Roy Koenig

MRI for diagnosis of pure ductal carcinoma in situ: a prospective observational study

BACKGROUND Diagnosing breast cancer in its intraductal stage might be helpful to prevent the development of invasive cancer. Our aim was to investigate the sensitivity with which ductal carcinoma in situ (DCIS) is diagnosed by mammography and by breast MRI. METHODS During a 5-year period, 7319 women who were referred to an academic national breast centre received MRI in addition to mammography for diagnostic assessment and screening. Mammograms and breast MRI studies were assessed independently by different radiologists. We investigated the sensitivity of each method of detection and compared the biological profiles of mammography-diagnosed DCIS versus DCIS detected by MRI alone. We also compared the risk profiles of women with mammography-detected DCIS with those of MRI-detected DCIS. FINDINGS 193 women received a final surgical pathology diagnosis of pure DCIS. Of those, 167 had undergone both imaging tests preoperatively. 93 (56%) of these cases were diagnosed by mammography and 153 (92%) by MRI (p<0.0001). Of the 89 high-grade DCIS, 43 (48%) were missed by mammography, but diagnosed by MRI alone; all 43 cases missed by mammography were detected by MRI. By contrast, MRI detected 87 (98%) of these lesions; the two cases missed by MRI were detected by mammography. Age, menopausal status, personal or family history of breast cancer or of benign breast disease, and breast density of women with MRI-only diagnosed DCIS did not differ significantly from those of women with mammography-diagnosed DCIS. INTERPRETATION MRI could help improve the ability to diagnose DCIS, especially DCIS with high nuclear grade.

A new MRI technique for imaging scoliosis in the sagittal plane

The purpose of the present study was to introduce a new magnetic resonance imaging (MRI) procedure showing the whole spine in a coronal and sagittal plane, and to study the assessment of sagittal Cobb angle measurements using this technique. Prospectively we studied 32 patients (average age 14.8 years) with idiopathic scoliosis (mean thoracic Cobb angle 33° on radiograph) and 18 patients (average age 14.5 years) without scoliosis. The MRI investigation was carried out in a standard supine position. The cervical and upper thoracic spine and the lower thoracic and lumbar spine were measured on a 1.5-T Gyroscan ACS-NT Powertrak 6000 system. An algorithm was developed to combine the results of the cranial and caudal scans into a coronal and a sagittal image of the whole spine (MR total spine imaging). Measurement of the sagittal Cobb angle conducted ten times by four independent investigators revealed an intraobserver variance of 1.6° and an interobserver variance of 1.8°. In the group with scoliosis the mean sagittal Cobb angle from T4 to T12 was 12° (range –3° to 24°) and in the group without scoliosis 22° (range 16° to 30°), which was a significant difference. MR total spine imaging makes it possible to image scoliosis in the sagittal plane. On these MR projections, idiopathic thoracic scoliosis was identified by a reduced sagittal Cobb angle. MR total spine imaging would allow monitoring of scoliosis in the sagittal plane, which can reveal relevant clinical data without radiation exposure.

Prospective use of subtraction ictal SPECT coregistered to MRI (SISCOM) in presurgical evaluation of epilepsy

Purpose:  In patients with drug‐refractory focal epilepsy, nonlesional magnetic resonance imaging (MRI) or discordant data of presurgical standard investigations leads to failure generating a sufficient hypothesis for electrode implantation or epilepsy surgery. The seizure‐onset zone can be further investigated by subtraction ictal single‐photon emission computed tomography (SPECT) coregistered to MRI (SISCOM). This is an observational study of a large consecutive cohort of patients undergoing prospective SISCOM to generate hypothesis for electrode implantation or site of epilepsy surgery.

Limbic System Abnormalities Associated with Ammon's Horn Sclerosis Do Not Alter Seizure Outcome after Amygdalohippocampectomy

Summary:  Purpose: To evaluate whether limbic system abnormalities associated with Ammons horn sclerosis alter seizure outcome after selective amgydalohippocampectomy.

Neurodevelopmental disruption in early-onset temporal lobe epilepsy: Evidence from a voxel-based morphometry study

Childhood onset of epilepsy has long been associated with an adverse impact on brain development and cognition. In this study it is proposed that earlier (vs later) onset of temporal lobe epilepsy (TLE) has a negative developmental impact on distant brain structures. One hundred ten patients with TLE were assigned to early (≤14 years, N=58) and late (>15 years, N=52) age at onset of epilepsy groups. Voxel-based morphometry revealed onset-dependent abnormalities (in terms of a gray matter excess in the early-onset group), which were found mainly in frontal regions. An excess of gray matter is not a usual finding in TLE. However, within a neurodevelopmental framework, retained gray matter is discussed as reflecting neurodevelopmental disruption. The findings indicate the importance of quantitative MRI for the detection of subtle secondary abnormalities in focal TLE and once more underline the importance of early seizure management in children with intractable TLE.

Selective Middle Cerebral Artery Wada Tests as a Part of Presurgical Evaluation in Patients with Drug-resistant Epilepsies

Summary:  Purpose: To analyze the role of selective middle cerebral artery (MCA) Wada tests in the presurgical workup of patients with drug‐resistant focal epilepsies.