The Role of Diffusion Tensor MRI and Fiber Tractography of the Brain in Evaluation of Pediatric Epilepsy

Abstract

Introduction: Diffusion tensor imaging (DTI) and fiber tractography of the brain plays an important role in evaluation of patients with childhood epilepsy. It shows diffuse white matter abnormalities in patients with pediatric epilepsy. DTI might show the extent of microstructural alterations when the imaging features are normal. Aim of the work: To evaluate the diagnostic value of diffusion tensor MRI and fiber tractography of the brain in detection and characterization of white matter abnormalities in patients with pediatric epilepsy. Patients and Methods: Our study is a prospective study which included 40 pediatric patients with clinical presentation and EEG changes suggesting childhood epilepsy as a case group and 20 subjects as healthy control group. They all referred from pediatric neurology unit to MRI unit at radiology department, Minia University hospital for children, Minia, Egypt, in the period between June 2019 and July 2020. We examined the effects of epilepsy on 15 major WM tracts. We relied on both FA and MD parameters to characterize the integrity of WM tracts in our analysis. These WM tracts include corpus callosum, forceps minor, forceps major, both corticospinal tracts, both uncinate fasciculi, both cingulum (including cingulate gurus part and hippocampal part), both superior longitudinal fasciculi and both inferior longitudinal fasciculi. Results: The case group (N=40) showed significantly low fractional anisotropy (FA) at all examined tracts excepts right cingulum (cingulate gyrus part) and showed high mean diffusivity (MD) at all examined WM tracts except right cingulum (cingulate gyrus part) and right inferior longitudinal fasciculus. Conventional MRI negative group (N=18) showed significantly low fractional anisotropy (FA) at corpus callosum, forceps minor, left corticospinal tract and left inferior longitudinal fasciculus. High mean diffusivity (MD) was noted at corpus callosum, forceps minor, both uncinate fasciculi and both inferior longitudinal fasciculi.