Role of Volumetric Magnetic Resonance Imaging of the Brain in Children with Non-Lesional Epilepsy

Document Type : Original Article

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Diagnostic Radiology Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt

10.21608/scumj.2025.268200.1548

Abstract

Background: Epilepsy in children carries high risks of comorbidity and mortality, and non-lesional epilepsy (NLE), where MRI appears normal, is particularly difficult to diagnose and treat. Volumetric MRI (vMRI) improves the detection of subtle cortical abnormalities and provides quantitative brain volume analysis. It is essential for enhancing diagnosis and guiding surgical decisions in pediatric NLE. Aim: To evaluate the role of volumetric MRI in diagnosing children with non-lesional epilepsy.  Subjects and Methods: Fifty-nine children with NLE and 59 controls under 18 years underwent comprehensive clinical evaluation, electroencephalography, and standardized 1.5T MRI using an epilepsy protocol. vMRI using volBrain 1.0 for whole-brain segmentation and HIPS 1.0 for hippocampal subfield segmentation. Quantitative measures assessed gray matter (GM), white matter (WM), subcortical structures, and hippocampal subfields, with asymmetry indices and age- and sex-adjusted norms applied to identify subtle abnormalities. Results: Children with NLE showed reduced volume of WM and subcortical structures, with no significant GM differences from controls. The amygdala was the most significantly affected structure, followed by bilateral reductions in hippocampal subfields (CA1, CA2–CA3, CA4–DG, SR-SL-SM), thalamus, putamen, and globus pallidus. No significant differences were detected in the caudate nucleus or subiculum. Receiver Operating Characteristic (ROC) analysis revealed that amygdala volume was the strongest diagnostic marker (AUC 0.963, sensitivity 94.9%, specificity 100%). Hippocampal volume showed moderate diagnostic accuracy (AUC 0.705, sensitivity 67.8%, specificity 64.4%). Conclusion: Volumetric MRI is a valuable tool for detecting subtle brain changes in childhood non-lesional epilepsy. Early validation in pediatric patients is recommended to improve prognosis and guide therapy

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Suez Canal University Medical Journal
Volume 27, Issue 11
November 2024
Pages 29-41

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