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106 - Focal Cortical Dysplasia

from Section 4 - Abnormalities Without Significant Mass Effect

Published online by Cambridge University Press:  05 August 2013

Zoran Rumboldt
Affiliation:
Medical University of South Carolina
Maria Gisele Matheus
Affiliation:
Department of Radiology and Radiological Science, Charleston, SC
Zoran Rumboldt
Affiliation:
Medical University of South Carolina
Mauricio Castillo
Affiliation:
University of North Carolina, Chapel Hill
Benjamin Huang
Affiliation:
University of North Carolina, Chapel Hill
Andrea Rossi
Affiliation:
G. Gaslini Children's Research Hospital
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Summary

Specific Imaging Findings

Focal cortical dysplasia (FCD) Type I shows only localized blurring of the gray–white matter junction and sometimes decreased volume of the subcortical white matter and cortex that may be detected with dedicated high spatial resolution heavily T1-weighted inversion recovery spin echo and 3D gradient echo images. The lesions are preferentially located at the bottom of an abnormally deep sulcus. The subcortical white matter may show hyperintense T2 signal, best depicted on high-resolution FLAIR images. These findings can be very subtle, typically not seen on CT and routine MRI scans, and in a significant number of cases not even on dedicated MR imaging. Functional studies (PET, SPECT and MEG) may be able to localize the seizure focus and tailored MRI of the suspicious area with a surface coil may then depict the lesion. Co-registration of PET and MR images substantially increases sensitivity. FCD Type II shows localized cortical thickening and T2 hyperintensity, which can characteristically extend in a tapered linear fashion towards the ventricle, known as the transmantle sign. Gray–white matter junction blurring and subtle white matter T1 hyointensity may be present. The gyral pattern may be abnormal with broad gyri and irregular sulci. A lesion detected on imaging is not necessarily the seizure focus, and FCD may occur in a multifocal and multilobar distribution.

Type
Chapter
Information
Brain Imaging with MRI and CT
An Image Pattern Approach
, pp. 219 - 220
Publisher: Cambridge University Press
Print publication year: 2012

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References

1. Colombo, N, Salamon, N, Raybaud, C, et al. Imaging of malformations of cortical development. Epileptic Disord 2009;11:194–205.Google ScholarPubMed
2. Hofman, PA, Fitt, GJ, Harvey, AS, et al. Bottom-of-sulcus dysplasia: imaging features. AJR 2011;196:881–5.CrossRefGoogle ScholarPubMed
3. Abdel Razek, AA, Kandell, AY, Elsorogy, LG, et al. Disorders of cortical formation: MR imaging features. AJNR 2009;30:4–11.CrossRefGoogle ScholarPubMed
4. Blumcke, I, Mühlebner, A. Neuropathological work-up of focal cortical dysplasias using the new ILAE consensus classification system – practical guideline article invited by the Euro-CNS Research Committee. Clin Neuropathol 2011;30:164–77.CrossRefGoogle ScholarPubMed
5. Wagner, J, Urbach, H, Niehusmann, P, et al. Focal cortical dysplasia type IIb: completeness of cortical, not subcortical, resection is necessary for seizure freedom. Epilepsia 2011;52:1418–24.CrossRefGoogle Scholar

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