Detection of Epileptogenic Cortical Malformations with Surface-Based MRI Morphometry

Magnetic resonance imaging has revolutionized the detection of structural abnormalities in patients with epilepsy. However, many focal abnormalities remain undetected in routine visual inspection. Here we use an automated, surface-based method for quantifying morphometric features related to epileptogenic cortical malformations to detect abnormal cortical thickness and blurred gray-white matter boundaries. Using MRI morphometry at 3T with surface-based spherical averaging techniques that precisely align anatomical structures between individual brains, we compared single patients with known lesions to a large normal control group to detect clusters of abnormal cortical thickness, gray-white matter contrast, local gyrification, sulcal depth, jacobian distance and curvature. To assess the effects of threshold and smoothing on detection sensitivity and specificity, we systematically varied these parameters with different thresholds and smoothing levels. To test the effectiveness of the technique to detect lesions of epileptogenic character, we compared the detected structural abnormalities to expert-tracings, intracranial EEG, pathology and surgical outcome in a homogeneous patient sample. With optimal parameters and by combining thickness and GWC, the surface-based detection method identified 92% of cortical lesions (sensitivity) with few false positives (96% specificity), successfully discriminating patients from controls 94% of the time. The detected structural abnormalities were related to the seizure onset zones, abnormal histology and positive outcome in all surgical patients. However, the method failed to adequately describe lesion extent in most cases. Automated surface-based MRI morphometry, if used with optimized parameters, may be a valuable additional clinical tool to improve the detection of subtle or previously occult malformations and therefore could improve identification of patients with intractable focal epilepsy who may benefit from surgery

Sequential then Interactive Processing of Letters and Words in the Left Fusiform Gyrus

Despite decades of cognitive, neuropsychological, and neuroimaging studies, it is unclear if letters are identified prior to word-form encoding during reading, or if letters and their combinations are encoded simultaneously and interactively. Here, using functional magnetic resonance imaging, we show that a ‘letter-form’ area (responding more to consonant strings than false fonts) can be distinguished from an immediately anterior ‘visual word-form area’ in ventral occipitotemporal cortex (responding more to words than consonant strings). Letter-selective magnetoencephalographic responses begin in the letter-form area ~60ms earlier than word-selective responses in the word-form area. Local field potentials confirm the latency and location of letter-selective responses. This area shows increased high gamma power for ~400ms, and strong phase-locking with more anterior areas supporting lexico-semantic processing. These findings suggest that during reading, visual stimuli are first encoded as letters before their combinations are encoded as words. Activity then rapidly spreads anteriorly, and the entire network is engaged in sustained integrative processing

Detection of epileptogenic cortical malformations with surface-based MRI morphometry.

Magnetic resonance imaging has revolutionized the detection of structural abnormalities in patients with epilepsy. However, many focal abnormalities remain undetected in routine visual inspection. Here we use an automated, surface-based method for quantifying morphometric features related to epileptogenic cortical malformations to detect abnormal cortical thickness and blurred gray-white matter boundaries. Using MRI morphometry at 3T with surface-based spherical averaging techniques that precisely align anatomical structures between individual brains, we compared single patients with known lesions to a large normal control group to detect clusters of abnormal cortical thickness, gray-white matter contrast, local gyrification, sulcal depth, jacobian distance and curvature. To assess the effects of threshold and smoothing on detection sensitivity and specificity, we systematically varied these parameters with different thresholds and smoothing levels. To test the effectiveness of the technique to detect lesions of epileptogenic character, we compared the detected structural abnormalities to expert-tracings, intracranial EEG, pathology and surgical outcome in a homogeneous patient sample. With optimal parameters and by combining thickness and GWC, the surface-based detection method identified 92% of cortical lesions (sensitivity) with few false positives (96% specificity), successfully discriminating patients from controls 94% of the time. The detected structural abnormalities were related to the seizure onset zones, abnormal histology and positive outcome in all surgical patients. However, the method failed to adequately describe lesion extent in most cases. Automated surface-based MRI morphometry, if used with optimized parameters, may be a valuable additional clinical tool to improve the detection of subtle or previously occult malformations and therefore could improve identification of patients with intractable focal epilepsy who may benefit from surgery

Sequential then interactive processing of letters and words in the left fusiform gyrus.

Despite decades of cognitive, neuropsychological and neuroimaging studies, it is unclear if letters are identified before word-form encoding during reading, or if letters and their combinations are encoded simultaneously and interactively. Here using functional magnetic resonance imaging, we show that a 'letter-form' area (responding more to consonant strings than false fonts) can be distinguished from an immediately anterior 'visual word-form area' in ventral occipito-temporal cortex (responding more to words than consonant strings). Letter-selective magnetoencephalographic responses begin in the letter-form area ∼60 ms earlier than word-selective responses in the word-form area. Local field potentials confirm the latency and location of letter-selective responses. This area shows increased high-gamma power for ∼400 ms, and strong phase-locking with more anterior areas supporting lexico-semantic processing. These findings suggest that during reading, visual stimuli are first encoded as letters before their combinations are encoded as words. Activity then rapidly spreads anteriorly, and the entire network is engaged in sustained integrative processing

Detection sensitivity and specificity calculations for cortical surface measures calculated across patients and normal controls for different statistical thresholds (at FWHM = 5 mm).

<p>Detection sensitivity and specificity calculations for cortical surface measures calculated across patients and normal controls for different statistical thresholds (at FWHM  = 5 mm).</p

Receiver Operator Characteristics (ROC) curve showing effects of smoothing (smoothing level [sm] in FWHM [mm]) on sensitivity and specificity for thickness at different smoothing levels.

<p>Larger area under the curve shows higher discriminability.</p

Sensitivity and specificity for quantitatively derived areas of abnormality compared to expert-delineated lesion margins for different thresholds.

<p>Sensitivity and specificity for quantitatively derived areas of abnormality compared to expert-delineated lesion margins for different thresholds.</p

Summary of patient demographics and clinical profile.

<p><b>Clinical MRI:</b> diagnosis based on visual inspection of routine clinical MRI (FCD: focal cortical dysplasia; EM: encephalomalacia; PMG: polymicrogyria; HT: heterotopia); <b>Location:</b> (Lobe, R =  right hemisphere, L =  left hemisphere, B =  bilateral); <b>Scalp EEG:</b> seizure onset location based on scalp video-EEG monitoring.</p

False positive clusters in normal control samples at different z-scores and different quantitative measures (gwc = grey-white contrast; sulc = sulcal depth; lgi = local gyrification index; curv = curvature; jacobia = jacobian distance).

<p>Calculations were performed for all controls (n = 41, 82 hemispheres).</p