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Abstracts

Quantifying Arterial Spin Labeling MRI in Pediatric Focal Cortical Dysplasia-Related Epilepsy

Abstract number : 1.418
Submission category : 9. Surgery / 9B. Pediatrics
Year : 2025
Submission ID : 551
Source : www.aesnet.org
Presentation date : 12/6/2025 12:00:00 AM
Published date :

Authors :
Presenting Author: Jacklyn Smith, MD, MSc – Cincinnati Children's Hospital

Hua Xie, PhD – Children's National Hospital
Xiaotong Li, BS – Children's National Hospital
Priyanka Venkata Sita Illapani, MSc – Children's National Hospital
Gilbert Vezina, MD – Children's National Hospital
Chima Oluigbo, MD – Children's National Hospital, George Washington University
William Gaillard, MD – Children's National Hospital
Nathan Cohen, MD – Children's National Hospital

Rationale: Focal cortical dysplasia (FCD) is the most common cause of lesional, surgically-treatable drug-resistant epilepsy in children1. Arterial spin labeling MRI (ASL MRI) is a noninvasive method to magnetically ‘tag’ protons in red blood cells to quantify cerebral blood flow (CBF). FCDs are often found to be in electrical status (or near status) epilepticus2,3. Most present ASL MRI data rely on qualitative interpretation of CBF. We hypothesized that FCDs would have increased CBF compared to the contralateral cortex.

Methods: This was a retrospective review from Children’s National Hospital with radiologically and/or pathologically-confirmed FCD who had 3T ASL MRI as part of the phase 1 evaluation. FCDs were masked on 3D T1 MRI in FSL eyes, and co-registered to ASL MRI. Paired t-test was used to compare mean CBF (mL/100g/min) computed within the lesion mask and it’s flipped homolog. Absolute difference in CBF was calculated between the FCD and homologous contralateral cortex as a function of CBF(FCD) – CBF(contralateral cortex). 

Results: Thirty children (16 male) with an average age of 9 years at MRI (SD 4.5) and onset of epilepsy at 5 years (SD 3.5) were identified. Patients had FCD identified on MRI, and 22/30 patients had histopathology consisting of type IIa (32%), type IIIa (27%), type IIb (14%), type Ic (9%), type I (4.5%) and type Ia (4.5%). There was no difference in CBF between the FCD and contralateral cortex (t = -1.9, p = 0.07) (Figure 1). There were two FCD outliers with marked hypoperfusion identified from the absolute difference of cerebral blood flow (FCD-contralateral mask) mean difference -7.68 (SD 22.08) (Figure 2).

Conclusions: Quantitative analysis of ASL MRI failed to detect difference in CBF between FCD and the contralateral cortex. Data trended towards hypoperfusion in FCD tissue. Resting state fMRI connectivity is diminished at the FCD and in the homologous cortex4. This functional coupling may partially explain the present results. Future studies should integrate multimodal imaging data in larger populations to more fully assess the potential augmented value of quantitative ASL MRI in the identification of the seizure onset zone in FCD-related epilepsy.

References:

1. Cohen NT, Chang P, You X, Zhang A, Havens KA, Oluigbo CO, et al. Prevalence and Risk Factors for Pharmacoresistance in Children With Focal Cortical Dysplasia-Related Epilepsy Neurology. 2022 Aug 19;99:e2006-2013.

2. Cohen NT, Vezina LG, Oluigbo C, Anwar T, Archer J, Bernhardt BC, et al. ILAE neuroimaging task force highlight: MRI detection of early life epilepsy caused by focal cortical dysplasia Epileptic disorders : international epilepsy journal with videotape. 2025 May 3.

3. Cohen NT, Buraniqi E, Smith JD, Vezina LG, Gaillard WD. Ictal Arterial Spin Labeling-Magnetic Resonance Imaging Identifies Seizure Onset Zone in Epilepsia Partialis Continua Annals of neurology. 2024 Apr;95:760-761.

4. Xie H, Illapani VSP, Vezina LG, Gholipour T, Oluigbo C, Gaillard WD, et al. Mapping Functional Connectivity Signatures of Pharmacoresistant Focal Cortical Dysplasia-Related Epilepsy Annals of neurology. 2024 Aug 27.

 



Funding: NTC is funded by an AAN Career Development Award and the Hess Foundation.

Surgery