Prospective detection of cortical dysplasia on clinical MRI in pediatric intractable epilepsy

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Abstract

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.

Materials and 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%.

Conclusion

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.

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Authors and Affiliations

  1. Department of Radiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., ML 5031, Cincinnati, OH, 45229, USA

    Rupa Radhakrishnan, James L. Leach & Michael J. Gelfand

  2. Department of Neurosurgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Francesco T. Mangano

  3. Department of Pathology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Lili Miles

  4. Department of Neurology, Comprehensive Epilepsy Treatment Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Leonid Rozhkov & Hansel M. Greiner

Authors
  1. Rupa Radhakrishnan
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  2. James L. Leach
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  3. Francesco T. Mangano
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  4. Michael J. Gelfand
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  5. Leonid Rozhkov
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  6. Lili Miles
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  7. Hansel M. Greiner
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Correspondence to Rupa Radhakrishnan.

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Radhakrishnan, R., Leach, J.L., Mangano, F.T. et al. Prospective detection of cortical dysplasia on clinical MRI in pediatric intractable epilepsy. Pediatr Radiol 46, 1430–1438 (2016). https://doi.org/10.1007/s00247-016-3623-x

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  • DOI: https://doi.org/10.1007/s00247-016-3623-x

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