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. 2015 May 19;84(20):2021–2028. doi: 10.1212/WNL.0000000000001591

Figure 3. Coregistered PET and MRI of a right frontal BOSD.

Figure 3

Coregistered coronal FDG-PET and T1-weighted MRI scans (A) through the right frontal lobe in a 10-year-old boy with versive seizures and right frontal epileptiform activity on scalp EEG showing localized cortical hypometabolism in the right inferior frontal sulcus. Magnified coronal FLAIR (B) and T2-weighted (C) MRI scans at 3.0 tesla with a 32-channel head coil showing subtle thickening of cortex with blurring of gray–white junction (thick arrow) and faint subcortical signal hyperintensity (hatched arrow) in the bottom of the hypometabolic sulcus, but no “transmantle sign.” The BOSD was not detected on this MRI scan until after coregistration with the PET scan and recognition that there was thickened gray matter deeper than the apparent depth of the hypometabolic sulcus on the PET scan, being more hypometabolic than the sulcal banks. Focal cortical dysplasia type 2B pathology was identified at the depth of the resected sulcus. BOSD = bottom-of-sulcus dysplasia; FDG = fluorodeoxyglucose; FLAIR = fluid-attenuated inversion recovery.