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Pediatric Radiology

, Volume 46, Issue 10, pp 1430–1438 | Cite as

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

  • Rupa Radhakrishnan
  • James L. Leach
  • Francesco T. Mangano
  • Michael J. Gelfand
  • Leonid Rozhkov
  • Lili Miles
  • Hansel M. Greiner
Original Article

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.

Keywords

Brain Cerebral cortex Children Cortical dysplasia Magnetic resonance imaging Seizures 

Notes

Compliance with ethical standards

Conflicts of interest

None

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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Rupa Radhakrishnan
    • 1
  • James L. Leach
    • 1
  • Francesco T. Mangano
    • 2
  • Michael J. Gelfand
    • 1
  • Leonid Rozhkov
    • 4
  • Lili Miles
    • 3
  • Hansel M. Greiner
    • 4
  1. 1.Department of RadiologyCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  2. 2.Department of NeurosurgeryCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  3. 3.Department of PathologyCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  4. 4.Department of Neurology, Comprehensive Epilepsy Treatment CenterCincinnati Children’s Hospital Medical CenterCincinnatiUSA

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