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Seizure Disorders: Functional MR Imaging for Diagnostic Evaluation and Surgical Treatment—Prospective Study¹

¹ From the Department of Radiology (L.S.M., B.B., L.C., M.R., E.P., N.R.A.), Health Outcomes, Policy and Economics (HOPE) Center (L.S.M., L.C., M.R., N.R.A.), Brain Institute (L.S.M., B.B., C.D., E.P., P.J., G.M., J.R., N.R.A.), and Departments of Neurology (C.D., P.J.) and Neurological Surgery (G.M., J.R.), Miami Children's Hospital, 3100 SW 62 Ave, Miami, FL 33155. Received April 16, 2004; revision requested June 25; revision received August 12; accepted September 8. Supported in part by a grant from the American Society of Pediatric Neuroradiology. Address correspondence to L.S.M. (e-mail: smedina{at}post.harvard.edu).

View larger version (44K): [in a new window]   Figure 1. Questionnaire used before and after functional MR imaging by the seizure team.

View larger version (123K): [in a new window]   Figure 2. Transverse functional MR image in 8-year-old left-handed female patient, obtained with T2*-weighted sequence (3750/60; flip angle, 90°) overlaid on a T1-weighted spoiled gradient-recalled acquisition in the steady state MR image. Functional MR imaging performed with the verb generation paradigm revealed language dominance in the left hemisphere for both Wernicke language-receptive areas (arrowheads) in posterior third of the middle temporal gyrus on the left side and Broca language-expressive areas (arrow) in inferior frontal gyrus on the left side. Bilateral auditory representation is noted in the temporal lobes because verb generation paradigm input to the patient is given orally. Color scale follows the spectrum of white light from high (red) to low (violet) activation.

View larger version (123K): [in a new window]   Figure 3. Transverse functional MR image in 9-year-old left-handed male patient, obtained with T2*-weighted sequence (3750/60; flip angle, 90°) overlaid on a T1-weighted spoiled gradient-recalled acquisition in the steady state MR image. Functional MR imaging performed with the paradigm of listening to a story revealed language dominance on the right side for Wernicke language-receptive areas (arrowheads) and Broca language-expressive areas (black arrow). Diffuse cerebral cortical dysplasia on the left side is noted (white arrows). Color scale follows the spectrum of white light from high (red) to low (violet) activation.

View larger version (126K): [in a new window]   Figure 4. Transverse functional MR image in 10-year-old male patient, obtained with T2*-weighted sequence (3750/60; flip angle, 90°) overlaid on T1-weighted spoiled gradient-recalled acquisition in the steady state MR image. Functional MR imaging performed with flashing lights revealed substantial visual activation in the occipital lobe on the left side, with minimal activation on the right side. Bilateral occipital cortical dysplasia (arrows) and occipital subependymal gray matter heterotopia (arrowheads) on the right side are noted. Color scale follows the spectrum of white light from high (red) to low (violet) activation.