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Updated: Aug 22, 2026
Scanning Dos and Don'ts: Using Magnetic Resonance Imaging in Awake Children Aged 3 to 5 Years to Assess Brain Structure and Function
Published on: March 10, 2026
[Functional neuroimaging in children]
1Service de Neurologie et Métabolisme, Hôpital Necker-Enfants Malades, INSERM U29, 149 rue des Sèvres, 75743 Paris cedex 15, France. pcchiron@wanadoo.fr
Insights
Functional brain imaging, including SPECT and PET scans, aids in pinpointing seizure origins and mapping critical brain areas in children with drug-resistant epilepsy. These techniques are valuable for surgical planning and understanding brain plasticity.
Area of Science:
- Neuroimaging
- Epilepsy Research
- Pediatric Neurology
Background:
- Pharmacoresistant partial epilepsy (PRPE) in children presents challenges in localizing the epileptogenic zone.
- Accurate localization is crucial for surgical intervention and improving patient outcomes.
- Functional neuroimaging modalities offer non-invasive methods to assess brain function.
Purpose of the Study:
- To evaluate the utility of functional cerebral imaging techniques in the presurgical work-up of pediatric PRPE.
- To assess the sensitivity and applicability of SPECT, PET, and functional MRI in identifying seizure foci and functional brain areas.
- To determine the role of these imaging modalities in surgical planning and understanding brain plasticity.
Main Methods:
- Review of Single Photon Emission Computed Tomography (SPECT) including ictal and interictal scans with subtraction processing.
- Evaluation of Positron Emission Tomography (PET) using tracers like 18FDG, 11C-flumazenil, and 11C-alpha-methyl-tryptophane.
- Assessment of functional Magnetic Resonance Imaging (fMRI) for motor and language cortex mapping, including its potential for assessing plasticity.
Main Results:
- Ictal SPECT demonstrates acceptable sensitivity (80%) for epileptogenic zone localization, especially with interictal SPECT and subtraction processing.
- PET sensitivity requires further validation against intracranial EEG, but both SPECT and PET aid in intracranial electrode placement decisions.
- Functional MRI offers a non-invasive method for language lateralization in cooperative children and can track network plasticity post-lesion or surgery.
Conclusions:
- Functional imaging techniques, particularly ictal SPECT and fMRI, provide valuable complementary information for presurgical evaluation in pediatric PRPE.
- These methods assist in localizing the epileptogenic zone and mapping functional cortices, guiding surgical planning.
- Functional MRI shows promise for non-invasive language mapping and assessing brain plasticity in pediatric epilepsy patients.
Abstract:
In pharmacoresistant partial epilepsy (PRPE) in children, functional cerebral imaging helps localizing the epileptogenic zone using SPECT (Single Photon Emission Computed Tomography) and PET (Positron Emission Tomography) and the functional motor and language cortex using functional MRI. Regarding SPECT, only ictal SPECT exhibits an acceptable sensitivity (80 p. 100), together with interictal SPECT and subtraction image processing. Regarding PET, sensitivity has not been validated yet compared with intracranial EEG, neither using 18FDG, nor using more recent tracers such as 11C-flumazénil or 11C-alpha-méthyl-tryptophane. However, both techniques are useful to decide the placement of the intracranial electrodes, particularly in cryptogenic cases or when preoperative data are discordant. Functional MRI for language is going to be validated compared with WADA test and to provide a very useful and non invasive alternative method to lateralize the language networks in children able to cooperate. FMRI also provides a unique opportunity to follow the post-lesional or post-surgery plasticity of these networks using repeated examinations in a same patient. Functional imaging techniques therefore provide a useful additional contribution in the presurgery work-up of PRPE in children.
