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Susceptibility-weighted imaging in acute-stage pediatric convulsive disorders
Hiroki Iwasaki1, Yukihiko Fujita2, Mitsuhiko Hara3
1Department of Pediatrics, Tama-Hokubu Medical Center.
Insights
Acute-stage susceptibility-weighted imaging (SWI) shows promise in identifying seizure lateralization in children with prolonged convulsive disorder. This technique may aid in clinical diagnosis and management of pediatric seizure disorders.
Area of Science:
- Pediatric Neurology
- Neuroimaging
- Epileptology
Background:
- Prolonged convulsive disorder in children presents diagnostic challenges.
- Susceptibility-weighted imaging (SWI) is an advanced MRI technique.
Purpose of the Study:
- To evaluate the clinical utility of acute-stage SWI in pediatric prolonged convulsive disorder.
- To assess SWI findings in relation to seizure activity and electroencephalography (EEG).
Main Methods:
- Compared cerebral venous vasculature using SWI in children with acute vs. delayed seizure imaging.
- Subdivided acute SWI group based on venous signal intensity (regional vs. generalized).
- Correlated SWI findings with inter-ictal EEG and venous blood gas analysis.
Main Results:
- Acute-stage SWI revealed low cerebral vein signals in all affected children.
- Regional low signals correlated with EEG abnormalities and more pronounced venous pH/pCO2 changes.
- Low-signal areas resolved on follow-up SWI, indicating transient changes.
Conclusions:
- Acute-stage SWI is a potentially valuable tool for seizure lateralization in children.
- SWI may help differentiate seizure focus and severity in prolonged convulsive disorder.
Background:
The aim of this preliminary study was to investigate the clinical use of acute-stage susceptibility-weighted imaging (SWI) in children with prolonged convulsive disorder.
Methods:
Ten children with prolonged convulsive disorder who underwent SWI within 2 h after termination of seizure (acute-stage SWI group) and 15 control children who underwent SWI > 2 h after their seizures terminated or for other purposes were enrolled. The cerebral venous vasculature was compared between the groups. The acute-stage SWI group was further divided into three subgroups: normal group, those with regional low signals in the cerebral veins (regional group) and those with diffuse low signals in the cerebral veins (generalized group). Inter-ictal electroencephalography (EEG) and venous blood gas findings during seizure activity were compared between these subgroups.
Results:
All patients in the acute-stage SWI group had low cerebral vein signal. Four patients were assigned to the regional group and six patients to the generalized group. Decrease of venous pH and the increase of venous pCO2 during seizure activity was more prominent in the regional group than in the generalized group. In the regional group, low-signal areas in the cerebral veins were consistent with abnormal areas on EEG; these low-signal areas resolved completely in all patients on follow-up SWI. Ten patients in the control group had normal SWI, and five had a generalized low signal.
Conclusions:
Acute-stage SWI may be a useful alternative for identifying lateralization of seizures in children with prolonged convulsive disorder.
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