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Sanjay M. Sisodiya, MA, MRCP; John M. Stevens, DRACR, FRCR; David R. Fish, MD, FRCP; Samantha L. Free, PhD; Simon D. Shorvon, MD, FRCP

Arch Neurol. 1996;53(1):28-34.

Abstract
Background
Despite the use of high-resolution magnetic resonance imaging (MRI) in the demonstration of structural abnormalities underlying chronic partial epilepsy, a significant proportion of MRI scans in such cases still appear normal when viewed conventionally as two-dimensional images, especially in extratemporal epilepsies.

Objectives
To increase the yield of MRI in patients with extratemporal epilepsies. To examine specific regions of three-dimensional surface renderings of the cerebral hemispheres.

Design
Postprocessing of volumetric MRI data was used to detect abnormalities of gyration that may not be seen otherwise.

Setting
Scans were obtained at a hospital clinical imaging facility.

Participants
Sixty-four subjects were studied: 33 controls, 15 patients with hippocampal sclerosis (as disease controls), and 16 patients with cryptogenic partial epilepsy that on clinical grounds was extratemporal.

Main Outcome Measures
Gyral patterns were evaluated for abnormality by visual comparison between subjects.

Results
Inspection of the routine two-dimensional images had failed to demonstrate relevant underlying neocortical abnormality in any of the patients' scans. Three-dimensional reconstruction revealed abnormal gyral patterns in the frontal lobe convexity in seven of the 16 cryptogenic clinically extratemporal cases. Macrogyria was revealed in one case and increased gyral complexity with altered disposition was seen in six cases. Similar gyral patterns were not seen in any subjects from the other groups.

Conclusion
Three-dimensional analysis of volumetric MRI data can reveal structural abnormality that is not visible when the data are viewed as two-dimensional images only.

Author Affiliations
From the Epilepsy Research Group, Institute of Neurology (Drs Sisodiya, Stevens, Fish, Free, and Shorvon), and Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery (Dr Stevens), London, England; and the National Society for Epilepsy, Chalfont Centre for Epilepsy, Bucks, England (Drs Sisodiya, Stevens, Fish, Free, and Shorvon).

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