Magnetic resonance imaging (MRI) volumetry in children with nonlesional epilepsy, does it help?
Authors: Abdelgawad Ehab Ali , Mounir Samir M. , Abdelhay Marah M. , Ameen Mohammed A. 
Published: January 2021

Abstract
Background
Epilepsy is a chronic condition characterized by repeated spontaneous seizures. It affects up to 1% of the population worldwide. Children with magnetic resonance imaging (MRI) negative (or “nonlesional”) focal epilepsy constitute the most challenging pharmacoresistant group undergoing pre-neurosurgical evaluation. Volumetric magnetic resonance imaging (VMRI) is a non-invasive brain imaging technique done to measure the volume and structure of specific regions of the brain. It is useful for many things, but primarily for discovering atrophy (wasting away of body tissue) and measuring its progression. The aim of this study is to assess role of volumetric magnetic resonance imaging in evaluation of nonlesional childhood epilepsy in which no specific findings detected in conventional MRI.

Results
There were 20 children with normal MRI brain volumetry (33.3%) and 40 children (66.6%) with abnormal MRI brain volumetry.
Grey matter volume in the abnormal group was significantly higher (P value was 0.001*) than the normal group (mean ± S.D 934.04 ± 118.12 versus 788.57 ± 57.71 respectively). White matter volume in the abnormal group was significantly smaller (P value was < 0.0001*) than in the normal group (mean ± S.D 217.79 ± 65.22 versus 418.07 ± 103.76 respectively). Right hippocampus CA4-DG volume in the abnormal volume group was found to be significantly smaller (P value < 0.0001*) than that of the normal group volume (mean ± S.D 0.095 ± 0.04 versus 0.32 ± 0.36 respectively). Right hippocampus subiculum volume in the abnormal volume group were found to be significantly smaller (P value was < 0.0001*) than that of the normal group volume (mean ± S.D 0.42 ± 0.11 versus 0.84 ± 0.09 respectively). Thalamus volume in the abnormal group was significantly smaller (P value 0.048*) than in the normal group (mean ± S.D 10.235 ± 3.22 versus 11.82 ± 0.75 respectively). Right thalamus was significantly smaller (P value was 0.028*) than in the normal group (mean ± S.D 5.01 ± 1.62 versus 5.91 ± 0.39 respectively). The sensitivity of the right hippocampus subiculum volume and right hippocampus CA4-DG was 100%. The sensitivity of white matter volume and grey matter volume and thalamus was 85% and 75% and 55% respectively. The specificity of the right hippocampus subiculum volume and right hippocampus CA4-DG was 90% and 90% respectively. The specificity of the right hippocampus subiculum volume and right hippocampus CA4-DG and grey matter volume and white matter volume and total hippocampus and thalamus was 100%. The specificity of brain volume was 60%. The accuracy of the right hippocampus subiculum volume and right hippocampus CA4-DG was 100%. The specificity of white matter volume, grey matter volume, thalamus, total hippocampus, and brain volume was 97%, 87%, 65%, 61%, and 57% respectively.

Conclusion
Volumetric magnetic resonance imaging is a promising imaging technique that can provide assistance in evaluation of nonlesional pharmacoresistant childhood epilepsy.