Epileptogenic brain lesions in children: The added-value of combined diffusion imaging and proton MR spectroscopy to the presurgical differential diagnosis

Slim Fellah, Virginie Callot, Patrick Viout, Sylviane Confort-Gouny, Didier Scavarda, Philippe Dory-Lautrec, Dominique Figarella-Branger, Patrick J. Cozzone, Nadine Girard

Research output: Contribution to journalArticlepeer-review

22 Scopus citations

Abstract

Purpose: Focal cortical dysplasia (FCD), dysembryoplastic neuroepithelial tumors (DNTs), and gangliogliomas (GGs) share many clinical features, and the presurgical differential diagnosis of these lesions using conventional magnetic resonance imaging (MRI) is challenging in some cases. The purpose of this work was thus to evaluate the capacity of diffusion-weighted imaging (DWI) and proton magnetic resonance spectroscopy (MRS) to distinguish each lesion from the others. Methods: Seventeen children (mean age 9.0 ± 4.7 years), who had been referred for epilepsy associated with a brain tumor and operated, were selected. Preoperative MRI examinations were performed on a 1.5 T system and included anatomical images [T2-weighted, fluid-attenuated inversion recovery (FLAIR) and T1 pre- and post-injection images] as well as DWI and MRS [echo time (TE) = 30 and 135 ms]. Apparent diffusion coefficient (ADC) values were calculated in the lesion and healthy control. MRS relative quantification consisted in normalizing each metabolite by the sum (S) of all metabolites (STE=135 ms = NAA+Cr+Cho; STE=30 ms = NAA+Cr+Cho+Glx+mI). Univariate and multivariate analyses were performed in order to determine which criteria could differentiate the different epileptogenic brain lesions. Results: When taken alone, none of the MRI parameters was able to distinguish each disease from the others. Conventional MRI failed classifying two patients. When adding ADC to the linear discriminant analysis (LDA), one patient was still misclassified. Complete separation of the three groups was possible when combining conventional MRI, diffusion, and MRS either at long or short TE. Conclusion: This study shows the added-value of multimodal MRI and MRS in the presurgical diagnosis of epileptogenic brain lesions in children.

Original languageEnglish
Pages (from-to)273-282
Number of pages10
JournalChild's Nervous System
Volume28
Issue number2
DOIs
StatePublished - Feb 2012

Keywords

  • Child
  • Diffusion MRI
  • Dysembryoplastic neuroepithelial tumors
  • Focal cortical dysplasia
  • Intracranial gangliogliomas
  • MR spectroscopy

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