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Qualitative and quantitative evaluation for the heterogeneity of cortical tubers using structural imaging and diffusion-weighted imaging to predict the epileptogenicity in tuberous sclerosis complex patients

  • Paediatric Neuroradiology
  • Published:
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Abstract

Purpose

We aimed to evaluate whether the heterogeneity of tuber imaging features, evaluated on the structural imaging and apparent diffusion coefficient (ADC) map, can facilitate detecting epileptogenic tubers before surgery in tuberous sclerosis complex (TSC) patients.

Methods

Twenty-three consecutive patients, who underwent tuber resection at our institute, were retrospectively selected. A total of 125 tubers (39 epileptogenic, 86 non-epileptogenic) were used for the analysis. Tuber heterogeneity was evaluated, using a 5-point visual scale and standard deviation of ADC values (ADCsd). A 5-point visual scale reflected the degree of T1/T2 prolongation, presence of internal cystic degeneration, and their spatial distribution within the tuber. These results were statistically compared between epileptogenic and non-epileptogenic groups, and their performance in predicting the epileptogenicity was also evaluated by receiver operating characteristic (ROC) analysis.

Results

A 5-point visual scale demonstrated that more heterogeneous tubers were significantly more epileptogenic (p < 0.001). Multiplicity of internal cystic degeneration moderately correlated with epileptogenicity (p < 0.03) based on the comparison between class 4 and class 5 tubers. ADCsd was significantly higher in epileptogenic tubers (p < 0.001). ROC curves revealed that a 5-point visual scale demonstrated higher area under the curve (AUC) value than ADCsd (0.75 and 0.72, respectively).

Conclusion

Tuber heterogeneity may help identify the epileptogenic tubers in presurgical TSC patients. Visual assessment and standard deviation of ADC value, which are easier to implement in clinical use, may be a useful tool predicting epileptogenic tubers, improving presurgical clinical management for TSC patients with intractable epilepsy.

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Data Availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Radiology, University of the Ryukyus Hospital, 207 Uehara, Nishihara-Cho, Nakagami-Gun, Okinawa, 903-0215, Japan

    Akira Yogi

  2. Department of Radiological Science, David Geffen School of Medicine, University of California, 924 Westwood Blvd, Los AngelesLos Angeles, CA, 90024, USA

    Akira Yogi, Yoko Hirata, Michael Linetsky, Benjamin M. Ellingson & Noriko Salamon

  3. Department of Neurosurgery, Toho University Ohashi Medical Center, 2-22-36 Ohashi, Meguro-Ku, Tokyo, 153-8515, Japan

    Yoko Hirata

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Correspondence to Akira Yogi.

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The Institutional Review Board at our institute approved the use of human subjects. The need for written informed consent and signed patient consent-to-disclose forms was waived because all testing was deemed clinically relevant to patient care.

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Yogi, A., Hirata, Y., Linetsky, M. et al. Qualitative and quantitative evaluation for the heterogeneity of cortical tubers using structural imaging and diffusion-weighted imaging to predict the epileptogenicity in tuberous sclerosis complex patients. Neuroradiology 65, 845–853 (2023). https://doi.org/10.1007/s00234-022-03094-6

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  • DOI: https://doi.org/10.1007/s00234-022-03094-6

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