Article Sidebar

PDF
Issue: No. 97 (2026)
Section: Overview
DOI: 10.58490/ctjump.2026i97.4513
Date Published: 25/04/2026
Views 10
Downloads 6
How to Cite
Pham, T. A. T., Nguyen, N. P. D., & Tran, N. H. (2026). THE ROLE OF NEUROIMAGING IN THE DIAGNOSTIC EVALUATION OF PEDIATRIC EPILEPSY. Cantho Journal of Medicine and Pharmacy, 97, 170-182. https://doi.org/10.58490/ctjump.2026i97.4513

THE ROLE OF NEUROIMAGING IN THE DIAGNOSTIC EVALUATION OF PEDIATRIC EPILEPSY

Thi Anh Thu Pham1, , Ngọc Pi Doanh Nguyen2, Nam Hung Tran2
1 Can Tho University of Medicine and Pharmacy
2 Children’s Hospital 2, Ho Chi Minh City

Main Article Content

Abstract

Epilepsy is a chronic neurological disorder characterized by sudden, excessive, and synchronous neuronal discharges within the cerebral cortex, resulting in motor, sensory, or psychiatric disturbances in children. Neuroimaging plays a pivotal role in identifying the underlying etiology to guide appropriate therapeutic interventions. Computed Tomography (CT) is limited by spatial resolution, with a reported false-negative rate of up to 50% for epileptogenic lesions. Magnetic Resonance Imaging (MRI) offers superior anatomical resolution and is highly effective in detecting temporal lobe pathologies, focal cortical dysplasia (FCD), small tumors, subtle structural changes, and vascular malformations. High-field MRI, such as 3 Tesla (3T) or 7 Tesla (7T), combined with multi-channel coils, has significantly enhanced diagnostic sensitivity. Advanced sequences, including Susceptibility-Weighted Imaging (SWI) or Gradient Echo (GRE), facilitate the detection of subtle cortical lesions. Diffusion Tensor Imaging (DTI) investigates localized epileptogenic foci in patients with refractory epilepsy. Functional magnetic resonance imaging (fMRI) is used for preoperative functional mapping in surgical candidates with refractory epilepsy. Magnetic resonance spectroscopy (MRS) provides prognostic information in patients undergoing epilepsy surgery. In MRI-negative cases, Single-Photon Emission Computed Tomography (SPECT) for perfusion assessment and Positron Emission Tomography (PET) for metabolic evaluation are invaluable; interictal imaging typically reveals hypoperfusion or hypometabolism within the epileptogenic zone. Adherence to the HARNESS (Harmonized Neuroimaging of Epilepsy Structural Sequences) protocol, as recommended by the ILAE, enhances sensitivity for detecting subtle epileptogenic lesions. 

Keywords

Pediatric Epilepsy, Computed Tomography (CT), Magnetic Resonance Imaging (MRI), Single-Photon Emission Computed Tomography (SPECT), Positron Emission Tomography (PET)

Article Details

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

References

1. Fisher RS, Acevedo C, Arzimanoglou A, Bogacz A, Cross JH, Elger CE, et al. ILAE official report: a practical clinical definition of epilepsy. Epilepsia. 2014. 55(4),475-482. https://doi.org/ 10.1111/epi.12550.
2. Kim YS, Kim MS, Park S, Smith L, Radua J, Oh SS, et al. Global, regional and national burden of epilepsy in children and adolescents, 1990–2021: A systematic analysis for the Global Burden of Disease Study 2021. European Journal of Clinical Investigation. 2026. 56(1),e70139. https://doi.org/https://doi.org/10.1111/eci.70139.
3. Laurens De Cocker, Felice D'Arco and Philippe Demaerel and Robin Smithuis. Epilepsy - Role of MRI. 2012. https://radiologyassistant.nl/ neuroradiology/epilepsy/role-of-mri.
4. Shaikh Z, Torres A, Takeoka M. Neuroimaging in Pediatric Epilepsy. Brain Sci. 2019. 9(8). https://doi.org/10.3390/brainsci9080190.
5. Kuzniecky RI. Neuroimaging of epilepsy: therapeutic implications. NeuroRx. 2005. 2(2),384393, https://doi.org/10.1602/neurorx.2.2.384.
6. Gastaut H, Gastaut JL. Computerized transverse axial tomography in epilepsy. Epilepsia. 1976. 17(3),325-336. https://doi.org/10.1111/j.1528-1157.1976.tb03411.x.
7. Hsieh DT, Chang T, Tsuchida TN, Vezina LG, Vanderver A, Siedel J, et al. New-onset afebrileseizures in infants: role of neuroimaging. Neurology. 2010. 74(2),150-156. https://doi.org/ 10.1212/WNL.0b013e3181c91847.
8. Gaillard WD, Chiron C, Cross JH, Harvey AS, Kuzniecky R, Hertz-Pannier L, et al. Guidelines for imaging infants and children with recent-onset epilepsy. Epilepsia. 2009. 50(9),2147-2153. https://doi.org/10.1111/j.1528-1167.2009.02075.x.
9. Society ARR. 3T MRI Leads to Better Diagnosis for Focal Epilepsy. Study Suggests. ScienceDaily: Spring City, PA, USA. 2008. https://doi.org/https://www.sciencedaily.com/ releases/2008/09/080905153753.htm.
10. Guerrini R, Duchowny M, Jayakar P, Krsek P, Kahane P, Tassi L, et al. Diagnostic methods and treatment options for focal cortical dysplasia. Epilepsia. 2015. 56(11), 1669-1686. https://doi.org/ https://doi.org/10.1111/epi.13200.
11. De Ciantis A, Barba C, Tassi L, Cosottini M, Tosetti M, Costagli M, et al. 7T MRI in focal epilepsy with unrevealing conventional field strength imaging. Epilepsia. 2016.57(3),445-454. https://doi.org/10.1111/epi.13313.
12. Tae WS, Ham BJ, Pyun SB, Kang SH, Kim BJ. Current Clinical Applications of DiffusionTensor Imaging in Neurological Disorders. J Clin Neurol. 2018. 14(2). 129-140. https://doi.org/ 10.3988/jcn.2018.14.2.129.
13. Arfanakis K, Hermann BP, Rogers BP, Carew JD, Seidenberg M, Meyerand ME. Diffusion tensor MRI in temporal lobe epilepsy. Magn Reson Imaging. 2002. 20(7),511-519. https://doi.org/ 10.1016/s0730-725x(02)00509-x.
14. Rugg-Gunn FJ, Eriksson SH, Symms MR, Barker GJ, Duncan JS. Diffusion tensor imaging of cryptogenic and acquired partial epilepsies. Brain. 2001. 124(Pt 3),627-636. https://doi.org/ 10.1093/brain/124.3.627.
15. Kim CH, Chung CK, Koo BB, Lee JM, Kim JS, Lee SK. Changes in language pathways in patients with temporal lobe epilepsy: diffusion tensor imaging analysis of the uncinate and arcuate fasciculi. World Neurosurg. 2011. 75(3-4),509-516. https://doi.org/10.1016/ j.wneu.2010.11.006.
16. Otte WM, van Eijsden P, Sander JW, Duncan JS, Dijkhuizen RM, Braun KP. A meta-analysis of white matter changes in temporal lobe epilepsy as studied with diffusion tensor imaging. Epilepsia. 2012. 53(4),659-667. https://doi.org/10.1111/j.1528-1167.2012.03426.x.
17. Guye M, Ranjeva JP, Bartolomei F, Confort-Gouny S, McGonigal A, Régis J, et al. What is the significance of interictal water diffusion changes in frontal lobe epilepsies?. Neuroimage. 2007. 35(1), 28-37. https://doi.org/10.1016/j.neuroimage.2006.11.049.
18. Rastogi S, Lee C, Salamon N. Neuroimaging in pediatric epilepsy: a multimodality approach. Radiographics. 2008. 28(4),1079-1095. https://doi.org/10.1148/rg.284075114.
19. Kuchukhidze G TE. Considerations about the Clinical Role of fMRI in Epileptology. Epileptologie, 2011, 206 – 214.
20. Wilke C, van Drongelen W, Kohrman M, He B. Neocortical seizure foci localization by means of a directed transfer function method. Epilepsia. 2010. 51(4), 564-572. https://doi.org/10.1111/ j.1528-1167.2009.02329.x.
21. Huster RJ, Debener S, Eichele T, Herrmann CS. Methods for simultaneous EEG-fMRI: an introductory review. J Neurosci. 2012. 32(18), 6053-6060. https://doi.org/10.1523/ jneurosci. 0447-12.2012.
22. Roy T, Pandit A. Neuroimaging in epilepsy. Ann Indian Acad Neurol. 2011. 14(2),78-80. https://doi.org/10.4103/0972-2327.82787.
23. Krsek P, Kudr M, Jahodova A, Komarek V, Maton B, Malone S, et al. Localizing value of ictal SPECT is comparable to MRI and EEG in children with focal cortical dysplasia. Epilepsia. 2013. 54(2),351-358. https://doi.org/10.1111/epi.12059.
24. Kevin R. Moore M, Luke L. Linscott, MD, Bernadette L. Koch, MD et al. Diagnostic Imaging: Pediatric Neuroradiology. In: 3, editor. Focal Cortical Dysplasia: Elsevier. 2020. 60-22.
25. Rincon SP, Blitstein MB, Caruso PA, González RG, Thibert RL, Ratai EM. The Use of Magnetic Resonance Spectroscopy in the Evaluation of Pediatric Patients With Seizures. Pediatr Neurol. 2016. 58,57-66. https://doi.org/10.1016/j.pediatrneurol.2016.01.013.
26. Shin HW, Jewells V, Sheikh A, Zhang J, Zhu H, An H, et al. Initial experience in hybrid PETMRI for evaluation of refractory focal onset epilepsy. Seizure. 2015. 31,1-4. https://doi.org/ 10.1016/j.seizure.2015.06.010.
27. Garibotto V, Heinzer S, Vulliemoz S, Guignard R, Wissmeyer M, Seeck M, et al. Clinical applications of hybrid PET/MRI in neuroimaging. Clin Nucl Med. 2013. 38(1), e13-18, https://doi.org/10.1097/RLU.0b013e3182638ea6.
28. Desarnaud S, Mellerio C, Semah F, Laurent A, Landre E, Devaux B, et al. (18)F-FDG PET in drug-resistant epilepsy due to focal cortical dysplasia type 2: additional value of electroclinical data and coregistration with MRI. Eur J Nucl Med Mol Imaging. 2018. 45(8), 1449-1460. https://doi.org/10.1007/s00259-018-3994-3.
29. Wellmer J, Quesada CM, Rothe L, Elger CE, Bien CG, Urbach H. Proposal for a magnetic resonance imaging protocol for the detection of epileptogenic lesions at early outpatient stages. Epilepsia. 2013. 54(11),1977-1987. https://doi.org/10.1111/epi.12375.
30. Saini J, Kesavadas C, Thomas B, Kapilamoorthy TR, Gupta AK, Radhakrishnan A, et al. Susceptibility weighted imaging in the diagnostic evaluation of patients with intractable epilepsy. Epilepsia. 2009. 50(6), 1462-1473. https://doi.org/10.1111/j.1528-1167.2008.01882.x.
31. Bernasconi A, Cendes F, Theodore WH, Gill RS, Koepp MJ, Hogan RE, et al. Recommendations for the use of structural magnetic resonance imaging in the care of patients with epilepsy: A consensus report from the International League Against Epilepsy Neuroimaging Task Force. Epilepsia. 2019. 60(6), 1054-1068. https://doi.org/10.1111/epi.15612.