Cortical changes in epilepsy patients with focal cortical dysplasia: new insights with T2 mapping

  • Background: In epilepsy patients with focal cortical dysplasia (FCD) as the epileptogenic focus, global cortical signal changes are generally not visible on conventional MRI. However, epileptic seizures or antiepileptic medication might affect normal-appearing cerebral cortex and lead to subtle damage. Purpose: To investigate cortical properties outside FCD regions with T2-relaxometry. Study Type: Prospective study. Subjects: Sixteen patients with epilepsy and FCD and 16 age-/sex-matched healthy controls. Field Strength/Sequence: 3T, fast spin-echo T2-mapping, fluid-attenuated inversion recovery (FLAIR), and synthetic T1-weighted magnetization-prepared rapid acquisition of gradient-echoes (MP-RAGE) datasets derived from T1-maps. Assessment: Reconstruction of the white matter and cortical surfaces based on MP-RAGE structural images was performed to extract cortical T2 values, excluding lesion areas. Three independent raters confirmed that morphological cortical/juxtacortical changes in the conventional FLAIR datasets outside the FCD areas were definitely absent for all patients. Averaged global cortical T2 values were compared between groups. Furthermore, group comparisons of regional cortical T2 values were performed using a surface-based approach. Tests for correlations with clinical parameters were carried out. Statistical Tests: General linear model analysis, permutation simulations, paired and unpaired t-tests, and Pearson correlations. Results: Cortical T2 values were increased outside FCD regions in patients (83.4 ± 2.1 msec, control group 81.4 ± 2.1 msec, P = 0.01). T2 increases were widespread, affecting mainly frontal, but also parietal and temporal regions of both hemispheres. Significant correlations were not observed (P ≥ 0.55) between cortical T2 values in the patient group and the number of seizures in the last 3 months or the number of anticonvulsive drugs in the medical history. Data Conclusion: Widespread increases in cortical T2 in FCD-associated epilepsy patients were found, suggesting that structural epilepsy in patients with FCD is not only a symptom of a focal cerebral lesion, but also leads to global cortical damage not visible on conventional MRI. Evidence Level: 21. Technical efficacy Stage: 3 J. MAGN. RESON. IMAGING 2020;52:1783–1789.

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Author:Rida Ahmad, Michelle Maiworm, Ulrike Nöth, Alexander Seiler, Elke HattingenORCiDGND, Helmuth Steinmetz, Felix RosenowORCiDGND, Ralf Deichmann, Marlies Wagner, René-Maxime Gracien
Parent Title (English):Journal of magnetic resonance imaging
Place of publication:New York, NY
Document Type:Article
Date of Publication (online):2020/05/07
Date of first Publication:2020/05/07
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2022/03/09
Tag:T2; cortex; epilepsy; focal cortical dysplasia; relaxometry
Page Number:7
First Page:1783
Last Page:1789
Dr. E. Hattingen has received speaker's honoraria from BRACCO. Dr. F. Rosenow has received honoraria for presentations and consultations from EISAI, UCB Pharma, Desitin Arzneimittel, Hexal, Novartis, Medtronic, GW-Pharma, Shire, Sandoz, and Cerbomed, as well as research grants from UCB, European Union, Deutsche Forschungsgemeinschaft, European Science Foundation and the Hessonian Ministries of Science and Arts and of Social Affairs and Integration. Dr. H. Steinmetz has received speaker's honoraria from Bayer, Sanofi, and Boehringer Ingelheim.
Contract grant sponsor: State of Hesse with a LOEWE-Grant to the CePTER-Consortium (; Contract grant sponsor: Clinician Scientists program at Goethe University. The sponsors did not influence the study design or the collection, analysis, or interpretation of data.
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Licence (German):License LogoCreative Commons - Namensnennung 4.0