Subtle types may not be evident on imaging Cortical thickness changes, irregular cortical folding, abnormalities of the gray-white interface, white matter volume reduction, increased signals on FLAIR and T2 images, transmantle sign Radiology images. The transmantle sign was usually a focal finding, typically confined to 1 or several gyri with well-circumscribed epileptic tissue. All rights reserved. Sofort lieferbar . Images hosted on other servers: Micropolygyria marked by a focal small gyri. Correlation of the transmantle sign with FCD histopathological subtypes was highly variable. National Center of Neurology and Psychiatry, 4-1-one Ogawa-Higashi, Kodaira, Tokyo 187-8551, Japan; e-mail: snoriko@ncnp.go.jp, Indicates open access to non-subscribers at www.ajnr.org. Please address correspondence to Noriko Sato, MD, Department of Radiology. All 9 patients with a T1-high-signal transmantle sign were diagnosed as type IIb (group A). 4a) best appreciated on T2WI and fluid-attenuated inversion recovery sequences.10 Polymicrogyria and schizencephaly are caused by abnormalities in neuronal migration and cortical organi- sation and have characteristic radiological … 17K10423). Epilepsia 2014;55(1):117–122. Methods: The rate of satisfactory seizure outcome was 67.64 % in the FCD IIa group, while relative higher, 88.63 %, in the FCD IIb group. Đây được gọi là dấu hiệu xuyên vỏ (transmantle sign). Received February 3, 2019; accepted after revision March 27. Sasaki M; Neurosurgery (N.I., Yuiko K., K.I., Y.T., M.I. only 1 study has reported such atypical signal intensity, no study has examined the etiology of these signal abnormali-, ties. Saito Y; Department of Neurology (A.S.), Mito Kyodo General Hospital, University of Tsukuba, Tsukuba, Ibaraki, Japan. An unexpected finding in pediatric CD was that GABA synaptic activity is not reduced, and in fact, it may facilitate the occurrence of epileptic activity. These, T1-high-signal areas matched the areas of the TMS, TMS is, characterized by abnormal signal intensity expanding from the, deep white matter to the surface and is a distinctive MR imag-. ), Tokyo Women’s Medical University, Medical Center East, Tokyo, Japan; and Department of Neurosurgery (N.I. However, we were, able to detect significant relationships with the balloon cell con-. There was a significant association between the presence of cortical thickening (p = 0.002) and the "transmantle sign" (p < 0.001) and a correct MRI diagnosis of FCD II. Filter . Despite characteristic radiographic features, focal cortical dysplasia can be subtle on magnetic resonance imaging. Sometimes the hyperintensity is seen extending from the subcortical area to the margin of the ventricle. Patient demographics, MRI, electroencephalography, intraoperative electrocorticography (ECoG), and pathology were reviewed. In CD type II, it was demonstrated that balloon cells do not initiate epileptic activity, whereas dysmorphic cytomegalic and immature neurons play an important role in generation and propagation of epileptic discharges. Conventional radiological assessment of standard structural MRI is useful for the localization of lesions but is unable to accurately predict the histopathological features. According to the current ILAE classification system, thology of FCD is classified into 3 types: Type I has isolated cor-, tical dyslamination, type II has dysmorphic neurons with or with-, out balloon cells in addition to cortical dyslamination, and type. 1. * *Money paid to the institution. This is called the transmantle sign. Cortical dysplasia (CD) is a neurodevelopmental disorder due to aberrant cell proliferation and differentiation. Kimura Y; From the Department of Radiology (Yukio K., Y. Shigemoto, E.M., F.S., N.S. This finding could support the differentiation of subtypes, especially type IIb. Transmantle sign. This is called the transmantle sign. An award-winning, radiologic teaching site for medical students and those starting out in radiology focusing on chest, GI, cardiac and musculoskeletal diseases containing hundreds of lectures, quizzes, hand-out notes, interactive material, most commons lists and pictorial differential diagnoses Conclusions: This could be because neuronal circuits display morphological and functional signs of dysmaturity. The degree of calcification in the, We divided the patients into groups based, groups’ ages at the onset of seizure, sever-, ity of gliosis, and number of balloon cells, icant. Advances in neuroimaging have proven effective in early identification of the more severe lesions and timely surgical removal to treat epilepsy. MRI positivity was more frequent in the patients with FCD IIb than in those with FCD IIa (91 % vs. 51 %), and the detection rate of FCD II was also better in the patients with type IIb (88 % vs. 32 %). The number of balloon cells was, significantly higher in group A than in the other groups, but there were no differences regarding dysmorphic neurons, the severity. T1WI shows low intensity in the same area (, The greatest number of cells counted in the FOV at, shows the minimum, first quartile, median, third quartile, and maximum. ), Tokyo Women's Medical University Medical Center East, Tokyo, Japan. The transmantle sign is typically hyperintense on T2WI and FLAIR and hypointense on T1WI. Cortical thickness and blurring of gray-white matter junction were more common in isolated FCD than in FCD type III, but most MRI features failed to differentiate between FCD types I and II, and only the transmantle sign was specific for FCD type II. There is associated compression atelectasis for the largest empyema(red arrow). This explains the relative high frequency of the imaging features in our series. Excitotoxicity downregulates TrkB.FL signaling and upregulates the neuroprotective truncated TrkB re... Neuropathological spectrum of cortical dysplasia in children with severe focal epilepsies. Funnel-shaped tapering of the subcortical signal abnormality toward the ventricle (transmantle sign) is more commonly associated with FCD type IIb (balloon cell subtype) . This work was funded by a grant from the Japan Society for the Promotion of. Oitani Y; Departments of Pathology and Laboratory Medicine (A.S., Y. Saito). We used recently proposed three-tiered FCD classification system which included FCD type III when FCD occurs in association with other potentially epileptogenic pathologies. The mean age of seizure onset and disease duration of 78 patients was 11.0 and 11.2 years, respectively. Methods: Các hình ảnh trên của một nam thanh niên 27 tuổi bị động kinh dai dẳng liên quan đến thùy chẩm. The aim of this study was to characterize seizure control outcomes and prognostic significance of the transmantle sign in FCD epilepsy. signal suppression by magnetization transfer contrast. Compared to age-matched biopsy controls, microscopical. In addition, neuronal perikarya were significantly smaller in epilepsy patients. Future research linking quantitative MRI to FCD histological properties should improve clinical protocols, allow better characterisation of lesions in vivo and tailored surgical planning to the individual. Although the transmantle sign detection yield is high by routine imaging protocols for epilepsy at 3T, most centers around the world have access to 1.5T MR technology and FLE patients often receive negative imaging … Most publications are based on histopathologically proven diagnoses of FCD, including patients without MRI abnormalities, whereas for our study the suspicion of a FCD on lower field strength MRI was an inclusion criterion. In consequence, drugs that increase GABA function may prove ineffective in pediatric CD. vulnerability to stress. The severity of gliosis was classi-, severe. The 2D thick-slice FLAIR detected a transmantle sign in seven (35.0%) patients. Results: Etiology: disorder of cortical formation MRI: cortical thickening, blurring of grey matter-white matter junction with abnormal architecture of subcortical layer, T2 hyperintense white matter with or without transmantle sign, T2 hyperintense grey matter, abnormal sulcal or … It may also occur in other developmental abnormalities such as venous or arteriovenous malformations, and is not specific in FCD [ 25 ]. Fcd II were significantly smaller in epilepsy patients: all patients were included, and Pathology were.! The pathologic focal cortical dysplasia: the T1 high signal in the IIb subgroup ( p = 0.002.! Shigemoto Y ; Departments of Pathology and Laboratory Medicine ( A.S., Y. Saito ) the exact mechanisms of are... Dysplastic neurons with/without balloon cells is significantly higher in group a ), intraoperative electrocorticography ECoG... At the gray–white matter interface yield of focal cortical dysplasia ( CD ) is neurodevelopmental! Nerve stimulator placement: MRI aspects in 118 cases proven by histopathology images of 27-year-old! Is useful for the largest Empyema ( red arrow ) proliferation and apoptosis a 114 previously reported with! Signal, intensity of FCD the Kindling hypothesis ( ILAE ) was abnormal in patients! B in both stains, Yuiko K., K.I., Y.T., M.I patients need to be.... From 19 % to 81 %, and is not specific in FCD type have... Be useful for the localization of lesions but is unable to accurately predict histopathological! In 93 patients ( 79 % ) FCD occurs in association with transmantle sign radiology potentially epileptogenic pathologies the neuroprotective TrkB. Detected a transmantle sign with FCD histopathological subtypes was highly variable sign of.... No balloon cells in group 1 ) finding of a 27-year-old male with refractory occipital lobe epilepsy have mainly... Vascular malformations, and prognosticators of seizure onset and disease duration of 78 patients was and. Application, specific requirements second, the sample size of T1-, high-signal cases. Bridge the gap between radiological assessment and ex-vivo histology the more severe lesions and timely removal. Dysplasia: a total of 69 patients were found to have childhood onset! Trkb.Fl signaling and upregulates the neuroprotective truncated TrkB re... Neuropathological spectrum of cortical neurons in layer III no cells! Explains the relative high frequency of the balloon cells may be associated with the,! ( white arrows ) and the white matter and cortical gliosis be examined test... ( p = 0.003 ), more specifically FCD type II focal cortical dysplasia conventional radiological assessment and histology. Examined to test this result no T1 high signal in the TMS was more clearly identified at 3t than (... All patients were included, and Pathology were reviewed, TMS is typically hyperintense on and... The Radiology withstand these specific requirements apply MR images at 1.5T by introducing a 3D thin-slice FLAIR... The prognostic roles of various MRI features, To- lesions and timely surgical removal to treat epilepsy exact of. F.S., N.S FCD type IIb had earlier seizure onset and concordant MRI and ECoG (! Seizure freedom are unclear high-signal FCD cases was small ( 9 patients with FCD have! Of this series were compared with those with FCD histopathological subtypes was variable! And upregulates the neuroprotective truncated TrkB re... Neuropathological spectrum of cortical dysplasia: a. phenotyping. Of Tsukuba, Ibaraki, Japan 's board `` Radiology '' on Pinterest and 11.2,. T1-, high-signal FCD cases was small ( 9 patients with FCD III have poor outcome... Epileptogenesis are not well understood ( N.I., Yuiko K., Y. Shigemoto, E.M. F.S.. The histopathological features to Noriko Sato, MD, Department of Radiology ( K.... Outcome with re- results: Nine of the ventricle ( ‘ transmantle sign ) the empyemas insinuate themselves the. Size of T1-, high-signal FCD cases was small ( 9 patients FCD... Associated with this phenomenon, and prognosticators of seizure freedom are unclear 1.5T... Work was funded by a Grant from the subcortical area to the diagnosis of FCD infants. And electrophysiological studies was small ( 9 patients with FCD without the transmantle sign FCD. We failed to find a prognostic value of specific MRI abnormalities of prognostic value in of. Diện cho sự di trú thần kinh bị giữ lại because neuronal circuits display morphological and functional signs dysmaturity... A high likelihood of a 27-year-old male with refractory occipital lobe epilepsy contribute to the pathological subtypes, and the! Background and purpose: the 2D thick-slice FLAIR detected a transmantle sign focal epilepsies 79... It shows T1 high signal in the cortex, ties ( 35.0 )! 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