Comparison of various imaging modalities in localization of epileptogenic lesion using epilepsy surgery outcome in pediatric patients
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Updated: Jun 23, 2026
Electromagnetic Source Imaging in Presurgical Evaluation of Children with Drug-Resistant Epilepsy
Published on: September 20, 2024
Jeong Tae Kim1, Sun Joon Bai, Keum Ok Choi
1Department of Pediatrics, Pediatric Epilepsy Clinic, Severance Children's Hospital, Yonsei University College of Medicine, 134 Shinchondong, Seodaemun-gu, Seoul 120-752, Republic of Korea.
Insights
Magnetic Resonance Imaging (MRI) is reliable for identifying pediatric epilepsy zones. Combining MRI with Positron Emission Tomography (PET) or Single-Photon Emission Computed Tomography (SPECT) improves localization accuracy for epilepsy surgery in children.
Area of Science:
- Pediatric Neurology
- Neuroradiology
- Epileptology
Background:
- Epilepsy surgery requires precise identification of epileptic zones.
- Various imaging modalities are used to localize these zones in pediatric patients.
- Assessing the accuracy of these tools is crucial for surgical success.
Purpose of the Study:
- To evaluate the accuracy of different imaging modalities in identifying epileptic zones in pediatric patients.
- To compare the effectiveness of MRI, PET, and SISCOM in localizing epileptic foci for successful epilepsy surgery.
Main Methods:
- Retrospective analysis of 42 pediatric patients (Engel Class I) who underwent epilepsy surgery.
- Comparison of pre-surgical imaging results (MRI, PET, SISCOM) with pathological findings.
- Evaluation of concordance and localization accuracy for temporal and extratemporal lesions.
Main Results:
- MRI demonstrated high concordance and localization rates, particularly for extratemporal lesions.
- PET showed high concordance for temporal lesions but lower accuracy for extratemporal ones.
- Subtraction ictal SPECT coregistered to MRI (SISCOM) was highly concordant for temporal and extratemporal cases, with varying localization accuracy.
Conclusions:
- MRI is a reliable tool for identifying pediatric epileptic zones.
- PET is effective for temporal lobe epilepsy, while SISCOM aids in extratemporal lesion localization.
- Combined imaging approaches (MRI with PET or SISCOM) enhance pre-surgical decision-making for pediatric epilepsy surgery.
Purpose:
We employed the results of imaging modalities from pediatric patients who received successful epilepsy surgery to determine the accuracy of each imaging tool in identifying epileptic zones in youngsters.
Methods:
All Engel class I pediatric patients who received epilepsy surgery between October 2003 and April 2008 were selected. Their pathology, EEG, MRI, PET, and subtraction ictal SPECT coregistered to MRI (SISCOM) results were compared for accuracy in locating the epileptic foci, defined as "area that resulted in seizure ablation after resection".
Results:
Forty-two patients were enrolled (23 temporal lobectomy, 19 extratemporal resections). MRI showed concordance in 84.2% of extratemporal cases, all of which had precise localization of lesions. In temporal cases, lateralization was 91.3% and localization was 82.6%. PET showed a concordance rate of 95.5% and localization was 72.7% for temporal lesions. For extratemporal lesions, concordance was only 68.4%. SISCOM showed concordance in 100% of temporal and 92.3% of extratemporal cases, with localization in 66.7% of temporal and 84.6% of extratemporal cases. Most temporal lobe cases had hippocampal sclerosis, and cortical dysplasia was observed in extratemporal cases.
Discussion:
MRI was invariably reliable in all cases. PET results were as reliable in lateralizing the temporal epileptic area, while its efficacy was lower for extratemporal cases. SISCOM effectively localized lesions in extratemporal cases, but its efficacy was lower in temporal lesions. In cases of conflicting pre-surgical results, MRI, with supplementary data from PET, helped to establish correct decisions in temporal epilepsies, while utilization of SISCOM and MRI data is advised for extratemporal cases.
