J Clin Neurol.  2019 Jul;15(3):347-352. 10.3988/jcn.2019.15.3.347.

Clinical Significance of Asymmetric Minimum Intensity Projection Images of Brain Magnetic Resonance Imaging in Children

• Kim HS
• Kim SJ
• Kong YH

• KMID: 2451119
• DOI: http://doi.org/10.3988/jcn.2019.15.3.347

Abstract

BACKGROUND AND PURPOSE
The susceptibility-weighted imaging form of brain MRI using minimum intensity projection (mIP) is useful for assessing traumatic brain injuries because it readily reveals deoxyhemoglobin or paramagnetic compounds. We investigated the efficacy of using this methodology in nontraumatic patients.
METHODS
We retrospectively analyzed the asymmetric mIP findings in nontraumatic patients. Asymmetric mIP images were first verified visually and then using ImageJ software. We enrolled patients with a difference of >5% between hemispheres in ImageJ analysis. All patients underwent detailed history-taking and EEG, and asymmetric mIP findings were compared.
RESULTS
The visual analysis identified 54 pediatric patients (37 males and 17 females) with asymmetric mIP findings. Ten patients were excluded because they did not meet the ImageJ verification criteria. The 44 patients with asymmetry comprised 36 with epilepsy, 6 with headache, and 2 with cerebral infarction. Thirty-one of the 36 epileptic patients showed definite partial seizure activities in semiology, while the remaining patients did not demonstrate a history of partial seizure manifestations. The MRI findings were normal in all patients except for five with periventricular leukomalacia unrelated to seizure symptoms. There was agreement between mIP images and semiology in 29 (93.5%) of the 31 epileptic patients with focal signs, while the other 2 demonstrated discordance. Twenty (64.5%) of the 31 patients showed consistent EEG abnormalities.
CONCLUSIONS
Our data suggest that asymmetric mIP findings are an excellent lateralizing indicator in pediatric patients with partial epilepsy.

Keyword

focal epilepsy; minimum intensity projection; susceptibility-weighted imaging

MeSH Terms

Brain Injuries
Brain*
Cerebral Infarction
Child*
Electroencephalography
Epilepsies, Partial
Epilepsy
Headache
Humans
Infant, Newborn
Leukomalacia, Periventricular
Magnetic Resonance Imaging*
Male
Retrospective Studies
Seizures

Figure

• 

  Fig. 1 Brain images of patients with Focal epilepsy on brain MRI and ImageJ. There were no specific findings in T2-weighted imaging (A). However, the difference in bilateral blood vessel volume was small when viewed in a minimum intensity projection image (B). We used ImageJ to obtain contrast images of blood vessels (C) for quantifying the difference in blood vessel volume (difference of 16%).

• 

  Fig. 2 Changes in mIP image over time after seizure in focal epilepsy patients. The initial MRI mIP image obtained 3 hours after the onset of seizures in a patient with right occipital lobe epilepsy showed an increase in venous vascularity (arrow) in the right occipital lobe (A). This finding was no longer evident in the mIP image obtained at follow-up performed 21 hours later (B). mIP: minimum intensity projection.

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