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Research ArticleFunctional

Abnormal Blood Oxygen Level–Dependent Fluctuations in Focal Cortical Dysplasia and the Perilesional Zone: Initial Findings

L. Gupta, P.A.M. Hofman, R.M.H. Besseling, J.F.A. Jansen and W.H. Backes
American Journal of Neuroradiology July 2018, 39 (7) 1310-1315; DOI: https://doi.org/10.3174/ajnr.A5684
L. Gupta
aFrom the Department of Radiology and Nuclear Medicine (L.G., P.A.M.H., R.M.H.B., J.F.A.J., W.H.B.)
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  • ORCID record for L. Gupta
P.A.M. Hofman
aFrom the Department of Radiology and Nuclear Medicine (L.G., P.A.M.H., R.M.H.B., J.F.A.J., W.H.B.)
bSchool for Mental Health and Neuroscience (P.A.M.H., J.F.A.J., W.H.B.), Maastricht University Medical Center, Maastricht, the Netherlands
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R.M.H. Besseling
aFrom the Department of Radiology and Nuclear Medicine (L.G., P.A.M.H., R.M.H.B., J.F.A.J., W.H.B.)
cDepartment of Electrical Engineering (R.M.H.B.), Eindhoven University of Technology, Eindhoven, the Netherlands.
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J.F.A. Jansen
aFrom the Department of Radiology and Nuclear Medicine (L.G., P.A.M.H., R.M.H.B., J.F.A.J., W.H.B.)
bSchool for Mental Health and Neuroscience (P.A.M.H., J.F.A.J., W.H.B.), Maastricht University Medical Center, Maastricht, the Netherlands
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W.H. Backes
aFrom the Department of Radiology and Nuclear Medicine (L.G., P.A.M.H., R.M.H.B., J.F.A.J., W.H.B.)
bSchool for Mental Health and Neuroscience (P.A.M.H., J.F.A.J., W.H.B.), Maastricht University Medical Center, Maastricht, the Netherlands
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    Fig 1.

    Sample orthogonal FLAIR images depicting an FCD lesion (arrows) of a 30-year-old woman. Inserts show the magnification of the lesion on FLAIR contrast and cortical parameter maps of fALFF, regional homogeneity, and wavelet entropy. Increased regional homogeneity, wavelet entropy, and decreased fALFF were observed in the FCD lesion and the immediate perilesional regions in comparison with the regions more distinct from the FCD. Only gray matter is visualized; white matter is masked out.

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    Fig 2.

    Fractional amplitude of low frequency fluctuations as a function of frequency in the range of 10–250 MHz. Only the lowest sub-band (ie, slow-5; 10–27 MHz, magnified) showed significantly lower amplitudes in the FCD lesion relative to the controls. Error bars represent the standard error of mean.

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    Table 1:

    Patient characteristics

    No.Age/SexSeizure FrequencyaFCD LocationMRI Structural Image Findings
    130/FHighRight insulaTransmantle sign, gray-white matter blurring, cortical thickening, T2-FLAIR hyperintensity
    229/FHighRight superior frontalTransmantle sign, gray-white matter blurring, cortical thickening, T2-FLAIR hyperintensity
    333/MLowRight inferior frontalTransmantle sign, gray-white matter blurring, T2-FLAIR hyperintensity
    447/FHighRight precentralTransmantle sign, gray-white matter blurring, T2-FLAIR hyperintensity
    521/MLowLeft postcentralGray-white matter blurring, cortical thickening, T2-FLAIR hyperintensity
    647/MHighLeft posterior cingulateTransmantle sign, gray-white matter blurring, cortical thickening, T2-FLAIR hyperintensity
    743/MHighLeft caudal middle frontalTransmantle sign, gray-white matter blurring, cortical thickening, T2-FLAIR hyperintensity
    826/MLowLeft rostral middle frontalTransmantle sign, gray-white matter blurring, cortical thickening, T2-FLAIR hyperintensity
    921/FLowCaudal anterior cingulateTransmantle sign, gray-white matter blurring, cortical thickening, T2-FLAIR hyperintensity
    1021/MHighRight supramarginalTransmantle sign, gray-white matter blurring, cortical thickening, T2-FLAIR hyperintensity
    1121/MLowRight insularTransmantle sign, gray-white matter blurring, cortical thickening, T2-FLAIR hyperintensity
    1227/MLowLeft precentralTransmantle sign, gray-white matter blurring, cortical thickening, T2-FLAIR hyperintensity
    1354/MHighRight rostral middle frontalTransmantle sign, gray-white matter blurring, cortical thickening, T2-FLAIR hyperintensity
    1425/MNoneLeft inferior parietalGray-white matter blurring, cortical thickening, T2-FLAIR hyperintensity
    • ↵a Seizure frequency: low, 1 per month; high, >1 per week.

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    Table 2:

    Absolute BOLD measures in the FCD lesion, the contralateral homotopic cortex, and healthy controlsa

    Absolute MeasureLesionContralateral Homotopic CortexControls
    fALFF0.327 ± 0.007b0.352 ± 0.0080.358 ± 0.008
    ReHo0.348 ± 0.0320.292 ± 0.0310.310 ± 0.024
    WE1.245 ± 0.005b1.227 ± 0.0041.227 ± 0.003
    • ↵a Data are mean ± standard error.

    • ↵b Significant differences (P < .05) with the contralateral homotopic cortex and the same region in controls, respectively.

    • View popup
    Table 3:

    The normalized BOLD measures in the FCD lesion, perilesional regions, contralateral homotopic region, and healthy controlsa

    Normalized MeasureLesionPerilesional ZonesContralateral HomotopicControl Subjects
    1 cm2 cm3 cm
    fALFF0.922 ± 0.016b0.941 ± 0.014b0.947 ± 0.014b0.981 ± 0.0130.983 ± 0.0121.005 ± 0.009
    ReHo1.206 ± 0.066b0.992 ± 0.0320.991 ± 0.0361.021 ± 0.0341.023 ± 0.0321.020 ± 0.022
    WE1.018 ± 0.004b1.013 ± 0.003b1.009 ± 0.003b1.003 ± 0.0031.003 ± 0.0021.002 ± 0.002
    • ↵a Data are mean ± standard error. Normalized fALFF was significantly decreased, while WE was significantly higher in FCD lesions and perilesional zones (up to 2 cm) than in the contralateral homotopic cortex and control subjects. ReHo was significantly higher in FCD lesions. BOLD measures were normalized with the entire contralateral cortex.

    • ↵b Significant differences (P < .05) with the contralateral homotopic cortex and the same region in controls, respectively.

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    Table 4:

    Number of patients with measures outside the 95% confidence interval of the normative (healthy control) valuesa

    Normalized MeasureLesionPerilesional ZoneContralateral Homotopic Cortex
    1 cm2 cm3 cm
    fALFF13 (93)12 (86)11 (79)6 (43)6 (43)
    ReHo11 (79)5 (36)5 (36)4 (29)4 (29)
    WE12 (86)11 (79)10 (71)4 (29)5 (36)
    • ↵a Data are the number of patients (percentage).

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American Journal of Neuroradiology: 39 (7)
American Journal of Neuroradiology
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1 Jul 2018
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L. Gupta, P.A.M. Hofman, R.M.H. Besseling, J.F.A. Jansen, W.H. Backes
Abnormal Blood Oxygen Level–Dependent Fluctuations in Focal Cortical Dysplasia and the Perilesional Zone: Initial Findings
American Journal of Neuroradiology Jul 2018, 39 (7) 1310-1315; DOI: 10.3174/ajnr.A5684

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Abnormal Blood Oxygen Level–Dependent Fluctuations in Focal Cortical Dysplasia and the Perilesional Zone: Initial Findings
L. Gupta, P.A.M. Hofman, R.M.H. Besseling, J.F.A. Jansen, W.H. Backes
American Journal of Neuroradiology Jul 2018, 39 (7) 1310-1315; DOI: 10.3174/ajnr.A5684
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