When are multiple imaging modalities indicated in the workup of Sturge-Weber syndrome (SWS)?

Updated: Dec 26, 2018
  • Author: Masanori Takeoka, MD; Chief Editor: George I Jallo, MD  more...
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Answer

Determining the maximum extent of disease in patients with SWS may require a combination of structural and functional neuroimaging, since a mismatch may exist among neuroimaging modalities. Each modality may demonstrate abnormalities not detected by the other. This is especially important in the identification of the epileptogenic region when considering surgery for refractory seizures. A combination of modalities may also demonstrate a larger area of functional abnormality affected by SWS and potentially provide more information on prognosis.

Juhász et al studied 13 children with SWS using susceptibility-weighted images and DTI, in conjunction with PET scanning. SWI detected cortical abnormalities and deep transmedullary veins in the white matter adjacent to the hypometabolic regions. DTI detected abnormalities in the hypometabolic cortex and the adjacent white matter with collateral veins. [84]

Alkonyi et al reported 20 unilateral SWS patients with DTI and fluorodeoxyglucose (FDG)-PET scanning, measuring the diffusion parameters and FDG uptake in the thalami. Severe asymmetries of glucose metabolism and diffusion were strong predictors for low IQ. [85]


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