ASL (Arterial Spin Labeling) – a novel modality of MR angiography – is based on radio-frequency labeling of aqueous protons in the arterial blood; the method is used to monitor blood supply to  organs, including the brain. So far there has been little information on the use of ASL in children with focal epilepsy, especially in the pre-surgery period.Aim:to evaluate the perfusion patterns in seizure-free children with drug resistant focal epilepsy (FE) using the ASL mode of MRI.Materials and methods.We studied the ASL data of 54 (23-boys/31 girls) patients with FE  treated in the Dpt. of Neurology at the Russian State Children Hospital from 2015 to 2018. The  patients’ age varied from 4 months to 17 years. All images were produced with a 3T GE Discovery  750W system.Results. We found several brain perfusion patterns in children with FE; among other factors, those patterns depended on the clinical status of the patient, i. e. the interictal period or the early post- seizure period. The main pattern of the interictal period was characterized by a focal decrease in  perfusion located around a structural focus identified on MRI scans. In the early post-seizure  period, there was an increase in the arterial perfusion in the area of a structural epileptogenic lesion.Conclusion.ASL-MRI is an effective diagnostic method providing more information on children  with FE during their pre-surgery phase. The ASL modality needs further research to rationalize its wider use as a preferred diagnostic tool or as a combination with the more complex PET and SPECT.

Цель исследования -анализ результатов магнитно-резонансной томографии (МРТ) у пациентов с симптоматической эпилепсией, ассоциированной с опухолью. Материал и методы. Были проанализированы данные МРТ 52 пациентов с симптоматической эпилепсией, проходивших лечение по поводу опухолей супратенториальной локализации. Были выявлены наиболее эпилептогенные опухоли. Особое внимание было уделено опухолям со стертой клинической картиной и не имевшим типичных МРТ-признаков. Все пациенты с опухолями были прооперированы с применением различных методик хирургического вмешательства. Результаты. Наиболее эпилептогенными опухолями оказались дизэмбриопластические нейроэпителиальные опухоли (ДНЭО), диффузные астроцитомы (ДА) и ганглиоглиомы (ГГ). Во всех случаях ДНЭО и у 4 пациентов с ГГ эпилептические приступы являлись дебютным, а в 4 из 5 случаев ДНЭО -единственным клиническим признаком наличия опухоли. При МРТ в случаях ДНЭО, ДА и ГГ выявлялись изо/ гипоинтенсивный сигнал на Т1-ВИ и варьирующий по интенсивности от умеренного до гиперинтенсивного сигнала на Т2-и FLAIR-ВИ, при этом в случаях с ДНЭО и ГГ практически отсутствовали масс-эффект и перифокальный отек, а на FLAIR-ВИ наиболее четко прослеживалась так называемая пеноподобная (мультикистозная) структура. Не отмечено существенного изменения размеров ДНЭО и ГГ. В 1 случае отмечено сочетание ДНЭО с корковой дисплазией. При ДА трудно отличить перифокальный отек от туморозной ткани и неизмененных тканей головного мозга, и, как правило, рост опухоли замедлен. Заключение. Эпилептогенные опухоли могут копировать рентгенологические характеристики друг друга, а также мимикрировать ганглиоглиомы, олигодендроглиомы и астроцитомы Gr I, II и др. Они являются наиболее частыми причинами возникновения симптоматической фокальной эпилепсии. Эти образования необходимо в первую очередь исключать в случаях фармакорезистентной эпилепсии. Ключевые слова: опухоли головного мозга у детей, симптоматическая фокальная эпилепсия, эпилептическая хирургия, нейровизуализация.Objective -to analyze MR-images in patients with symptomatic epilepsy associated with the brain tumor. Material and methods. MRI results of 52 patients with symptomatic epilepsy operated for tumors of supratentorial localization were analyzed. The most epileptogenic tumors with atypical MRI signs and subtle clinical presentation were identified. All patients with tumors were operated using different methods of surgical intervention. Results. Dysembryoplastic neuroepithelial tumors (DNET), diffuse astrocytomas (DA) and gangliogliomas (GG) were the most frequent epileptogenic tumors. In all the cases of DNET and in 4 patients with GG, epileptic seizures were the first, and in 4 of 5 cases of DIO were the only clinical sign of tumor presence. In DNET, DA and GG, there was an iso-or hypointensive signal on T1 WI and a signal varying in intensity from moderate to hyperintense in T2 and FLAIR WI, while in cases with DNET and GG, no mass effect and perifocal edema was practically seen. The so-called «spume-like» (multicystic) structure was m...

Introduction. The MRI method has revolutionized the diagnosis of epilepsy. However, the widespread adoption of MRI in clinical practice is slowed by an insufficient number of high-field MRI scanners, a shortage of trained specialists, and the lack of standard examination protocols. The aim of this article is to present the Recommendations of the Russian League Against Epilepsy (RLAE) on the use of magnetic resonance imaging in the diagnosis of epilepsy.Materials and methods. As a structural element of the International League Against Epilepsy (ILAE), the RLAE considers it important to adapt the Protocol developed by ILAE for specialists in Russia and EAEU countries. The working group analyzed and generalized the clinical practice existing in the Russian Federation, the Republic of Kazakhstan, the Republic of Belarus and the Republic of Uzbekistan. These recommendations are intended for doctors in specialized centers of epilepsy surgery, and for doctors in general medical centers. The recommendations are applicable primarily to adult patients, but the general principles are relevant to children as well.Results. In all patients with convulsive seizures shortly after the first seizure, or patients diagnosed with epilepsy who have an unexplained increase in the frequency of seizures, rapid decrease in cognitive functions or the appearance / worsening of neuropsychiatric symptoms, the RLAE recommends using a unified MR protocol for the neuroimaging of structural sequences in epilepsy with three-dimensional pulse sequences T1 and T2 FLAIR with isotropic voxel 1 × 1 × 1 mm3 and two-dimensional T2- weighted pulse sequences with a pixel size of 1 × 1 mm2 or less. The MRI examination should be combined with EEG or EEG-video monitoring. Using this protocol allows one to set a unified standard for examining patients with epilepsy in order to detect (with high sensitivity) brain lesions playing a key role in the occurrence of seizures. Here, all 13 recommendations are presented.Conclusion. Implementation of these recommendations in clinical practice will improve the access to high-tech medical care and optimize health care costs.