Longitudinal Findings of MRI and PET in West Syndrome with Subtle Focal Cortical Dysplasia

MR imaging and PET findings of 4 patients. Longitudinal findings of T2-weighted MR imaging and PET of patient 1 (upper row, A–E), patient 2 (second row, F–I), patient 3 (third row, J–N), and patient 4 (lower row, O–S). Patient 1: note a focal hyperintense lesion in the subcortical white matter of the left frontal lobe on axial MR imaging at onset (arrow, A). PET hypometabolism is seen in the left frontotemporal lobe at 11 months of age (arrows, B), in the right frontotemporal lobe at 24 months of age (arrows, C), and in the left frontal lobe at 36 months of age (arrow, D). PET at 24 months of age also shows possible hypermetabolism in the left temporal lobe (arrowheads, C). A coregistered coronal image of PET on MR imaging at 36 months of age shows hypometabolism in the left orbitofrontal area that corresponds to the MR imaging lesion (arrow, E). Patient 2: a hyperintense area in the subcortical white matter of the left frontal lobe on axial MR imaging at onset (arrow, F). Multifocal hypometabolism in the frontal and temporal lobes is seen on PET at onset (arrows, G) that disappears at 24 months of age (H). No PET hypometabolism at 24 months of age (H) is seen. Hypometabolism in the left frontal lobe corresponds to the MR imaging lesion on a coronal MR imaging–PET coregistration image (arrows, I). Patient 3: normal MR imaging findings at onset (J). Hyperintense subcortical white matter is seen in the right precentral area on MR imaging at 12 months of age (arrow, K). Left parietotemporal hypometabolism and right frontal hypermetabolism on PET is seen at onset (arrow, L). Right frontal hypermetabolism disappears at 12 months of age (M). Left temporal hypometabolism is seen on PET at 24 months of age, whereas MR imaging shows no abnormality (arrow, N). Patient 4: both MR imaging (O) and PET (Q) findings are normal at onset. A hyperintense area in the right orbitofrontal white matter is seen on axial MR imaging at 24 months of age (arrow, P). Hypometabolism in the right orbitofrontal lobe corresponds to the MR imaging lesion (arrow, R and S) and is seen in the left temporal lobe on PET (arrows, R).