title: Arterial Spin Labeling MRI: a step forward in non-invasive delineation of focal cortical dysplasia in children.
abstract: The aim was to localize the interictal cerebral perfusion abnormalities of focal cortical dysplasia (FCD) in children with Arterial Spin Labeling MRI (ASL) in a retrospective study of nine consecutive children explored with multimodal investigation during interictal periods. We analyzed brain morphology with a 1.5T MRI and a dedicated protocol for epilepsy. Brain perfusion was quantified with pseudo continuous ASL. Brain metabolism was imaged with (18)FDG-PET in six patients. Microvessel histology was studied in five children who underwent epilepsy surgery with CD34 immunostaining on FCD and control samples. Localized decrease of cerebral blood flow (CBF) was found on visual analysis in all patients with ASL. It was co-localized with the structural MRI abnormalities in every case, with PET hypo-metabolism in 5/6 cases, and with histologically proven FCD type IIb in 5/5 cases (all seizure free after surgery). CBF was lower (Kruskal-Wallis test, p=0.001) in FCD than in normal cortex. The total count of CD34+ microvessels was similar in FCD and control cases, but microvasculature showed disorganized architecture. Interictal ASL is a non-invasive method that may help to localize the epileptogenic zone showing hypo-perfusion in FCD. Whether this finding could be generalized to MRI-negative FCD needs to be further studied.
authors.affiliation: APHP, Department of Pediatric Neurosurgery, Hospital Necker, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; INSERM U1129, Pediatric Epilepsies and Brain Plasticity, Paris, France. Electronic address: thomas.blauwblomme@nck.aphp.fr.
authors.forename: Thomas
authors.initials: T
authors.lastname: Blauwblomme
authors.affiliation: Université Paris Descartes, Sorbonne Paris Cité, Paris, France; APHP, Department of Neuroradiology, Hospital Necker, Paris, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Boddaert
authors.affiliation: Université Paris Descartes, Sorbonne Paris Cité, Paris, France; INSERM U1129, Pediatric Epilepsies and Brain Plasticity, Paris, France; APHP, Department of Pediatric Neurology, Reference Centre for Rare Epilepsies, Hospital Necker, Paris, France.
authors.forename: Nicole
authors.initials: N
authors.lastname: Chémaly
authors.affiliation: Université Paris Descartes, Sorbonne Paris Cité, Paris, France; INSERM U1129, Pediatric Epilepsies and Brain Plasticity, Paris, France; APHP, Department of Pediatric Neurology, Reference Centre for Rare Epilepsies, Hospital Necker, Paris, France; CEA, I2BM, Service Hospitalier Frédéric Joliot, Orsay, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Chiron
authors.affiliation: APHP, Department of Neuropathology, Hôpital Saint-Anne, Paris, France.
authors.forename: Mélanie
authors.initials: M
authors.lastname: Pages
authors.affiliation: APHP, Department of Neuropathology, Hôpital Saint-Anne, Paris, France.
authors.forename: Pascale
authors.initials: P
authors.lastname: Varlet
authors.affiliation: APHP, Department of Pediatric Neurosurgery, Hospital Necker, Paris, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Bourgeois
authors.affiliation: APHP, Department of Pediatric Neurosurgery, Hospital Necker, Paris, France; APHP, Department of Pediatric Neurology, Reference Centre for Rare Epilepsies, Hospital Necker, Paris, France.
authors.forename: Nadia
authors.initials: N
authors.lastname: Bahi-Buisson
authors.affiliation: Université Paris Descartes, Sorbonne Paris Cité, Paris, France; INSERM U1129, Pediatric Epilepsies and Brain Plasticity, Paris, France; APHP, Department of Electrophysiology, Hospital Necker, Paris, France.
authors.forename: Anna
authors.initials: A
authors.lastname: Kaminska
authors.affiliation: Université Paris Descartes, Sorbonne Paris Cité, Paris, France; APHP, Department of Neuroradiology, Hospital Necker, Paris, France.
authors.forename: David
authors.initials: D
authors.lastname: Grevent
authors.affiliation: Université Paris Descartes, Sorbonne Paris Cité, Paris, France; APHP, Department of Neuroradiology, Hospital Necker, Paris, France.
authors.forename: Francis
authors.initials: F
authors.lastname: Brunelle
authors.affiliation: APHP, Department of Pediatric Neurosurgery, Hospital Necker, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Sainte-Rose
authors.affiliation: INSERM U1129, Pediatric Epilepsies and Brain Plasticity, Paris, France; CEA, I2BM, Service Hospitalier Frédéric Joliot, Orsay, France; APHP, Department of Nuclear Medicine, Hospital Bicêtre, Le Kremlin Bicêtre, France.
authors.forename: Frédérique
authors.initials: F
authors.lastname: Archambaud
authors.affiliation: Université Paris Descartes, Sorbonne Paris Cité, Paris, France; INSERM U1129, Pediatric Epilepsies and Brain Plasticity, Paris, France; APHP, Department of Pediatric Neurology, Reference Centre for Rare Epilepsies, Hospital Necker, Paris, France.
authors.forename: Rima
authors.initials: R
authors.lastname: Nabbout
mesh_terms: D000293:Adolescent; D018952:Antigens, CD34 / Q000378:metabolism; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*; D002560:Cerebrovascular Circulation / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D054220:Malformations of Cortical Development / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*; D055806:Microvessels / Q000473:pathology / Q000503:physiopathology; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D013113:Spin Labels
chemical_list: D018952:Antigens, CD34; D019275:Radiopharmaceuticals; D013113:Spin Labels; D019788:Fluorodeoxyglucose F18
keywords: Arterial Spin Labeling; Epilepsy surgery; FDG-PET; Focal cortical dysplasia