CT may have an advantage over MRI in only uncommon situations of children with unstable clinical status with generalized seizures and abnormal neurological examination. In these cases, CT may provide initial diagnostic information that helps to guide early therapeutic decisions [44]. FDG-PET/CT Brain There is no relevant literature to support the use of FDG-PET/CT in the workup of a child with generalized seizure and abnormal neurological findings. HMPAO SPECT or SPECT/CT Brain There is no relevant literature to support the use of Tc-99m HMPAO SPECT or SPECT/CT in the workup of a child with generalized seizure and abnormal neurological findings. Variant 8: Children 1 month to 17 years of age. Intractable seizures or refractory epilepsy. Refractory seizures define a small percentage of patients with seizures or epilepsy. In these patients, the use of both anatomical and functional imaging modalities is needed in selected cases, and some of these cases are potentially treatable by surgical intervention. Anatomic imaging with MRI may assist in determining the underlying pathology and help assess anatomical changes associated with seizure activity. Functional imaging, using MRI, PET, or SPECT, may depict seizure foci that are occult by anatomic imaging and may help guide a safe and effective surgical outcome. US Head US is not useful in the workup of a child with intractable seizures or refractory epilepsy. MRI Head MRI is considered the most sensitive and specific anatomic imaging technique in the evaluation of patients with intractable seizures and should be performed using dedicated epilepsy protocols with 3T scanners whenever possible. This includes, but is not limited to, a T1-weighted volumetric acquisition (3-D) with isotropic voxel size of 1 mm as well as images optimized for the evaluation of hippocampal pathology that include high-resolution thin coronal slices.
Seizures Child. CT may have an advantage over MRI in only uncommon situations of children with unstable clinical status with generalized seizures and abnormal neurological examination. In these cases, CT may provide initial diagnostic information that helps to guide early therapeutic decisions [44]. FDG-PET/CT Brain There is no relevant literature to support the use of FDG-PET/CT in the workup of a child with generalized seizure and abnormal neurological findings. HMPAO SPECT or SPECT/CT Brain There is no relevant literature to support the use of Tc-99m HMPAO SPECT or SPECT/CT in the workup of a child with generalized seizure and abnormal neurological findings. Variant 8: Children 1 month to 17 years of age. Intractable seizures or refractory epilepsy. Refractory seizures define a small percentage of patients with seizures or epilepsy. In these patients, the use of both anatomical and functional imaging modalities is needed in selected cases, and some of these cases are potentially treatable by surgical intervention. Anatomic imaging with MRI may assist in determining the underlying pathology and help assess anatomical changes associated with seizure activity. Functional imaging, using MRI, PET, or SPECT, may depict seizure foci that are occult by anatomic imaging and may help guide a safe and effective surgical outcome. US Head US is not useful in the workup of a child with intractable seizures or refractory epilepsy. MRI Head MRI is considered the most sensitive and specific anatomic imaging technique in the evaluation of patients with intractable seizures and should be performed using dedicated epilepsy protocols with 3T scanners whenever possible. This includes, but is not limited to, a T1-weighted volumetric acquisition (3-D) with isotropic voxel size of 1 mm as well as images optimized for the evaluation of hippocampal pathology that include high-resolution thin coronal slices.