Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Mar;64(3):443-452.
doi: 10.1007/s00234-021-02865-x. Epub 2021 Nov 27.

MRI of focal cortical dysplasia

Horst Urbach  1 , Elias Kellner  2 , Nico Kremers  3 , Ingmar Blümcke  4 , Theo Demerath  3
Affiliations
Review

MRI of focal cortical dysplasia

Horst Urbach et al. Neuroradiology. 2022 Mar.

Abstract

Focal cortical dysplasia (FCD) are histopathologically categorized in ILAE type I to III. Mild malformations of cortical development (mMCD) including those with oligodendroglial hyperplasia (MOGHE) are to be integrated into this classification yet. Only FCD type II have distinctive MRI and molecular genetics alterations so far. Subtle FCD including FCD type II located in the depth of a sulcus are often overlooked requiring the use of dedicated sequences (MP2RAGE, FLAWS, EDGE) and/or voxel (VBM)- or surface-based (SBM) postprocessing. The added value of 7 Tesla MRI has to be proven yet.

Keywords: Focal cortical dysplasia; Lesions; MRI.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
FCD type IIb in the depth of the right superior frontal sulcus. A–C 3 Tesla axial, coronal, and sagittal 3D FLAIR SPACE images show a thickenend cortex and a hyperintense transmantle sign tapering towards the frontal horn of lateral ventricle (B, C: arrow). D–F 3 Tesla sagittal MP2RAGE images at inversion times TI of 700 ms (D) and 2500 ms (E). Calculated so-called unified image (F). G–I 3 Tesla sagittal FLAWS images at inversion times TI of 409 ms (G) and 1160 ms (H). Calculated minimum intensity image (I). J 3 Tesla calculated sagittal EDGE image at an inversion time of 442 ms according to Bydder and Young (1995) and Hornak (2008). K–L MAP-postprocessed MP2RAGE images after inverse normalization and co-registration of the CNN output map to the unified images
Fig. 2
Fig. 2
A 24-year-old man with two FCD in the right cingulate gyrus. The anterior one with a transmantle sign was visually detected on a 3 Tesla 3D FLAIR sequence with isotropic 1 mm3 voxels (A, C–D: arrow). The posterior one was detected with the aid of the morphometric analysis program only (B, C, E hollow arrow, F crosshair on so-called junction image before first surgery, G–H crosshair on co-registered MP2RAGE and probability maps after second surgery). While the anterior lesion was classified as FCD IIb, no FCD was diagnosed for the posterior lesion. As the patient did not get seizure-free the posterior lesionectony was extended and histology now revealed a FCD IIa
Fig. 3
Fig. 3
Mild malformation of cortical development with oligodendroglial hyperplasia (MOGHE) in the left frontal lobe in a 3-year-old girl. A–C 3 Tesla coronal 3D T2 SPACE (A), axial T2 TSE (B), coronal T1 MPRAGE (C), and axial T2 TSE (D) images. T2-weighted images show a juxtacortical hyperintense signal band (A–B, arrows), extending into the left precentral gyrus (B, arrowhead). On the MPRAGE image, the T2-hyperintense band looks like a subtle blurring of the gray-white matter junction (C arrows). D Axial T2w image after subtotal left frontal lobe resection. Despite residual lesion in the left precentral gyrus, the patient was seizure-free (Engel IA) after 3 months
See this image and copyright information in PMC

References

    1. Blumcke I, Spreafico R, Haaker G, Coras R, Kobow K, Bien CG, Pfäfflin M, Elger C, Widman G, Schramm J, Becker A, Braun KP, Leijten F, Baayen JC, Aronica E, Chassoux F, Hamer H, Stefan H, Rössler K, Thom M, Walker MC, Sisodiya SM, Duncan JS, McEvoy AW, Pieper T, Holthausen H, Kudernatsch M, Meencke HJ, Kahane P, Schulze-Bonhage A, Zentner J, Heiland DH, Urbach H, Steinhoff BJ, Bast T, Tassi T, Lo Russo G, Özkara C, Oz B, Krsek P, Vogelgesang S, Runge U, Lerche H, Weber Y, Honavar M, Pimentel J, Arzimanoglou A, Campos, AU, Noachtar S, Hartl E, Schijns O, Guerrini R, Barba C, Jacques TS, Cross HJ, Feucht M, Mühlebner A, Grunwald T, Trinka E, Winkler PA, Gil-Nagel A, Toledano Delgado R, Mayer T, Lutz M, Zountsas B, Garganis K, Rosenow F, Hermsen A, von Oertzen TJ, Diepgen TL, Avanzini G, on behalf of the European Epilepsy Brain Bank (EEBB) Consortium Histopathological findings in brain tissue obtained during epilepsy surgery. N Engl J Med. 2017;377:1648–1656. doi: 10.1056/NEJMoa1703784. - DOI - PubMed
    1. Blumcke I, Thom M, Aronica E, Armstrong DD, Vinters HV, Palmini A, Jacques TS, Avanzini G, Barkovich AJ, Battaglia G, Becker A, Cepeda C, Cendes F, Colombo N, Crino P, Cross JH, Delalande O, Dubeau F, Duncan J, Guerrini R, Kahane P, Mathern G, Najm I, Ozkara C, Raybaud C, Represa A, Roper SN, Salamon N, Schulze-Bonhage A, Tassi L, Vezzani A, Spreafico R. The clinico-pathological spectrum of Focal Cortical Dysplasias: a consensus classification proposed by an ad hoc Task Force of the ILAE Diagnostic Methods Commission. Epilepsia. 2011;52:158–174. doi: 10.1111/j.1528-1167.2010.02777.x. - DOI - PMC - PubMed
    1. Coras R, Holthausen H, Sarnat HB. Focal cortical dysplasia type 1. Brain Pathol. 2021;31(4):e12964. doi: 10.1111/bpa.12964. - DOI - PMC - PubMed
    1. Palmini A, Najm I, Avanzini G, Babb T, Guerrini R, Foldvary-Schaefer N, Jackson G, Luders HO, Prayson R, Spreafico R, Vinters HV. Terminology and classification of the cortical dysplasias. Neurology. 2004;62:S2–8. doi: 10.1212/01.WNL.0000114507.30388.7E. - DOI - PubMed
    1. Schurr J, Coras R, Rössler K, Pieper T, Kudernatsch M, Holthausen H, Winkler P, Woermann F, Bien CG, Polster T, Schulz R, Kalbhenn T, Urbach H, Becker A, Grunwald T, Huppertz HJ, Gil-Nagel A, Toledano R, Feucht M, Mühlebner A, Czech T, Blümcke I. Mild malformation of cortical development with oligodendroglial hyperplasia in frontal lobe epilepsy: a new clinico-pathological entity Brain Pathol. 2017;27:26–35. doi: 10.1111/bpa.12347. - DOI - PMC - PubMed

MeSH terms