Advances in magnetic resonance imaging for the assessment of paediatric focal epilepsy: a narrative review

Luigi Vincenzo Pastore; Enrico De Vita; Sniya Valsa Sudhakar; Ulrike Löbel; Kshitij Mankad; Asthik Biswas; Luigi Cirillo; Suresh Pujar; Felice D'Arco

doi:10.21037/tp-24-166

Advances in magnetic resonance imaging for the assessment of paediatric focal epilepsy: a narrative review

Transl Pediatr. 2024 Sep 30;13(9):1617-1633. doi: 10.21037/tp-24-166. Epub 2024 Sep 12.

Authors

Luigi Vincenzo Pastore^{1

2}, Enrico De Vita³, Sniya Valsa Sudhakar³, Ulrike Löbel³, Kshitij Mankad³, Asthik Biswas³, Luigi Cirillo^{1

2}, Suresh Pujar^{4

5}, Felice D'Arco³

Affiliations

¹ Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.
² Neuroradiology Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Bellaria, Bologna, Italy.
³ Department of Neuroradiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
⁴ Neurology/Epilepsy Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
⁵ Developmental Neurosciences Unit, University College London-Great Ormond Street Institute of Child Health, London, UK.

Abstract

Background and objective: Epilepsy affects approximately 50 million people worldwide, with 30-40% of patients not responding to medication, necessitating alternative therapies such as surgical intervention. However, the accurate localization of epileptogenic lesions, particularly in pediatric magnetic resonance imaging (MRI)-negative drug-resistant epilepsy, remains a challenge. This paper reviews advanced neuroimaging techniques aimed at improving the detection of such lesions to enhance surgical outcomes.

Methods: A comprehensive literature search was conducted using PubMed, focusing on advanced MRI sequences, focal epilepsy, and the integration of artificial intelligence (AI) in the diagnostic process.

Key content and findings: New MRI sequences, including magnetization prepared 2 rapid gradient echo (MP2RAGE), edge-enhancing gradient echo (EDGE), and fluid and white matter suppression (FLAWS), have demonstrated enhanced capabilities in detecting subtle epileptogenic lesions. Quantitative MRI techniques, notably magnetic resonance fingerprinting (MRF), alongside innovative post-processing methods, are emphasized for their effectiveness in delineating cortical malformations, whether used alone or in combination with ultra-high field MRI systems. Furthermore, the integration of AI in radiology is progressing, providing significant support in accurately localizing lesions, and potentially optimizing pre-surgical planning.

Conclusions: While advanced neuroimaging and AI offer significant improvements in the diagnostic process for epilepsy, some challenges remain. These include long acquisition times, the need for extensive data analysis, and a lack of large, standardized datasets for AI validation. However, the future holds promise as research continues to integrate these technologies into clinical practice. These efforts will improve the clinical applicability and effectiveness of these advanced techniques in epilepsy management, paving the way for more accurate diagnoses and better patient outcomes.

Keywords: Focal epilepsy; artificial intelligence (AI); malformations of cortical development (MCDs); neuroimaging; paediatric.

Publication types

Review