Real-time functional MR imaging (fMRI) for presurgical evaluation of paediatric epilepsy.
BACKGROUND
The role of fMRI in the presurgical evaluation of children with intractable epilepsy is being increasingly recognized. Real-time fMRI allows the clinician to visualize functional brain activation in real time. Since there is no off-line data analysis as in conventional fMRI, the overall time for the procedure is reduced, making it clinically feasible in a busy clinical sitting.


OBJECTIVE
(1) To study the accuracy of real-time fMRI in comparison to conventional fMRI with off-line processing; (2) to determine its effectiveness in mapping the eloquent cortex and language lateralization in comparison to invasive procedures such as intraoperative cortical stimulation and Wada testing; and (3) to evaluate the role of fMRI in presurgical decision making in children with epilepsy.


METHODS
A total of 23 patients (age range 6-18 years) underwent fMRI with sensorimotor, visual and language paradigms. Data processing was done in real time using in-line BOLD.


RESULTS
The results of real-time fMRI matched those of off-line processing done using the well-accepted standard technique of statistical parametric mapping (SPM) in all the initial ten patients in whom the two techniques were compared. Coregistration of the fMRI data on a 3-D FLAIR sequence rather than a T1-weighted image gave better information regarding the relationship of the lesion to the area of activation. The results of intraoperative cortical stimulation and fMRI matched in six out of six patients, while the Wada test and fMRI had similar results in four out of five patients in whom these techniques were performed. In the majority of patients in this series the technique influenced patient management.


CONCLUSIONS
Real-time fMRI is an easily performed and reliable technique in the presurgical workup of children with epilepsy.
Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695011, India. chandkesav@yahoo.com
Chandrasekharan
C
Kesavadas
Bejoy
B
Thomas
Sreedharan
S
Sujesh
Radhakrishnan
R
Ashalata
Mathew
M
Abraham
Arun Kumar
AK
Gupta
Kurupath
K
Radhakrishnan
D000293:Adolescent; D002648:Child; D003199:Computer Systems; D004827:Epilepsy / Q000175:diagnosis* / Q000601:surgery*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D018579:Patient Selection; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome