Pediatric Radiology Department, AP-HP, Hôpital Universitaire Necker-Enfants Malades, Paris, France.
INSERM U1299, Université Paris Cité, Paris, France.
Neurosurgery. 2023 Apr 1;92(4):820-826. doi: 10.1227/neu.0000000000002310. Epub 2022 Dec 22.
Focal cortical dysplasia (FCD) causes drug-resistant epilepsy in children that can be cured surgically, but the lesions are often unseen by imaging.
To assess the efficiency of arterial spin labeling (ASL), voxel-based-morphometry (VBM), fMRI electroencephalography (EEG), resting-state regional homogeneity (ReHo), 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET), and their combination in detecting pediatric FCD.
We prospectively included 10 children for whom FCD was localized by surgical resection. They underwent 3T MR acquisition with concurrent EEG, including ASL perfusion, resting-state BOLD fMRI (allowing the processing of EEG-fMRI and ReHo), 3D T1-weighted images processed using VBM, and FDG PET-CT coregistered with MRI. Detection was assessed visually and by comparison with healthy controls (for ASL and VBM).
Eight children had normal MRI, and 2 had asymmetric sulci. Using MR techniques, FCD was accurately detected by ASL for 6/10, VBM for 5/10, EEG-fMRI for 5/8 (excluding 2 with uninterpretable results), and ReHo for 4/10 patients. The combination of ASL, VBM, and ReHo allowed correct FCD detection for 9/10 patients. FDG PET alone showed higher accuracy than the other techniques (7/9), and its combination with VBM allowed correct FCD detection for 8/9 patients. The detection efficiency was better for patients with asymmetric sulci (2/2 for all techniques), but advanced MR techniques and PET were useful for MR-negative patients (7/8).
A combination of multiple imaging techniques, including PET, ASL, and VBM analysis of T1-weighted images, is effective in detecting subtle FCD in children.
局灶性皮质发育不良（FCD）可导致儿童药物难治性癫痫，这种疾病可以通过手术治愈，但病变通常在影像学上无法观察到。
评估动脉自旋标记（ASL）、基于体素的形态测量学（VBM）、功能磁共振成像脑电图（fMRI-EEG）、静息态局部一致性（ReHo）、18F-氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）及其联合应用在检测儿科 FCD 中的效率。
我们前瞻性纳入了 10 名因手术切除而定位 FCD 的儿童患者。他们接受了 3T 磁共振采集，同时进行脑电图检查，包括 ASL 灌注、静息状态血氧水平依赖功能磁共振成像（允许 EEG-fMRI 和 ReHo 处理）、3D T1 加权图像采用 VBM 处理、以及 FDG PET-CT 与 MRI 配准。通过视觉评估和与健康对照组（用于 ASL 和 VBM）比较来评估检测结果。
8 名儿童的 MRI 正常，2 名儿童的 MRI 显示不对称脑沟。使用磁共振技术，ASL 准确检测到 6/10 例 FCD，VBM 准确检测到 5/10 例，EEG-fMRI 准确检测到 5/8 例（排除 2 例结果不可解释），ReHo 准确检测到 4/10 例。ASL、VBM 和 ReHo 的联合应用可正确检测 9/10 例 FCD。单独的 FDG PET 比其他技术具有更高的准确性（7/9），并且与 VBM 的联合应用可正确检测 8/9 例 FCD。对于不对称脑沟的患者（所有技术均为 2/2），检测效率更好，但高级磁共振技术和 PET 对 MRI 阴性患者也有帮助（7/8）。
包括 PET、ASL 和 T1 加权图像 VBM 分析在内的多种成像技术的联合应用，在检测儿童的细微 FCD 方面是有效的。
