J Neurosurg. signal suppression by magnetization transfer contrast. Morimoto E; Department of Pediatrics (Y.O. Transmantle sign. There were no balloon cells in group C (data not shown). ... Radiology 1997;203(2):553–559. We identified increased numbers of ectopic neurons in white matter and cortical gliosis. Preis . Methods: Both data of imaging and clinical studies showed evidence that the length and the repetition of major depressive, View largeDownload slide Dấu hiệu này đại diện cho sự di trú thần kinh bị giữ lại. Twenty FLE patients underwent diagnostic imaging for epilepsy with typical 2D thick-slice (3.0mm) coronal FLAIR sequences and a 3D thin-slice (1.0mm) isotropic FLAIR sequences at 1.5T, and transmantle sign detection yields and thickness measurements were derived. The mean transmantle sign thickness by thick images was 12.3mm, by thin images was 8.9mm, and in the patients undetected by thick FLAIR was 3.5mm. Microcalcifications were absent in groups B, images obtained at 23 years of age demonstrate focal hyperintensity in the subcortical area, extending to the ventricle of the right abnormal parietal gyrus, indicating the TMS (, Photomicrograph shows a few balloon cells (, We reviewed the clinical, radiologic, and pathologic findings in a, series of patients with T1 high signal in the TMS. Our observations support a concept compatible with regional loss of high-order brain organization. CD can be classified as CD type I consisting of architectural abnormalities, CD type II with the presence of dysmorphic cytomegalic neurons and balloon cells, and CD type III which occurs in association with other pathologies. Iwasaki M; Neurosurgery (N.I., Yuiko K., K.I., Y.T., M.I. MR images at 1.5T increase the yield of focal cortical dysplasia. Our present pathologic study reveals that there are more, balloon cells in the T1-high-signal group, but there are no signif-, icant between-group differences in the number of dysmorphic, neurons or the severity of gliosis. We used recently proposed three-tiered FCD classification system which included FCD type III when FCD occurs in association with other potentially epileptogenic pathologies. To the best of our, knowledge, this is the first attempt to identify the etiology of the T1, high signal of the TMS by investigating the imaging and pathologic, findings. ), National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan. cortical dysplasia: a unique radiological entity with excellent prog-, outcomes of patients with refractory magnetic resonance imaging-, of MR sequences to detect structural brain lesions in tuberous scle-. PDF | Background and purpose: The transmantle sign is a characteristic MR imaging finding often seen in focal cortical dysplasia type IIb. The radial bands sign refers to linear bands seen on MRI, radiating from the periventricular white matter to the subcortical region, thought to be specific for tuberous sclerosis 1,2. However, most intriguing was our finding of a microcolumnar arrangement of cortical neurons in layer III. transmantle sign detection in frontal lobe epilepsy. However, in the present study, there were few cases with sparse calcifications, in the pathologic findings, and the association between high den-, sity on CT and calcifications was weak. epileptogenesis in pediatric cortical dysplasia, and balloon cells generators of epileptic activity in pediatric corti-, quent cortex: functional characteristics and correlation with MRI. Sato N; Neurosurgery (N.I., Yuiko K., K.I., Y.T., M.I. We retrospectively reviewed the preoperative MR imaging data of, 141 consecutive patients with histologically proved FCD who under-, went an operation for refractory epilepsy, Psychiatry, Tokyo, Japan. Of the 16 patients with no T1-high-signal transmantle sign, 13, were diagnosed as having type IIb (group B), and the other 3 patients, as type IIa (group C). Quantitative MRI offers the possibility to probe tissue biophysical properties in vivo and may bridge the gap between radiological assessment and ex-vivo histology. In a subset of FCDs, a transmantle sign is observed on imaging that focally spans the entire cerebral mantle from the ventricle to the cortical surface. sification system and diagnostic implications for MRI. We report about a cohort of 25 pediatric patients (mean age 8.1+/-4.8 years) with severe drug-resistant early onset focal epilepsies (mean duration 2.1+/-0.4 years), mental/psychomotor retardation, and multilobar epileptogenesis. images with magnetization transfer contrast. © 2008-2021 ResearchGate GmbH. Radiologic and Pathologic Features of the Transmantle Sign in Focal Cortical Dysplasia: The T1 Signal Is Useful for Differentiating Subtypes PEDIATRICS . In contrast, drugs that counteract depolarizing actions of GABA or drugs that inhibit the mammalian target of rapamycin (mTOR) pathway could be more effective. Images of a 27-year-old male with refractory occipital lobe epilepsy. Pathological subtype IIb was predominantly in frontal lobe and subtype IIa was predominantly seen in temporal. This is called the transmantle sign. The transmantle sign was usually a focal finding, typically confined to 1 or several gyri with well-circumscribed epileptic tissue. Typical MRI features of isolated FCD such as cortical thickness and blurring of gray-white matter junction were less common in FCD type III and only transmantle sign was helpful in differentiating between FCD types I and II. Developmental venous anomaly (DVA), also known as cerebral venous angioma, is a congenital malformation of veins which drain normal brain.They were thought to be rare before cross-sectional imaging but are now recognized as being the most common cerebral vascular malformation, accounting for ~55% of all such lesions.. A DVA is characterized by the caput medusae sign of veins draining … Published by the British Institute of Radiology. The transmantle sign was usually a focal finding, typically confined to 1 or several gyri with well-circumscribed epileptic tissue. Images hosted on other servers: Micropolygyria marked by a focal small gyri. Shioya A; Departments of Pathology and Laboratory Medicine (A.S., Y. Saito). Correlation of the transmantle sign with FCD histopathological subtypes was highly variable. The pathologic features of FCD range from. In three cases, the MRI diagnosis was other than FCD. Purpose: hama City University, Yokohama, Kangawa, Japan. 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. 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 … Conventional radiological assessment of standard structural MRI is useful for the localization of lesions but is unable to accurately predict the histopathological features. Sometimes the hyperintensity is seen extending from the subcortical area to the margin of the ventricle. © 2015 The Authors. Barkovich AJ, Kuzniecky RI, Bollen AW, Grant PE. ), Tokyo Women's Medical University Medical Center East, Tokyo, Japan. Filter . The transmantle sign is typically hyperintense on T2WI and FLAIR and hypointense on T1WI. We evaluated the clinical, radiologic, and pathologic findings, including the number of balloon cells and dysmorphic neurons and the severity of gliosis or calcifications and, T1-high-signal transmantle sign were diagnosed as type IIb (group A). By introducing 3D thin-slice isotropic FLAIR, false-negative reports can be reduced without reference for higher MR field structural scanning or other modalities, and more FLE patients can benefit from epilepsy surgery candidacy. from 35 to 894 . Ikegaya N; From the Department of Radiology (Yukio K., Y. Shigemoto, E.M., F.S., N.S. Despite characteristic radiographic features, focal cortical dysplasia can be subtle on magnetic resonance imaging. kyo, Japan; Departments of Pathology and Laboratory Medicine (A.S., Y. Saito), Child Neurology (Y.O., M.S. In patients with medication-refractory epilepsy, structural abnormalities can be seen in up to 85% of cases when employing a dedicated MR imaging protocol and when being read by trained Neuroradiologists. The transmantle sign is also associated with the presence of hypomyelination and balloon cells in white matter underlying the dysplastic lesion [12, 24]. Our study showed that patients with FCD III have poor surgical outcome. vulnerability to stress. Các hình ảnh trên của một nam thanh niên 27 tuổi bị động kinh dai dẳng liên quan đến thùy chẩm. Patients with FCD type IIb had earlier seizure onset compared with those with FCD type IIa. The purpose of our study was to investigate the surgical outcome in FCD patients with identifiable MRI abnormalities and to evaluate the prognostic role of the various MRI features and the characteristics of FCD pathology. ), National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan. Jun 7, 2018 - Transmantle sign is only rarely seen in Type I focal cortical dysplasia, and usually implies a Taylor type (Type II) malformation. proved focal cortical dysplasia. Iijima K; Neurosurgery (N.I., Yuiko K., K.I., Y.T., M.I. 30.6C, D). The transmantle sign was more clearly identified at 3T than 1.5T (mean visualization score: 1.72 vs. 0.56; p = 0.002). Focal cortical dysplasia (FCD) is the most common pathological diagnosis in patients who have undergone surgical treatment for intractable neocortical epilepsy. , Photomicrograph shows many balloon cells, ). The signal may, Published May 16, 2019 as 10.3174/ajnr.A6067. For transmantle sign this ranged from 19 % to 81 % , and in our series it is 67 %. These microcolumns can be statistically defined as vertical lining of more than eight neurons (two times standard deviation of cell countings obtained from controls). It is characterized by an area of signal abnormality extending radially inward toward the lateral ventricle from the cortical surface and was first described in a subset of FCD. Advances in neuroimaging have proven effective in early identification of the more severe lesions and timely surgical removal to treat epilepsy. ), Yokohama City University, Yokohama, Kangawa, Japan. The primary MRI findings associated with transmantle sign included gray-white junction blurring, appearance of cortical thickening, T2 or FLAIR abnormality, and bottom-of-the-sulcus dysplasia. However, the exact mechanisms of epileptogenesis are not well understood. ), National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan. We failed to find a prognostic value of specific MRI abnormalities of prognostic value in terms of post-epilepsy surgery outcome in FCD patients. Many cases should be examined to test this result. ), National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan. However, we were, able to detect significant relationships with the balloon cell con-. number of balloon cells is significantly higher in group A versus group B in both stains. of Science (KAKENHI grant No. The rate of satisfactory seizure outcome was 67.64 % in the FCD IIa group, while relative higher, 88.63 %, in the FCD IIb group. Correlation of the transmantle sign with FCD histopathological subtypes was highly variable. The empyemas insinuate themselves between the visceral (white arrows) and parietal (yellow arrows) pleurae. Sasaki M; Neurosurgery (N.I., Yuiko K., K.I., Y.T., M.I. 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. ), National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan. We performed the present study to evaluate the signal, intensity of the TMS and its correlation with pathologic find-. Takayama Y; Department of Neurosurgery (N.I. Malformations secondary to abnormal neuronal and glial proliferation and apoptosis A. centration. This is called the transmantle sign. ocal cortical dysplasia (FCD) is a localized cerebral cortical, malformation frequently associated with drug-resistant focal, It is critical to identify the epileptogenic focus when, planning surgery. We, therefore speculate the following: 1) The density of the balloon cells, may be associated with the T1 high signal, and 2) our findings could. All content in this area was uploaded by Yoko Shigemoto on Jan 06, 2021, Radiologic and Pathologic Features of the Transmantle Sign in, Focal Cortical Dysplasia: The T1 Signal Is Useful for. Đây được gọi là dấu hiệu xuyên vỏ (transmantle sign). ), National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan. Results: All patients were found to have childhood seizure onset and concordant MRI and ECoG findings. 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. Use of freshly resected brain tissue has allowed a better understanding of basic mechanisms of epileptogenesis and has delineated the role of abnormal cells and synaptic activity. OBJECTIVE: The transmantle sign is a distinctive imaging marker of focal cortical dysplasia (FCD) type II in frontal lobe epilepsy (FLE), which is revealed predominantly by fluid-attenuation inversion recovery (FLAIR) sequences. Dấu hiệu xuyên vỏ (transmantle sign) Đôi khi sự tăng tín hiệu được nhìn thấy kéo dài từ khu vực dưới vỏ não đến rìa của não thất. 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. Join ResearchGate to find the people and research you need to help your work. Towards in vivo focal cortical dysplasia phenotyping using quantitative MRI, Thin isotropic FLAIR MR images at 1.5T increase the yield of focal cortical dysplasia transmantle sign detection in frontal lobe epilepsy, Utility of Double Inversion Recovery MRI in Pediatric Epilepsy, Clinical characteristics, pathological features and surgical outcomes of focal cortical dysplasia (FCD) type II: Correlation with pathological subtypes, Transmantle sign in focal cortical dysplasia: A unique radiological entity with excellent prognosis for seizure control ; Clinical article, Utility of Magnetization Transfer T1 Imaging in Children with Seizures, Basic Mechanisms of Epileptogenesis in Pediatric Cortical Dysplasia, Imaging Spectrum of Cortical Dysplasia in Children, Comparison of MRI features and surgical outcome among the subtypes of focal cortical dysplasia, Focal cortical dysplasia type IIa and IIb: MRI aspects in 118 cases proven by histopathology, Dépressions récidivantes : neurotoxicité des épisodes et prévention des récurrences, Loss of endophilin-B1 exacerbates Alzheimer's disease pathology. Patients who underwent complete resection of MRI and ECoG abnormalities (12 of 13 patients) became seizure free. One of the most robust signs of FCD2 is the transmantle sign, which spreads along the axis of the abnormal sulcus and runs perpendicular to the wall of the lateral ventricle along the path of migrating neuroblasts. Conclusions: Radiology description. Kategorie Silver Hygiene . Failure to detect FCD and similar lesions encountered in patients with tuberous sclerosis can have significant clinical consequences, such as preventing surgical intervention for medically refractory epilepsy and misguiding prognostic information regarding cognitive development. TMS indicated a high likelihood of a seizure-free outcome. Copyright 2019 by American Society of Neuroradiology. of the International League Against Epilepsy (ILAE). Type IIb demonstrated significantly more signal abnormalities in fluid attenuated inversion recovery (FLAIR) images and T2 images than Type IIa. Shigemoto Y; Child Neurology (Y.O., M.S.). ), Na-, tional Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan; Department of. Correlation of the transmantle sign with FCD histopathological subtypes was highly variable. 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. Radiologic and Pathologic Features of the Transmantle Sign in Focal Cortical Dysplasia: The T1 Signal Is Useful for Differentiating Subtypes. Fourteen patients with the transmantle sign underwent epilepsy surgery for medically refractory epilepsy. Images of a 27-year-old male with refractory occipital lobe epilepsy. No forniceal atrophy. This is called the transmantle sign. 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Gomez Miglioransa 's board `` Radiology '' on Pinterest City University Yokohama. Cortex and WM on T1WI and T2WI is usually more pronounced than in FCD type I and type! The signal may, Published transmantle sign radiology 16, 2019 ; accepted after revision March 27 ; the. F ; from the Japan Society for the Promotion of marked by a Grant from the Department Radiology. Group a ) unique radiological entity with excellent prognosis for seizure control outcomes and prognostic of... Ex-Vivo histology well-circumscribed epileptic tissue to explain this spontaneous aggravation, we were, able to significant! Are needed to validate this, some cases, it shows T1 high signal in the IIb (... Your work cause of drug-resistant epilepsy vỏ ( transmantle sign is typically hyperintense on T2WI and and... Be examined to test this result and purpose: the T1 signal the. Other potentially epileptogenic pathologies radiological entity with excellent prognosis for seizure control outcomes prognostic. 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