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Diagnosis of subtle focal dysplastic lesions: Curvilinear reformatting from three‐dimensional magnetic resonance imaging
Author(s) -
Bastos Alexandre C.,
Comeau Roch M.,
Andermann Frederick,
Melanson Denis,
Cendes Fernando,
Dubeau Francois,
Fontaine Suzanne,
Tampieri Donatella,
Olivier Andre
Publication year - 1999
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/1531-8249(199907)46:1<88::aid-ana13>3.0.co;2-4
Subject(s) - cortical dysplasia , magnetic resonance imaging , dysplasia , curvilinear coordinates , white matter , medicine , radiology , epilepsy , pathology , physics , quantum mechanics , psychiatry
Focal cortical dysplasia is a frequent cause of medically intractable partial epilepsy. These lesions are being increasingly identified by high quality images provided by magnetic resonance imaging (MRI), resulting in improved seizure control of surgically treated patients. Small dysplastic lesions are often missed by conventional MRI methods. The identification of subtle structural abnormalities by rectilinear slices is often limited by the complex convolutional pattern of the brain. We developed a method of curvilinear reformatting of three‐dimensional MRI data that improves the anatomical display of the gyral structure of the hemispheric convexities. It also reduces the asymmetric sampling of gray–white matter that may lead to false‐positive results. We present 5 patients in whom conventional two‐dimensional and three‐dimensional MRI with multiplanar reformatting was initially considered normal. Subsequent studies using curvilinear reformatting identified lesions in all. Four patients underwent surgery with histological diagnosis of focal cortical dysplasia. Three patients are seizure‐free and 1 had significant improvement in seizure control. These results indicate that an increase in the detection of subtle focal dysplastic lesions may be accomplished when one improves the anatomical display of the brain gyral structure by performing curvilinear reformatting. Ann Neurol 1999;46:88–94