Studies have shown that in this clinical scenario, MRI has a sensitivity of 84% with specificity of 70%, whereas the sensitivity of CT is approximately 62% [45]. MRI is particularly useful in the evaluation of mesial temporal sclerosis and cortical abnormalities that may be the cause of refractory seizures [46,47]. The data are limited on the additional value of specialized MRI sequences, such as diffusion tensor imaging, which may help to improve specificity in localization of the epileptogenic lesion in cases where conventional structural MRI is Seizures-Child CT Head CT has lower sensitivity compared with MRI in localization and characterization of a potential epileptogenic focus. Available data indicate that the diagnostic yield of CT in evaluation of a child presenting with a breakthrough seizure in the setting of known refractory epilepsy is also very low. Allen et al [50] showed that in a cohort of 124 children presenting with breakthrough seizures, almost 17% underwent CT scans and none of them demonstrated acute findings. FDG-PET/CT Brain Functional imaging is most utilized for refined evaluation when surgical intervention is contemplated or when structural imaging with MRI is normal or shows nonspecific findings [36]. A study by Leach et al [51] showed that MRI failed to demonstrate findings that would allow guidance for surgery in up to 58% of patients with surgically proven focal cortical dysplasia, supporting the need for a multimodality approach and underscoring the importance of functional studies in preoperative surgical planning. FDG-PET/CT has been shown to improve lesion detection and can be a helpful modality when anatomic imaging (CT and MRI) is normal or in cases when multiple structural abnormalities are present. In a study by Kim et al [52], interictal FDG-PET was shown to have statistically significantly better detection power (P = . 013) than MRI, with the higher percentage of cases with MRI discordance and PET localization than in reverse.
Seizures Child. Studies have shown that in this clinical scenario, MRI has a sensitivity of 84% with specificity of 70%, whereas the sensitivity of CT is approximately 62% [45]. MRI is particularly useful in the evaluation of mesial temporal sclerosis and cortical abnormalities that may be the cause of refractory seizures [46,47]. The data are limited on the additional value of specialized MRI sequences, such as diffusion tensor imaging, which may help to improve specificity in localization of the epileptogenic lesion in cases where conventional structural MRI is Seizures-Child CT Head CT has lower sensitivity compared with MRI in localization and characterization of a potential epileptogenic focus. Available data indicate that the diagnostic yield of CT in evaluation of a child presenting with a breakthrough seizure in the setting of known refractory epilepsy is also very low. Allen et al [50] showed that in a cohort of 124 children presenting with breakthrough seizures, almost 17% underwent CT scans and none of them demonstrated acute findings. FDG-PET/CT Brain Functional imaging is most utilized for refined evaluation when surgical intervention is contemplated or when structural imaging with MRI is normal or shows nonspecific findings [36]. A study by Leach et al [51] showed that MRI failed to demonstrate findings that would allow guidance for surgery in up to 58% of patients with surgically proven focal cortical dysplasia, supporting the need for a multimodality approach and underscoring the importance of functional studies in preoperative surgical planning. FDG-PET/CT has been shown to improve lesion detection and can be a helpful modality when anatomic imaging (CT and MRI) is normal or in cases when multiple structural abnormalities are present. In a study by Kim et al [52], interictal FDG-PET was shown to have statistically significantly better detection power (P = . 013) than MRI, with the higher percentage of cases with MRI discordance and PET localization than in reverse.