Diffusion tensor imaging discriminates focal cortical dysplasia from normal brain parenchyma and differentiates between focal cortical dysplasia types

• Published in: Insights into imaging 2023-02, Vol.14 (1), p.36-36, Article 36
• Main Authors: Gennari, Antonio Giulio, Cserpan, Dorottya, Stefanos-Yakoub, Ilona, Kottke, Raimund, O’Gorman Tuura, Ruth, Ramantani, Georgia
• Format: Article
• Language: English
• Subjects: Anisotropy; Biomarkers; Brain; Diagnostic Radiology; Diffusion; Diffusivity; DTI; Epilepsy; Focal cortical dysplasia; Imaging; Internal Medicine; Interventional Radiology; Magnetic resonance imaging; Malformation of cortical development; Mathematical analysis; Medical imaging; Medicine; Medicine & Public Health; MRI; Neuroradiology; Original; Original Article; Paediatric focal epilepsy; Pediatrics; Radiology; Tensors; Ultrasound
• ISSN: 1869-4101; 1869-4101
• DOI: 10.1186/s13244-023-01368-y

Objectives Although diffusion tensor imaging (DTI) may facilitate the identification of cytoarchitectural changes associated with focal cortical dysplasia (FCD), the predominant aetiology of paediatric structural epilepsy, its potential has thus far remained unexplored in this population. Here, we investigated whether DTI indices can differentiate FCD from contralateral brain parenchyma (CBP) and whether clinical features affect these indices. Methods In this single-centre, retrospective study, we considered children and adolescents with FCD-associated epilepsy who underwent brain magnetic resonance (MRI), including DTI. Fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity, and radial diffusivity, were calculated in both FCD and CBP. The DTI indices best discriminating between FCD and CBP were subsequently used to assess the link between DTI and selected clinical and lesion-related parameters. Results We enrolled 32 patients (20 male; median age at MRI 4 years), including 15 with histologically confirmed FCD. FA values were lower ( p  = 0.03), whereas MD values were higher in FCD than in CBP ( p  = 0.04). The difference in FA values between FCD and CBP was more pronounced for a positive vs. negative history of status epilepticus ( p  = 0.004). Among histologically confirmed cases, the difference in FA values between FCD and CBP was more pronounced for type IIb versus type I FCD ( p  = 0.03). Conclusions FA and MD discriminate between FCD and CBP, while FA differentiates between FCD types. Status epilepticus increases differences in FA, potentially reflecting changes induced in the brain. Our findings support the potential of DTI to serve as a non-invasive biomarker to characterise FCD in the paediatric population. Key points DTI derived indices may be a useful tool for FCD characterisation. FA and MD discriminated between FCD and contralateral brain parenchyma (CBP). Status epilepticus increased the FA difference values between FCD and CBP. Type IIb showed higher FA difference values than type I FCD.