Marisa K. Blitstein MD, Presenter: Nothing to Disclose

Sandra Rincon MD, Abstract Co-Author: Nothing to Disclose

Paul Albert Caruso MD, Abstract Co-Author: Nothing to Disclose

Ramon Gilberto Gonzalez MD, PhD, Abstract Co-Author: Nothing to Disclose

Ronald Thibert, Abstract Co-Author: Nothing to Disclose

Eva-Maria Ratai PhD, Abstract Co-Author: Nothing to Disclose

To determine the utility of MR Spectroscopy (MRS) for evaluation of seizure in the pediatric patient: does MRS add information to the MRI?

A search was performed to identify patients <18 years old with both MRI and MRS for evaluation of seizure between 1/1/2011 and 12/31/2012. This search yielded 165 cases. 7 were discarded because the MRS was nondiagnostic, leaving 158 cases (146 patients). Chart review was performed to determine if the patient had a relevant diagnosis known at the time of imaging. We defined relevant diagnosis as a diagnosis related to seizure AND known to exhibit structural MRI features. MRI, MRS, and original radiology report were reviewed by 2 neuroradiologists and an MR physicist, to determine whether MRS was normal or abnormal, and whether MRS added information not provided by MRI. 

MRS yielded additional information for 34% (53/158) of cases. In the largest subset, 10/53 cases, MRS was useful for distinguishing dysplasia from neoplasm. Of all cases, 46/158 had a known relevant diagnosis and 112/158 had no known relevant diagnosis at the time of imaging. Of cases with a known diagnosis, MRS yielded additional information in 54% (25/46), the largest number of which was for a diagnosis of hypoxic-ischemic injury (HII) (8/25) or perinatal infection (4/25). Of cases without known diagnosis, MRS yielded additional information in 25% (28/112); the largest number were for cases with a focal lesion where differentiation between neoplasm and dysplasia was helpful (7/28), and for cases where MRS abnormalities prompted a metabolic or genetic workup (6/28). 

In our series, MRS provided additional information in 34% of pediatric patients with seizures, and was particularly helpful for distinguishing dysplasia from neoplasm. Furthermore, it was most helpful in patients with a known diagnosis vs patients without a diagnosis at the time of imaging. Of known diagnoses, it was most helpful for patients with HII or perinatal infection. For unknown diagnosis, it was most helpful differentiating dysplasia versus neoplasm, and was also helpful in prompting additional metabolic or genetic workup.

In select pediatric patients evaluated for seizure, MRS can add information that is not provided by MRI.

Blitstein, M, Rincon, S, Caruso, P, Gonzalez, R, Thibert, R, Ratai, E, The Utility of MR Spectroscopy (MRS) for the Evaluation of Seizure in Pediatric Patients.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14008128.html