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ATYPICAL RESULTS OF MR-PERFUSION IN THE DIAGNOSIS OF LONG-TERM

EPILEPSY ASSOCIATED TUMORS

 

Medvedeva N.А.1,  Khalilov V.S.1,2, Kislyakov A.N.3, Kopachev D.N.4, Serova N.S.5

 

Introduction. The aim of the paper is to demonstrate the possibilities of a modified MR scanning protocol for individual characteristics of particulars in patients with epileptogenic tumors of low malignancy.

Materials and methods. Superconductive MR systems (3 T), routine scanning with a slice thickness of 5 mm and a step of 2 mm with the inclusion in the protocol of pulse sequences T1, T2 (PROPELLER, Multivane, depending on the tomograph manufacturer), FLAIR, DWI, GRA T2 or SWI (SWAN) were used in our study. Used three-dimensional 3D sequences with a slice thickness of 1.0 mm in T1 — FSPGR, TFE (depending on the manufacturer of the tomograph).

In the case when an epileptogenic substrate of unclear etiology was revealed, the real-time scanning protocol was modified, intravenous contrast, contrast-free MR perfusion (ASL/DSC) and tractography (DTI) included if necessary. In one case, the obtained images were combined with the results of hybrid PET/CT with 11C methionine.

Results. According to routine MRI three patients were found to have substrates of unclear etiology, which in two cases was associated with pharmacoresistant epilepsy. When modifying the scanning protocol to the individual peculiarities of patients, increased values of MR perfusion were noted, which, in its turn, in combination with other radiological markers and clinical manifestations, let us  suggest the presence of neoplasm in the structure of these substrates.

When comparing the results of radiological methods and the histological analysis, a discrepancy between the perfusion characteristics with regard to the grade of tumors of the WHO classification of the Сentral nervous system tumors was revealed. Thus, further study is required.

Conclusion. The non-typical MR perfusion in the process the LEAT group tumors diagnosis requires further study as well as observation and may become an additional radiological marker in the near future. When detecting epileptogenic substrates of unclear etiology it is advisable to use a modified MR scanning protocol.

1 - Federal Research and Clinical Center for Children and Adolescents.

2 - Pirogov Russian National Research Medical University.

3 - Morozov Children Clinical Hospital.

4 - Research Center of Neurology.

5 - I.M. Sechenov First Moscow State Medical University (Sechenov University). Russia, Moscow.

Keywords: Long-Term Epilepsy Associated Tumors (LEAT), neuroimaging, MR – perfusion.

 


Corresponding author: Medvedeva N.А., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript

 

For citation: Medvedeva N.А.,  Khalilov V.S., Kislyakov A.N., Kopachev D.N., Serova N.S. Atypical results of MR-perfusion in the diagnosis of long-term epilepsy associated tumors. REJR 2022; 12(3):94-108. DOI: 10.21569/2222-7415-2022-12-3-94-108.

Received:        16.08.22 Accepted:       15.09.22