A Sierra-Marcos1, M Carreño1, X Setoain2,3, A López-Rueda2, J Aparicio1, A Donaire1, N Bargalló2,4. 1. Institute of Neurosciences, Hospital Clinic, Barcelona, Spain. 2. Image Diagnosis Center, Hospital Clinic, Barcelona, Spain. 3. Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Barcelona, Spain. 4. Medical Image Core Facility, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.
Abstract
BACKGROUND AND PURPOSE: Locating the epileptogenic zone (EZ) in patients with neocortical epilepsy presents major challenges. Our aim was to assess the accuracy of arterial spin labeling (ASL), an emerging non-invasive magnetic resonance imaging (MRI) perfusion technique, to locate the EZ in patients with drug-resistant neocortical epilepsy. METHODS: Twenty-five consecutive patients with neocortical epilepsy referred to our epilepsy unit for pre-surgical evaluation underwent a standardized assessment including video-electroencephalography (EEG) monitoring, structural MRI, subtraction ictal single-photon emission computed tomography co-registered to MRI (SISCOM) and fluorodeoxyglucose positron emission tomography (FDG-PET) studies. An ASL sequence was included in the MRI studies. Areas of hypoperfusion or hyperperfusion on ASL were classified into 15 anatomic-functional cortical regions; these regional cerebral blood flow maps were compared with the EZ determined by the other tests and the strength of concordance was assessed with the kappa coefficient. RESULTS: Of the 25 patients [16 (64%) women; mean age 32.4 (±13.8) years], 18 (72%) had lesions on structural MRI. ASL abnormalities were seen in 15 (60%) patients (nine hypoperfusion, six hyperperfusion). ASL had a very good concordance with FDG-PET (k = 0.84), a good concordance with structural MRI (k = 0.76), a moderate concordance with video-EEG monitoring (k = 0.53) and a fair concordance with SISCOM (k = 0.28). CONCLUSION: Arterial spin labeling might help to confirm the location and extent of the EZ in the pre-surgical workup of patients with drug-resistant neocortical epilepsy.
BACKGROUND AND PURPOSE: Locating the epileptogenic zone (EZ) in patients with neocortical epilepsy presents major challenges. Our aim was to assess the accuracy of arterial spin labeling (ASL), an emerging non-invasive magnetic resonance imaging (MRI) perfusion technique, to locate the EZ in patients with drug-resistant neocortical epilepsy. METHODS: Twenty-five consecutive patients with neocortical epilepsy referred to our epilepsy unit for pre-surgical evaluation underwent a standardized assessment including video-electroencephalography (EEG) monitoring, structural MRI, subtraction ictal single-photon emission computed tomography co-registered to MRI (SISCOM) and fluorodeoxyglucose positron emission tomography (FDG-PET) studies. An ASL sequence was included in the MRI studies. Areas of hypoperfusion or hyperperfusion on ASL were classified into 15 anatomic-functional cortical regions; these regional cerebral blood flow maps were compared with the EZ determined by the other tests and the strength of concordance was assessed with the kappa coefficient. RESULTS: Of the 25 patients [16 (64%) women; mean age 32.4 (±13.8) years], 18 (72%) had lesions on structural MRI. ASL abnormalities were seen in 15 (60%) patients (nine hypoperfusion, six hyperperfusion). ASL had a very good concordance with FDG-PET (k = 0.84), a good concordance with structural MRI (k = 0.76), a moderate concordance with video-EEG monitoring (k = 0.53) and a fair concordance with SISCOM (k = 0.28). CONCLUSION: Arterial spin labeling might help to confirm the location and extent of the EZ in the pre-surgical workup of patients with drug-resistant neocortical epilepsy.
Authors: Liesbeth De Coster; Koen Van Laere; Evy Cleeren; Kristof Baete; Patrick Dupont; Wim Van Paesschen; Karolien E Goffin Journal: EJNMMI Res Date: 2018-04-17 Impact factor: 3.138
Authors: Ilaria Boscolo Galazzo; Maria Vittoria Mattoli; Francesca Benedetta Pizzini; Enrico De Vita; Anna Barnes; John S Duncan; Hans Rolf Jäger; Xavier Golay; Jamshed B Bomanji; Matthias Koepp; Ashley M Groves; Francesco Fraioli Journal: Neuroimage Clin Date: 2016-04-12 Impact factor: 4.881
Authors: Oriol Puig; Otto M Henriksen; Mark B Vestergaard; Adam E Hansen; Flemming L Andersen; Claes N Ladefoged; Egill Rostrup; Henrik Bw Larsson; Ulrich Lindberg; Ian Law Journal: J Cereb Blood Flow Metab Date: 2019-09-09 Impact factor: 6.200