Diagnostic usefulness of arterial spin labeling in MR negative children with new onset seizures

Abstract

A B S T R A C TPurpose: Arterial spine labeling (ASL) magnetic resonance imaging (MRI) is the non-invasive measurement of cerebral blood flow that can localize the seizure focus in patients with epilepsy. The aim of this study was to identify its utility for localizing the seizure focus in children with no structural lesion on MRI. Methods: Forty-three consecutive children who underwent electroencephalography (EEG) and structural MRI, along with ASL for evaluation of newly developed seizures, were included. ASL abnormalities were classified as hypo/hyperperfusion, based on visual assessment, and compared with the seizure focus determined by clinical information and EEG. Results: Among the 43 patients (M 17: F 26, mean age, 6.3 ± 3.3 years), the seizure type was focal in 36 patients and generalized in seven patients. Twenty-five (58.1%) patients showed perfusion change. Out of 36 patients with focal seizure, 24 (66.7%) showed ASL abnormalities, and 19 (52.8%) showed concordance between ASL and clinical focus. Out of seven patients with generalized seizure, only one patient showed ASL abnormalities. The overall concordance revealed moderate agreement (k = 0.542). ASL acquisition within one day from seizure onset was the only significant associating factor with the concordance between the two (p = 0. 014). Conclusion: To our knowledge, this is the first study to assess the usefulness of ASL MRI to assist in localizing the seizure focus in MR-negative children with new onset seizures. The combined use of ASL with EEG and structural MRI may play an important role in the evaluation of pediatric epilepsy.

Automated fusion of multimodal imaging data for identifying epileptogenic lesions in patients with inconclusive magnetic resonance imaging

“…The C2 class comprises voxels where patients had gray matter loss, decreased perfusion, hypometabolism, higher perfusion in ictal state compared to interictal state, decrease of barriers for water diffusion, and enhanced water diffusion. This is in accordance with previous findings: the GMV loss was shown especially in temporal‐lobe patients with HS (Bernhardt, Hong, Bernasconi, & Bernasconi, 2015); decreased perfusion was reported in children (Lee et al, 2019); the hypometabolism seen in PET and interictal/ictal‐specific perfusion assessed by SPECT are well‐known markers of epileptogenic tissue (Krsek et al, 2013; Rathore, Dickson, Teotonio, Ell, & Duncan, 2014); and microstructure abnormalities in epileptogenic tissue identified by diffusivity metrics were reported to be sensitive to FCD (Feindel, 2013; Winston et al, 2020). The C4 class is similar to that of C2.…”

“…We used arterial spin labeling (ASL), which quantifies cerebral blood flow (Boscolo Galazzo et al, 2015) and has a potential to reveal perfusion abnormalities in patients with focal seizures (Lee, Kwon, & Lee, 2019).…”

Clinical utility of arterial spin labeling imaging in disorders of the nervous system

“…Pediatric patients with acute seizures and no abnormalities on structural MRI were studied with ASL and EEG. The study by Lee et al 23 showed concordance (kappa = 0.542) between ASL findings and clinical seizure focus. Therefore, ASL may have a role in evaluating epilepsy in the setting of normal structural MRI.…”

Recent developments in imaging of epilepsy

“…ASL perfusion revealed areas of focal hyperperfusion that corresponded to the presumed seizure onset zone in newborns [34] and in children who presented with a first seizure and normal MRI [35 ▪ ]. Perfusion changes were detected in 58% of children (focal in 36 and generalized in seven patients) with an overlapping area between the TPMA and the suspected seizure onset zone in 76%.…”