Akira Yogi MD, Presenter: Nothing to Disclose

Yoko Hirata, Abstract Co-Author: Nothing to Disclose

Elena Karavaeva MD, Abstract Co-Author: Nothing to Disclose

Joyce Wu MD, Abstract Co-Author: Nothing to Disclose

Sue Yudovin, Abstract Co-Author: Nothing to Disclose

Benjamin Michael Ellingson MS, PhD, Abstract Co-Author: Research Consultant, MedQIA Imaging Core Laboratory Research Consultant, F. Hoffmann-La Roche Ltd Research Consultant, Tocagen Inc Research Consultant, Boston Scientific Corporation Research Consultant, Amgen Inc Research Grant, Siemens AG Research Grant, F. Hoffmann-La Roche Ltd

Noriko Salamon MD, Abstract Co-Author: Nothing to Disclose

The purpose of this study is to evaluate if diffusion tensor imaging (DTI) can detect epileptogenic tubers and perituberal tissues in pediatric tuberous sclerosis complex (TSC) patients, and to investigate if background white matter myelination, which usually completes by 3 years old, influences DTI parameters.

Twenty-two patients (0.4-19.6 year old, mean age 5.3; 12 female, 10 male) who underwent tuber resection for treatment of epilepsy between 2004 and 2011 were retrospectively selected from TSC cohort of our institute. All patients had preoperative DTI. Total of 545 tubers were divided into as epileptogenic or non-epileptogenic. Epileptogenicity was defined by preoperative evaluation of EEG, FDG-PET, Magnetoencephalogram, and intraoperative electrocorticography. Two observers manually outlined all tubers (ROItuber) on ADC map as a reference of T2WI or FLAIR. 4 mm thick ring-shaped ROIs of perituberal tissue (ROIperituber) and ROIs including tuber and perituberal tissue (ROItuber+perituber) were also generated. Maximum, minimum, mean, and median values of ADC, FA, and RD were calculated. Mann-Whitney test and unpaired t test were used to analyze DTI parameters between epileptogenic and non-epileptogenic tubers. To investigate the influence of white matter myelination, a group of patients younger than 3 years old was separately analyzed and results were compared with all patients.

Maximum ADC and RD were significantly higher in epileptogenic tubers. FA showed no significant difference between groups. The changes were more significant in patients younger than 3. Furthermore, ROItuber and ROItuber+perituber showed higher mean ADC and lower minimum FA in epileptogenic tubers. Maximum ADC value of ROItuber+perituber showed most significant difference in all patients and patients younger than 3 (Fig. 1a, 1b). ROC curves showed higher value of area under curve in patients younger than 3 (Fig. 2a, 2b).

ADC and RD of tuber and tuber + perituberal tissue were higher in epileptogenic group. DTI can be a promising additional tool to predict epileptogenic tissue, especially in patients younger than 3 years old.

DTI can be a promising tool to detect epileptogenic tubers in pediatric TSC patients, which may lead to seizure control and better cognitive outcome.

Yogi, A, Hirata, Y, Karavaeva, E, Wu, J, Yudovin, S, Ellingson, B, Salamon, N, Diffusion Tensor Imaging Can Detect Epileptogenic Tissue in Pediatric Tuberous Sclerosis Patients.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14011828.html