Children with constitutional mismatch repair deficiency (CMMRD) syndrome have an increased risk of high-grade gliomas (HGG), and brain imaging abnormalities. This study analyzes brain imaging features in CMMRD syndrome children versus those with HGG without CMMRD. Retrospective comparative analysis of brain imaging in 30 CMMRD children (20 boys, median age eight years, 22 with HGG), seven with Lynch syndrome (7 HGG), 39 with type 1 neurofibromatosis (NF1) (four with HGG) and 50 with HGG without MMR or NF1 pathogenic variant (“no-predisposition” patients). HGG in CMMRD and Lynch patients were predominantly hemispheric (versus midline) compared to NF1 and no-predisposition patients (91

Supratentorial (ST) ependymoma subgroups are defined by two different fusions with different prognoses. Astroblastomas, MN1-altered, have ependymal-like histopathologic features and represent a differential diagnosis in children. We hypothesized that ZFTA-fused ependymoma and YAP1-fused ependymoma on the one hand, and astroblastoma, MN1-altered, on the other hand, show different MRI characteristics. We retrospectively analyzed the preoperative imaging of 45 patients with ST ependymoma or astroblastoma between January 2000 and September 2020, blinded to histomolecular grouping. Several characteristics, such as location, tumor volume, calcifications, solid/cystic component, and signal enhancement or diffusion were evaluated. We compared imaging characteristics according to their molecular subtype (ZFTA-fused, YAP1-fused, and astroblastoma, MN1-altered). Thirty-nine patients were classified as having an ependymoma, 35 with a ZFTA fusion and four with a YAP1 fusion, and six as having an astroblastoma, MN1-altered. YAP1-fused ependymomas were more likely to involve at least 3 lobes than ZFTA-fused ependymomas. Astroblastomas were located in the frontal lobe in 100

RATIONALE:Use of life support with extracorporeal membrane oxygenation (ECMO) is associated with brain injury. However, the consequences of these injuries on subsequent neurologic development and health-related quality of life (HRQoL) are poorly described in children. OBJECTIVES:The aim of this preliminary study was to describe short- and long-term neurologic outcomes in survivors of ECMO, as well as their HRQoL. DESIGN:Retrospective identified cohort with contemporary evaluations. SETTING:Necker Children's Hospital academic PICU. PATIENTS:Forty survivors who underwent ECMO (October 2014 to January 2020) were included in follow-up assessments in May 2021. INTERVENTIONS:None. MEASUREMENT AND MAIN RESULTS:We first reviewed the outcomes of ECMO at the time of PICU discharge, which included a summary of neurology, radiology, and Pediatric Overall/Cerebral Performance Category (POPC/PCPC) scores. Then, in May 2021, we interviewed parents and patients to assess HRQoL (Pediatric Quality of Life Inventory [PedsQL]) and POPC/PCPC for children 3 years old or older, and Denver II test (DTII) for younger children. An evaluation of DTII in the youngest patients 1 year after ECMO decannulation was also added. Median age at ECMO was 1.4 years (interquartile range [IQR], 0.4-6 yr). Thirty-five children (88%) underwent a venoarterial ECMO. At PICU discharge, 15 of 40 patients (38%) had neurologic impairment. Assessment of HRQoL was carried out at median of 1.6 years (IQR, 0.7-3.3 yr) after PICU discharge. PedsQL scores were over 70 of 100 for all patients (healthy peers mean results: 80/100), and scores were like those published in patients suffering with chronic diseases. In May 2021, seven of 15 patients had a normal DTII, and 36 of 40 patients had a POPC/PCPC score less than or equal to 3. CONCLUSIONS:None of our patients presented severe disability at long term, and HRQoL evaluation was reassuring. Considering the risk of neurologic impairment after ECMO support, a systematic follow-up of these high-risk survivor patients would be advisable.

We report on MRI evidence of polyradiculoneuritis in a 15-month-old undiagnosed developmentally delayed child with paralysis and absent deep-tendon reflexes of lower limbs, progressive demyelinating sensory-motor polyneuropathy on electroneuromyogram, and hyperproteinorachia mimicking Guillain-Barre syndrome (GBS). Inefficacy of usual treatment associated with psychomotor regression, generalized hypotonia, secondary gastrointestinal involvement, and hepatic cytolysis led to consider mitochondrial disease. Finally, a biallelic polymerase-gamma (POLG) mutation was identified (c.2419C>T, c.695G>A). Standard brain and spine MRI scans were normal, but post-gadolinium MRI revealed diffuse cranial nerves and cauda equina nerve root enhancement (Figure 1), unusually found in POLG mutation.(1,2)

INTRODUCTION:Description of neurological complications induced by intracranial hemangioma in infants and by the initiation of beta-blocker treatment (propranolol). OBSERVATION:A 2-month-old infant was referred for grade 5 non-congenital unilateral peripheral facial palsy. Work-up revealed ipsilateral profound hearing loss and two intracranial hemangiomas: one in the ipsilateral internal auditory canal (IAC), the other in the cerebellum opposite the nodule of vermis. Initial treatment with a beta-blocker (propranolol 1mg/kg/day for 1month, then 3mg/kg/day) resulted in disappearance of symptoms and regression of lesions within 8weeks. At 20months after introduction of maintenance therapy (propranolol 3mg/kg/day), two asthma attacks occurred, leading to initiation of fluticasone and continuation of the beta-blocker. Thirty months after discontinuation of treatment, no further progression was noted. DISCUSSION:Unilateral facial palsy in an infant suggests a number of diagnoses. MRI revealed IAC hemangioma. The choice of dosage and duration of treatment was based on a review of the literature and a strategy defined in multidisciplinary consultation.

OBJECTIVENon-echo-planar diffusion-weighted (DW) magnetic resonance imaging (non-EPI MRI) is the appropriate sequence to detect residual cholesteatoma. In the child, MRI may be clinically useful to determine the timing of the second-look procedure. The aim of this paper was to retrospectively evaluate the performance of early MRI (before the 18th postoperative month) in detecting residual cholesteatoma in children after review by experienced specialized neuroradiologists.STUDY DESIGNRetrospective study.SETTINGOne university center comparative cohort.METHODSAll patients who had a 2-staged procedure for cholesteatoma with an MRI before the second stage from 2010 to 2020 were included and analyzed. Three pediatric neuroradiologists reviewed all the images blinded to the surgical result.RESULTSN = 141 cholesteatoma events (140 children) were included with a mean age at MRI of 10 (±4) years old. Non-EPI MRIs were performed 10.7 (±3.8) months after the first-stage surgery and 2.2 (±2.6) months before the second-stage procedure. Non-EPI MRI had a 0.57 sensitivity (SE) and 0.83 specificity (SP). MRI was reviewed in 112 cases. The diagnosis was corrected in 17 cases (15.1%) (3 true positives, 7 false negatives, and 7 false positives). SE = 0.63 (p = 0.1) and SP = 0.92 (p = 0.08) after rereading.CONCLUSIONEarly MRI's SE is poor but SP is excellent after rereading. Evidence does not support the use of early non-EPI MRI to modify the surgical strategy or to postpone the second look. If performed, early non-EPI MRI should be read by specialized experienced radiologists with all 3 sequences (T1, T2, and non-EPI DW) and apparent diffusion coefficient calculation, especially in cases of otitis media with effusion.

PurposeClinical and radiological assessment of endoscopic third ventriculocisternostomy (ETV) patency can be challenging in children. The objective of our study was thus to test the accuracy and interrater reliability of 3D fast-spin echo (FSE) T2-weighted sequences to assess the patency of ETV.MethodsWe included all the consecutive children who underwent surgery for ETV over a two-year period and selected the children who presented ETV dysfunction and matched them with children without dysfunction. We evaluated the Kappa interrater reliability of three experienced physicians for prediction of ETV patency using solely the flow void sign in 3D FSE T2-weighted sequences.ResultsNineteen children underwent surgery for ETV dysfunction and 12 children without dysfunction were matched. Sensitivity was 0.79, 0.89 and 0.84 and specificity was 1 for all raters. None of the patent ETV was wrongly considered to be dysfunctional. Fleiss' kappa was 0.871 (p < 0.001). The interrater reliability was excellent with respect to the patency or not of the ETV.ConclusionFSE T2-weighted sequence is a simple and reproducible tool that can be widely used in daily practice to assess the patency of ETV. Interrater reliability of this sequence is high and accessibility in outpatient setting is acceptable.

OBJECTIVE To evaluate the accuracy, sensitivity, and specificity of nonecho planar (non-EPI) diffusion-weighted (DW) magnetic resonance imaging (MRI) to detect residual cholesteatoma in children. STUDY DESIGN Retrospective study. SETTING Tertiary comprehensive hospital. METHODS Children operated on for a first-stage cholesteatoma procedure from 2010 to 2019 were included. MRIs were performed with non-EPI DW sequences. Initial reports were collected, indicating the presence or absence of hyperintensity suggestive of cholesteatoma. Three hundred twenty-three MRIs were correlated with the subsequent surgery (66%) or year-later MRI (21%), or were considered accurate if performed 5 years or more after the last surgery (13%). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of each imaging procedure for the detection of cholesteatoma were calculated. RESULTS Two hundred twenty-four children with mean age of 9 ± 4 years old presented with cholesteatoma. MRIs were performed 27 ± 24 months after surgery. Residual cholesteatoma was diagnosed in 35%. The sensitivity, specificity, PPV, and NPV of MRI were 62%, 86%, 74%, and 78%, respectively. Accuracy, sensitivity, and specificity increased significantly over time (multivariate analysis). The mean delay after last surgery was of 30 ± 2.0 months for accurate MRI (true positive or negative) versus 17 ± 2.0 months for nonaccurate (false positive or negative) MRIs (p < .001). CONCLUSION However, long the delay after the last surgery, the sensitivity of non-EPI diffusion sequence MRI in children has limitations for the detection of residual cholesteatoma. Surveillance for residual cholesteatoma should incorporate findings at primary surgery, surgeon experience, a low threshold for second-look procedures, and routine imaging.

Hemophagocytic lymphohistiocytosis (HLH) is a rare and life-threatening condition affecting young children. It is potentially triggered by Epstein-Barr virus (EBV). This study describes the neuroradiological features observed in 75 children with genetically confirmed primary HLH, comparing EBV-induced with non-EBV-induced HLH forms. Brain MRIs between 2007 and 2021 from 75 children with HLH according to the 2004 Histiocyte Society criteria and with a confirmed HLH-related mutation, were retrospectively reviewed by two pediatric neuroradiologists blinded to EBV status and to mutation status. At diagnosis, 17 children with EBV viremia above a threshold of 1000 copies/mL were included in the EBV-induced HLH group. The remaining 58 patients were included in the non-EBV-induced HLH group. Of the 75 children initially included, 21 had abnormal MRI (21/75 (28 • In children with genetically proven HLH, only those with neurological signs did have brain abnormalities at MRI. • All patients with abnormal brain MRI had multiple white matter lesions with increased ADC values, including in the posterior fossa in almost all cases. • Basal ganglia and in particular the striatum were bilaterally and symmetrically affected in almost all EBV-induced HLH patients, in contrast to the non-EBV-induced HLH patients.

CHARGE syndrome, due to CHD7 pathogenic variations, is an autosomal dominant disorder characterized by a large spectrum of severity. Despite the great number of variations reported, no clear genotype-to-phenotype correlation has been reported. Unsupervised machine learning and clustering was undertaken using a retrospective cohort of 42 patients, after deep radiologic and clinical phenotyping, to establish genotype-phenotype correlation for CHD7-related CHARGE syndrome. It resulted in three clusters showing phenotypes of different severities. While no clear genotype-phenotype correlation appeared within the first two clusters, a single patient was outlying the cohort data (cluster 3) with the most atypical phenotype and the most distal frameshift variant in the gene. We added two other patients with similar distal pathogenic variants and observed a tendency toward mild and/or atypical phenotypes. We hypothesized that this finding could potentially be related to escaping nonsense mediated RNA decay, but found no evidence of such decay in vivo for any of the CHD7 pathogenic variation tested. This indicates that this milder phenotype may rather result from the production of a protein retaining all functional domains.

OBJECTIVE:Distinguishing tumor recurrence from therapy-induced imaging changes (TIIC) on brain MRI in children treated for primary malignant brain tumors may be challenging. The authors aimed to assess the diagnostic ability of multimodal MRI in differentiating TIIC from tumor recurrence.METHODS:The authors retrospectively included children with abnormal supratentorial brain MRI findings after treatment for primary malignant brain tumors (regardless of their localization) with complete resection and radiotherapy. A total of 18 patients with TIIC and 25 patients with tumor recurrence were compared, according to structural, apparent diffusion coefficient (ADC), and arterial spin labeling (ASL) imaging data accrued over time. TIIC were defined by a new MRI scan that was stable for at least 1 year or had regressed, or by histopathology findings in specimens obtained when the anomaly was surgically treated.RESULTS:The time interval between completion of radiotherapy and the appearance of abnormal brain MRI findings was significantly shorter in the TIIC group compared with the tumor recurrence group (median 6 vs 35 months; p < 0.001). TIIC appeared as foci of increased T2-weighted signal intensity, without nodule, associated with variable contrast enhancement. Tumor recurrence appeared as a well-defined nodule with intermediate signal intensity on T2-weighted images with nodular contrast enhancement. Relative ADC values were significantly higher in the TIIC group (median 1.43 vs 0.88; p < 0.001). Relative ASL-cerebral blood flow (CBF) values were significantly lower in the TIIC group (median 0.27 vs 0.43; p = 0.04). On follow-up MRI, TIIC could progress, regress, or remain stable. In most instances (72%), they decreased in size or remained stable at 4 years of follow-up.CONCLUSIONS:MRI features of TIIC include foci of increased signal intensity without a demonstrable nodule on T2-weighted images, high ADC values, and lower ASL-CBF values, whereas tumor recurrence appears as a well-defined nodule with low ADC values and higher ASL-CBF values.

Zolpidem is a sedative drug that has been shown to induce a paradoxical effect, restoring brain function in wide range of neurological disorders. The underlying functional mechanism of the effect of zolpidem in the brain in clinical improvement is still poorly understood. Thus, we aimed to investigate rest brain function to study zolpidem-induced symptom improvement in a patient who developed postoperative pediatric cerebellar mutism syndrome, a postoperative complication characterized by delayed onset transient mutism/reduced speech that can occur after medulloblastoma resection. The patient experienced clinical recovery after a single dose of zolpidem. Brain function was investigated using arterial spin labeling MRI and resting-state functional MRI. Imaging was performed at three time-points: preoperative, postoperative during symptoms, and after zolpidem intake when the symptoms regressed. Whole brain rest cerebral blood flow (CBF) and resting state functional connectivity using Pearson coefficient correlations between pairs of regions of interest were investigated two-by-two at the different time points. A comparison between postoperative and preoperative images showed a significant decrease in rest CBF in the left supplementary motor area, Broca’s area, and the left striatum and a decrease in functional connectivity within the dentato-thalamo-cortical and cortico-striato-pallido-thalamo-cortical loops. Post-zolpidem images showed increased CBF in the left striatum and increased functional connectivity within the disrupted loops relative to postoperative images. Thus, we observed functional changes within the broader speech network and thalamo-subcortical interactions associated with the paradoxical effect of zolpidem in promoting clinical recovery. This should encourage further functional investigations in the brain to better understand the mechanism of zolpidem in neurological recovery.

Les enfants atteints d'un syndrome de déficience constitutionnelle des gènes MMR (CMMRD) sont porteurs d'une mutation bi-allélique des gènes MMR entraînant un très haut risque de gliome de haut grade. D'autres anomalies neuroradiologiques ont été rapportées chez ces enfants. Notre étude avait pour but d'analyser les IRM cérébrales d'enfants porteurs d'un syndrome CMMRD et de les comparer à celles d'enfants atteints de gliomes de haut grade sans syndrome CMMRD. Nous avons analysé rétrospectivement les IRM cérébrales de 29 enfants CMMRD, dont 20 avaient un gliome de haut grade. Nous avons comparé leurs caractéristiques en imagerie avec celles d'autres enfants porteurs de gliome de haut grade, dont 7 atteints d'un syndrome de Lynch (mutation mono-allélique des gènes MMR) et 51 enfants sans mutation du système MMR. Tous les patients CMMRD avaient au moins une anomalie veineuse de développement (AVD) (29/29, 100%) alors qu'elles n’étaient présentes que chez un patient Lynch (1/7, 14%) et chez 3 enfants sans anomalie du système MMR (3/51, 6%) (p<0,001). Des AVD multiples (minimum 3) étaient retrouvées chez 71% des patients CMMRD et jamais dans les autres groupes. Des cavernomes (avant radiothérapie) n’étaient également présents que chez les patients CMMRD (30% des cas versus 0%, p=0,003). Les tumeurs étaient plus fréquemment de localisation périphérique chez les patients CMMRD et Lynch par rapport aux MMR non mutés (90% et 86%, versus 55%, p=0,009). Des hypersignaux FLAIR non reliés à la tumeur étaient plus fréquents chez les patients CMMRD (75% versus 43% et 24%, p=0,0001), notamment quand ces hypersignaux avaient des caractéristiques des objets brillants non identifiés (OBNI) associés à la neurofibromatose de type 1 (30% versus 14% et 2%, p=0,002). Des tumeurs gliales de haut grade, de localisation périphérique, associées à des AVD, cavernomes et OBNI like, sont très évocatrices de syndrome CMMRD.

Posterior fossa ependymoma group A (EPN_PFA) and group B (EPN_PFB) can be distinguished by their DNA methylation and give rise to different prognoses. We compared the MRI characteristics of EPN_PFA and EPN_PFB at presentation. Preoperative imaging of 68 patients with posterior fossa ependymoma from two centers was reviewed by three independent readers, blinded for histomolecular grouping. Location, tumor extension, tumor volume, hydrocephalus, calcifications, tissue component, enhancement or diffusion signal, and histopathological data (cellular density, calcifications, necrosis, mitoses, vascularization, and microvascular proliferation) were compared between the groups. Categorical data were compared between groups using Fisher’s exact tests, and quantitative data using Mann–Whitney tests. We performed a Benjamini–Hochberg correction of the p values to account for multiple tests. Fifty-six patients were categorized as EPN_PFA and 12 as EPN_PFB, with median ages of 2 and 20 years, respectively (p = 0.0008). The median EPN_PFA tumoral volume was larger (57 vs 29 cm3, p = 0.003), with more pronounced hydrocephalus (p = 0.002). EPN_PFA showed an exclusive central position within the 4th ventricle in 61

Les épendymomes de la fosse postérieure de groupe A(EPN_PFA) et de groupe B(EPN_PFB) peuvent être distingués par leur méthylation de l'ADN et ont des pronostics différents. Nous avons comparé les caractéristiques IRM au diagnostic des EPN_PFA et EPN_PFB. L'imagerie préopératoire de 68 patients atteints d'épendymome de fosse postérieure a été examinée, en aveugle du groupement histomoléculaire. La localisation, le volume tumoral, les calcifications, la composante tissulaire, le rehaussement ou la diffusion, et les données histopathologiques ont été comparés entre les groupes. Cinquante-six patients ont été classés comme EPN_PFA et 12 comme EPN_PFB, avec des âges médians de 2 et 20 ans, respectivement (p=0,0008). Le volume tumoral médian de l'EPN_PFA était plus important (57 vs 29 cm3, p =0,003). L'EPN_PFA a montré une position centrale exclusive dans le 4ème ventricule chez 61% des patients vs 92% pour l'EPN_PFB(p=0.047). Des calcifications intratumorales ont été trouvées dans 93% des EPN_PFA vs 40% des EPN_PFB (p=0.001). L'invasion des foramens de la fosse postérieure était principalement trouvée pour l'EPN_PFA, en particulier le foramen de Luschka (p=0.0008). L'EPN_PFA présentait un rehaussement tumoral entier et homogène dans 5 % des cas contre 75 % des EPN_PFB (p=0,0008). Toutes les tumeurs principalement kystiques étaient des EPN_PFB (p=0,002). L'ADC relatif minimal et maximal était légèrement inférieur dans l'EPN_PFA (p=0,02 et p=0,01, respectivement). Les caractéristiques morphologiques en imagerie permettent de distinguer les sous-types d'épendymomes de la fosse postérieure. Une masse calcifiée tissulaire médiane ou latérale, à rehaussement incomplet, touchant les jeunes enfants et responsable d'une hydrocéphalie prononcée et d'un envahissement des foramens de la fosse postérieure suggère le groupe EPN_PFA. A l'inverse, une masse non calcifiée médiane d'adolescents et d'adultes, à prédominance kystique, et peu invasive, avec un rehaussement total et homogène, suggère le groupe EPN_PFB.

OBJECTIVE Epidural hematoma (EDH) has rarely been studied specifically in infants. The objective of this study was to investigate the outcomes of patients aged < 18 months (infants) with EDH. METHODS The authors conducted a single-center retrospective study of 48 infants aged less than 18 months who underwent an operation for a supratentorial EDH in the last decade. Clinical, radiological, and biological variables were used in a statistical analysis to identify factors predictive of radiological and clinical outcome. RESULTS Forty-seven patients were included in the final analysis. Seventeen children (36%) had cerebral ischemia on postoperative imaging, either due to stroke (cerebral herniation) or by local compression. Factors associated with ischemia after multivariate logistic regression were the presence of an initial neurological deficit (76% vs 27%, p = 0.03), low platelet count (mean 192 vs 267 per mm3, p = 0.01), low fibrinogen level (mean 1.4 vs 2.2 g/L, p = 0.04) and long intubation time (mean 65.7 vs 10.1 hours, p = 0.03). Cerebral ischemia on MRI was predictive of a poor clinical outcome. CONCLUSIONS Infants with EDH have a low mortality rate but a high risk of cerebral ischemia, along with long-term neurological sequelae.

La lymphohistiocytose hémophagocytaire (LHH) est une affection rare et potentiellement mortelle qui touche les jeunes enfants. Elle est potentiellement déclenchée par le virus d'Epstein-Barr (EBV). Cette étude décrit les caractéristiques neuroradiologiques observées chez 75 enfants atteints de LHH primaire génétiquement confirmée, en comparant les formes de HLH induites par l'EBV et celles non induites par l'EBV. Les IRM cérébrales réalisées entre 2007 et 2021 chez 75 enfants atteints de HLH selon les critères de la Histiocyte Society de 2004 et présentant une mutation liée à la LHH, ont été examinées rétrospectivement par deux neuroradiologues pédiatriques en aveugle du statut EBV et du statut de la mutation. Au moment du diagnostic, 17 enfants présentant une virémie EBV supérieure à un seuil de 1000 copies/ml ont été inclus dans le groupe HLH induite par l'EBV, et les 58 autres patients ont été inclus dans le groupe HLH non induite par l'EBV. Sur les 75 enfants initialement inclus, 21 avaient une IRM anormale (21/75 (28%); 9/17 dans le groupe LHH induite par l'EBV et 12/58 dans le groupe LHH non induite par l'EBV). Tous les patients présentant une IRM anormale avaient des symptômes neurologiques. Les IRM anormales ont montré des lésions de la substance blanche dans 100% des cas, avec atteinte de la fosse postérieure dans 95% des cas. Il n'y avait pas de différence significative entre les groupes concernant la localisation ou la morphologie des lésions de la substance blanche. Le striatum était plus fréquemment touché dans le groupe LHH induite par l'EBV (8/9 (89 %) contre 1/12 (8 %), p = 0,00037). Toutes les lésions (substance blanche et noyaux gris centraux) présentaient des valeurs ADC augmentées. Dans cette étude portant sur 75 enfants atteints de HLH génétiquement confirmée, seuls les enfants présentant des signes neurologiques avaient une IRM cérébrale anormale. L'atteinte bilatérale du striatum a suggéré une forme de HLH induite par l'EBV.

BACKGROUND: Focal cortical dysplasia (FCD) causes drug-resistant epilepsy in children that can be cured surgically, but the lesions are often unseen by imaging. OBJECTIVE: To assess the efficiency of arterial spin labeling (ASL), voxel-based-morphometry (VBM), fMRI electroencephalography (EEG), resting-state regional homogeneity (ReHo), 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET), and their combination in detecting pediatric FCD. METHODS: We prospectively included 10 children for whom FCD was localized by surgical resection. They underwent 3T MR acquisition with concurrent EEG, including ASL perfusion, resting-state BOLD fMRI (allowing the processing of EEG-fMRI and ReHo), 3D T1-weighted images processed using VBM, and FDG PET-CT coregistered with MRI. Detection was assessed visually and by comparison with healthy controls (for ASL and VBM). RESULTS: Eight children had normal MRI, and 2 had asymmetric sulci. Using MR techniques, FCD was accurately detected by ASL for 6/10, VBM for 5/10, EEG-fMRI for 5/8 (excluding 2 with uninterpretable results), and ReHo for 4/10 patients. The combination of ASL, VBM, and ReHo allowed correct FCD detection for 9/10 patients. FDG PET alone showed higher accuracy than the other techniques (7/9), and its combination with VBM allowed correct FCD detection for 8/9 patients. The detection efficiency was better for patients with asymmetric sulci (2/2 for all techniques), but advanced MR techniques and PET were useful for MR-negative patients (7/8). CONCLUSION: A combination of multiple imaging techniques, including PET, ASL, and VBM analysis of T1-weighted images, is effective in detecting subtle FCD in children.