Perfusion-CT imaging in epileptic seizures

Strambo, Davide; Rey, V.; Rossetti, Andrea O.; Maeder, P.; Dunet, Vincent; Browaeys, P.; Michel, Patrik

doi:10.1007/s00415-018-9095-1

Cited by 32 publications

(33 citation statements)

References 29 publications

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“…In the present study, we exclusively included SE patients undergoing a dedicated PCT examination to analyze the perfusion changes occurring during the episode, and we found that almost 80% showed PCT abnormalities. The perfusion changes seen in our patients were similar to those usually described for focal‐onset seizures and SE; that is, cortical involvement with relative preservation of the underlying white matter . These findings are in line with those of previous studies reporting PCT evidence of MTT shortening and increases in flow and volume maps (rCBF and rCBV), consistent with a focal hyperemic state …”

Section: Discussionsupporting

confidence: 91%

“…Previous studies focusing on the usefulness of PCT in SE are mainly retrospective and involve patients who underwent this examination for suspected stroke, but were ultimately diagnosed with SE . To our knowledge, there is only one available prospective study that aimed to differentiate between the perfusion patterns of strokes and seizures based on a prompt PCT study.…”

Section: Discussionmentioning

confidence: 99%

“…[10][11][12] Previous studies focusing on the usefulness of PCT in SE are mainly retrospective and involve patients who underwent this examination for suspected stroke, but were ultimately diagnosed with SE. 14,15,[19][20][21][22] To our knowledge, there is only one available prospective study that aimed to differentiate between the perfusion patterns of strokes and seizures based on a prompt PCT study. The authors reported differences in F I G U R E 3 Comparison of PCT examinations in control group between the affected cortical region and unaffected contralateral region shows significantly decreased rCBF and rCBV in the affected hemispheres.…”

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…On visual inspection of the raw PCT images, hyperperfusion was defined as an increase in the rCBF and a decrease in the TTP and MTT in the maps, whereas hypoperfusion was defined as focally decreased rCBF and increased TTP and MTT relative to the healthy side (defined based on clinical and EEG criteria). 19,20 In nine patients, following SE resolution and in the absence of seizures for at least 24 hours, a follow-up PCT was performed within 90 days. The initial and follow-up data underwent comparative visual and quantitative analysis.…”

Section: Neuroimaging Protocolmentioning

confidence: 99%

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Usefulness of brain perfusion CT in focal‐onset status epilepticus

et al. 2019

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Objective To evaluate the perfusion computed tomography (PCT) patterns in patients with status epilepticus (SE). Methods We included consecutive SE patients, diagnosed by ictal encephalography (EEG) findings and clinical semiology, who prospectively underwent a dedicated PCT study of SE in the ictal phase. The perfusion maps were visually analyzed. For the quantitative assessment, regions of interest in areas where the maps suggested abnormalities were compared with the corresponding area in the unaffected contralateral cortex. Asymmetry indices between affected and unaffected hemispheres were calculated for the regional cerebral blood flow (rCBF), regional cerebral blood volume (rCBV), time to peak (TTP), and mean transit time (MTT). Nine patients underwent a follow‐up PCT after SE resolution, and the corresponding maps were compared to the ictal maps. In addition, we included a control group of 10 sex‐ and age‐matched patients with SE mimics or postictal phenomena, who also underwent acute PCT during the study period. Results The study included 19 patients: mean age 69.47 ± (standard deviation) 15.9 years, 68.4% men. On visual analysis of parametric perfusion maps during the ictal phase, regional cortical hyperperfusion was depicted in 78.9% of patients. Quantitative analysis showed significantly increased rCBF (P = 0.002) and rCBV (P = 0.004) values and decreased TTP (P < 0.001) and MTT (P = 0.001) in cortical areas of the affected vs the unaffected side. The mean asymmetry index was 12.8 for rCBF, 13.7 for rCBV, −3.0 for TTP, and −3.7 for MMT. In the nine patients with a follow‐up PCT, eight showed decreased intensity, rCBV (P = 0.035), and rCBF (P = 0.024) in the hyperperfusion areas. The sensitivity of hyperperfusion detection for the diagnosis of SE was 78.95%, specificity 90%, positive predictive value 93.75%, and negative predictive value 69.23%. Comparative quantitative analysis of asymmetry indices for rCBF, rCBV, and MTT between ictal PCT and control patients showed significant differences for all parameters (rCBF P = 0.001; rCBV P = 0.002; TTP P = 0.001; and MTT P = 0.001). Significance Visual and quantitative analysis of perfusion maps detects regional hyperperfusion in SE patients with good diagnostic capability. Perfusion was increased in PCT maps of the affected cerebral hemisphere as compared to the contralateral region during the ictal phase. PCT may provide valuable diagnostic information in patients with SE and complement the diagnostic value of EEG.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Neuroimaging Protocolmentioning

confidence: 99%

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Usefulness of brain perfusion CT in focal‐onset status epilepticus

et al. 2019

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Imaging of Stroke Mimics

Tang

2020

Atlas of Emergency Neurovascular Imaging

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Epileptic seizures in the emergency room: clinical and electroencephalographic findings associated with brain perfusion patterns on computed tomography

et al. 2022

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Background Diagnosis of epileptic seizures, particularly regarding status epilepticus (SE), may be challenging in an emergency room setting. The aim of the study was to study the diagnostic yield of perfusion computed tomography (pCT) in patients with single epileptic seizures and SE. Methods We retrospectively reviewed the records of patients who followed an acute ischemic stroke pathway during a 9-month period and who were finally diagnosed with a single epileptic seizure or SE. Perfusion maps were visually analyzed for the presence of hyperperfusion and hypoperfusion. Clinical data, EEG patterns, and neuroimaging findings were compared. ResultsWe included 47 patients: 20 (42.5%) with SE and 27 (57.5%) with single epileptic seizure. Of 18 patients who showed hyperperfusion on pCT, 12 were ultimately diagnosed with SE and eight had EEG findings compatible with an SE pattern. Focal hyperperfusion on pCT had a sensitivity of 60% (95% CI 36.4-80.2) and a specificity of 77.8% (95% CI 57.2-90.6) for predicting a final diagnosis of SE. The presence of cerebral cortical and thalamic hyperperfusion had a high specificity for predicting SE presence. Of note, 96% of patients without hyperperfusion on pCT did not show an SE pattern on early EEG. Conclusions In acute settings, detection by visual analysis of focal cerebral cortical hyperperfusion on pCT in patients with epileptic seizures, especially if accompanied by the highly specific feature of thalamic hyperperfusion, is suggestive of a diagnosis of SE and requires clinical and EEG confirmation. The absence of focal hyperperfusion makes a diagnosis of SE unlikely.

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Perfusion-CT imaging in epileptic seizures

Cited by 32 publications

References 29 publications

Usefulness of brain perfusion CT in focal‐onset status epilepticus

Usefulness of brain perfusion CT in focal‐onset status epilepticus

Imaging of Stroke Mimics

Epileptic seizures in the emergency room: clinical and electroencephalographic findings associated with brain perfusion patterns on computed tomography

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