• World Neurosurg · Feb 2017

    SUrface-PRojected FLAIR (SUPR-FLAIR) analysis: a novel tool for advanced imaging of epilepsy.

    • Francesco Cardinale, Stefano Francione, Luciana Gennari, Alberto Citterio, Maurizio Sberna, Laura Tassi, Roberto Mai, Ivana Sartori, Lino Nobili, Massimo Cossu, Laura Castana, Lo RussoGiorgioG"Claudio Munari" Center for Epilepsy Surgery, Niguarda Hospital, Milano, Italy., and Nadia Colombo.
    • "Claudio Munari" Center for Epilepsy Surgery, Niguarda Hospital, Milano, Italy. Electronic address: francesco.cardinale@ospedaleniguarda.it.
    • World Neurosurg. 2017 Feb 1; 98: 715-726.e1.

    ObjectiveThe objective of this pilot retrospective study is to describe the SUrface-PRojected FLuid-Attenuation-Inversion-Recovery (SUPR-FLAIR) analysis, a novel method mainly aimed at revealing cortical areas with subtle signal hyperintensity.MethodsImages from 101 healthy controls and 10 patients suffering from drug-resistant partial epilepsy were retrospectively postprocessed. The brain surface was reconstructed from a 3-dimensional (3D) T1-weighted fast field echo (T1W-FFE) magnetic resonance imaging (MRI) scan. A turbo spin echo fluid attenuated inversion recovery axial scan was registered to the 3D T1W-FFE scan, and its intensity values were normalized. The cortical intensity signal was projected onto the brain surface, and surface-based analysis was performed, comparing each patient against the 101 controls. The localizations of the first positive lower P value cluster (PLPC) peak and the resection zone (RZ) were compared. We studied 5 patients with focal cortical dysplasia (3 of them with negative MRI) and 5 with hippocampal sclerosis.ResultsSUPR-FLAIR analysis localized the first PLPC peak in the RZ in all cases. Because all patients have been seizure free since surgery, it can be assumed that the epileptogenic zone (EZ) was included in the RZ. Therefore, SUPR-FLAIR analysis correctly aligned with the EZ, with 100% sensitivity.ConclusionsSUPR-FLAIR analysis is a noninvasive technique that could be helpful for the definition of the EZ, especially when MRI is negative. Its use could reduce the indications for invasive electroencephalography or could provide essential data to refine the strategy of intracerebral electrode implantation in the most challenging cases.Copyright © 2016 Elsevier Inc. All rights reserved.

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