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Imaging in epilepsy: a paediatric perspective

Royal Liverpool Children's NHS Trust, Alder Hey, Eaton Road, Liverpool L12 2AP, UK

View larger version (181K): [in a new window]   Figure 1. Coronal T1 weighted gradient echo MR volume acquisition showing bilateral areas of cortical dysplasia (arrowheads).

View larger version (116K): [in a new window]   Figure 2. T2 maps of the temporal lobes showing the sampling area, and histograms of the T2 times with derived average values. The left temporal lobe shows an increased T2 time (123 ms), consistent with mesial sclerosis.

View larger version (148K): [in a new window]   Figure 3. CT of a child with tuberous sclerosis showing periventricular calcification and low attenuation parenchymal tubers. CT remains the imaging modality of choice for identifying focal calcification.

View larger version (95K): [in a new window]   Figure 4. 99Tcm-labelled hexamethyl propyleneamine oxime SPECT interictal brain images. The top two rows show a normal dataset, the bottom two rows show a number of focal defects, especially in the right frontal region.

View larger version (170K): [in a new window]   Figure 5. MR image of the temporal lobe showing atrophy and increased T2 signal in the left hippocampus, consistent with mesial temporal sclerosis.

View larger version (159K): [in a new window]   Figure 6. MR inversion recovery sequence demonstrating a subtle focal area of polymicrogyria/cortical dysplasia (arrowheads).

View larger version (86K): [in a new window]   Figure 7. (a,b) Three-dimensional cortical rendering from a volume acquisition clearly showing bilateral symmetrical pachygyria of the frontal lobes.

View larger version (150K): [in a new window]   Figure 8. Coronal T1 weighted MR image through the pituitary region showing the hypothalamic hamartoma responsible for the child's gelastic seizures (arrow).

View larger version (188K): [in a new window]   Figure 9. MR image showing the pial–ependymal seam of grey matter typical of schizencephaly in the right frontal lobe.

View larger version (131K): [in a new window]   Figure 10. Cerebral spinal fluid suppression (fluid attenuated inversion recovery (FLAIR)) MR image of the brain of a child with tuberous sclerosis showing multiple cortical tubers and subependymal nodules and a calcified focus in the right occipital lobe. Note the generalized increase in signal intensity of the right cerebral hemisphere related to a recent period of status epilepticus.

View larger version (107K): [in a new window]   Figure 11. (a) CT in the early stages of herpes encephalitis showing reduced attenuation in the right temporal lobe. (b) MR image showing bilateral changes involving the temporal lobes and right cingulate gyrus.

View larger version (152K): [in a new window]   Figure 12. MR image showing unusual, predominantly unilateral changes secondary to toxoplasmosis infection. Note the right orbital abnormality.

View larger version (131K): [in a new window]   Figure 13. MR image showing severe, widespread changes of multicystic encephalomalacia in a term child with seizures.

View larger version (161K): [in a new window]   Figure 14. Diffuse axonal injury. Cerebral spinal fluid suppression sequence showing a small area of parieto-occipital gliosis (arrow) following head injury in a child with post-traumatic seizures.

View larger version (170K): [in a new window]   Figure 15. MR image showing a small enhancing nodule in the left temporal lobe in this child with intractable epilepsy. Low grade glioma.