Perfusion Hyperintensities in Patients With Seizures: Evaluation With Arterial Spin Labeling Magnetic Resonance Imaging Within 24 Hours After Onset
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Purpose: We used arterial spin labeling (ASL) perfusion magnetic resonance (MR) imaging to evaluate cerebral perfusion abnormalities in patients with seizures within 24 hours of symptom onset. Materials and Methods: A retrospective search of our institutional database identified 27 patients who had undergone ASL perfusion studies for seizures or seizure-like symptoms. The inclusion criteria were as follows: 1) history of seizure, 2) MR examination performed within 24 hour of seizure onset, and 3) localized perfusion abnormality on ASL. We evaluated the presence, location, and extent of perfusion abnormalities on ASL and signal abnormalities on fluid-attenuated inversion recovery (FLAIR), diffusion-weighted image (DWI), and susceptibility-weighted image (SWI), respectively. All pathological MR findings, accompanying focal neurological symptoms, and electroencephalogram (EEG) findings were compared. Results: The mean time from symptom onset to MR examination was 5 h 54 min. All patients (n = 27) showed localized increased perfusion on ASL perfusion imaging. On FLAIR imaging, 20 patients (74.1%) showed hyperintensity in the area of perfusion abnormality. In 19 patients (70.4%), DWI showed hyperintensity of the lesion with decreased apparent diffusion coefficient value (ADC). Seven patients (25.9%) showed a focal parenchymal area of pseudo-narrowed cortical veins on SWI, associated with focal hyperperfusion. In 20 patients (74.1%), the extent of perfusion abnormalities on ASL was greater than that of signal abnormalities on FLAIR or DWI. In 14/16 patients (87.5%) with abnormal EEG findings, the area with EEG findings and the location of the hyperperfusion abnormality on ASL corresponded. Conclusion: In patients with seizures within 24 hours of symptom onset, ASL perfusion imaging revealed localized hyperperfusion, which was more frequent than signal intensity abnormalities on FLAIR or DWI. The locations of hyperperfusion areas correlated with EEG abnormalities. Thus, the ASL sequence may be a useful clinical assessment protocol for evaluating patients with seizures.
Abstract
Purpose: We used arterial spin labeling (ASL) perfusion magnetic resonance (MR) imaging to evaluate cerebral perfusion abnormalities in patients with seizures within 24 hours of symptom onset. Materials and Methods: A retrospective search of our institutional database identified 27 patients who had undergone ASL perfusion studies for seizures or seizure-like symptoms. The inclusion criteria were as follows: 1) history of seizure, 2) MR examination performed within 24 hour of seizure onset, and 3) localized perfusion abnormality on ASL. We evaluated the presence, location, and extent of perfusion abnormalities on ASL and signal abnormalities on fluid-attenuated inversion recovery (FLAIR), diffusion-weighted image (DWI), and susceptibility-weighted image (SWI), respectively. All pathological MR findings, accompanying focal neurological symptoms, and electroencephalogram (EEG) findings were compared. Results: The mean time from symptom onset to MR examination was 5 h 54 min. All patients (n = 27) showed localized increased perfusion on ASL perfusion imaging. On FLAIR imaging, 20 patients (74.1%) showed hyperintensity in the area of perfusion abnormality. In 19 patients (70.4%), DWI showed hyperintensity of the lesion with decreased apparent diffusion coefficient value (ADC). Seven patients (25.9%) showed a focal parenchymal area of pseudo-narrowed cortical veins on SWI, associated with focal hyperperfusion. In 20 patients (74.1%), the extent of perfusion abnormalities on ASL was greater than that of signal abnormalities on FLAIR or DWI. In 14/16 patients (87.5%) with abnormal EEG findings, the area with EEG findings and the location of the hyperperfusion abnormality on ASL corresponded. Conclusion: In patients with seizures within 24 hours of symptom onset, ASL perfusion imaging revealed localized hyperperfusion, which was more frequent than signal intensity abnormalities on FLAIR or DWI. The locations of hyperperfusion areas correlated with EEG abnormalities. Thus, the ASL sequence may be a useful clinical assessment protocol for evaluating patients with seizures.
참고문헌 (28)
- Annegers JF, "The treatment of epilepsy: principles and practice", pp.131~138 (2001), Lippincott Williams & Wilkins
- Wilden JA, "Evaluation of first nonfebrile seizures", Am Fam Physician, 86, pp.334~340 (2012)
- Cianfoni A, "Seizure-induced brain lesions : a wide spectrum of variably reversible MRI abnormalities", Eur J Radiol, 82, pp.1964~1972 (2013)
- Matsuura K, "Usefulness of arterial spin-labeling images in periictal state diagnosis of epilepsy", J Neurol Sci, 359, pp.424~429 (2015)
- Bauer G, "Transient and permanent magnetic resonance imaging abnormalities after complex partial status epilepticus", Epilepsy Behav, 8, pp.666~671 (2006)
- Buracchio T, "Restricted diffusion on magnetic resonance imaging in partial status epilepticus", Arch Neurol, 65, pp.278~279 (2008)
- Chu K, "Diffusion-weighted magnetic resonance imaging in nonconvulsive status epilepticus", Arch Neurol, 58, pp.993~998 (2001)
- Doherty MJ, "Clinical implications of splenium magnetic resonance imaging signal changes", Arch Neurol, 62, pp.433~437 (2005)
- Hormigo A, "Nonconvulsive status epilepticus in patients with cancer : imaging abnormalities", Arch Neurol, 61, pp.362~365 (2004)
- Oster J, "Diffusionweighted imaging abnormalities in the splenium after seizures", Epilepsia, 44, pp.852~854 (2003)
- Lansberg MG, "MRI abnormalities associated with partial status epilepticus", Neurology, 52, pp.1021~1027 (1999)
- Szabo K, "Diffusion-weighted and perfusion MRI demonstrates parenchymal changes in complex partial status epilepticus", Brain, 128(Pt 6), pp.1369~1376 (2005)
- Toledo M, "MRI findings in aphasic status epilepticus", Epilepsia, 49, pp.1465~1469 (2008)
- Aellen J, "Focal hemodynamic patterns of status epilepticus detected by susceptibility weighted imaging(SWI)", Eur Radiol, 24, pp.2980~2988 (2014)
- Shirozu N, "Comparison of pseudocontinuous arterial spin labeling perfusion MR images and timeof-flight MR angiography in the detection of periictal hyperperfusion", eNeurologicalSci, 19, pp.100233~ (2020)
- Bosque Varela P, "Imaging of status epilepticus : making the invisible visible. A prospective study on 206 patients", Epilepsy Behav, 141, pp.109130~ (2023)
- Pizzini F, "Pulsed-arterial-spin-labeling perfusion 3T MRI following single seizure : a first case report study", Epilepsy Res, 81, pp.225~227 (2008)
- Toledo M, "Localisation value of ictal arterial spin-labelled sequences in partial seizures", Epileptic Disord, 13, pp.336~339 (2011)
- Goodkin HP, "Subunitspecific trafficking of GABAA receptors during status epilepticus", J Neurosci, 28, pp.2527~2538 (2008)
- Liu H, "Substance P is expressed in hippocampal principal neurons during status epilepticus and plays a critical role in the maintenance of status epilepticus", Proc Natl Acad Sci U S A, 96, pp.5286~5291 (1999)
- Wasterlain CG, "Pathophysiological mechanisms of brain damage from status epilepticus", Epilepsia, 34(Suppl 1), pp.S37~S53 (1993)
- Plum F, "Cerebral metabolic and circulatory responses to induced convulsions in animals", Arch Neurol, 18, pp.1~13 (1968)
- Kim TJ, "Usefulness of arterial spin labeling perfusion as an initial evaluation of status epilepticus", Sci Rep, 11, pp.24218~ (2021)
- Verma RK, "Focal and generalized patterns of cerebral cortical veins due to non-convulsive status epilepticus or prolonged seizure episode after convulsive status epilepticus-a MRI study using susceptibility weighted imaging", PLoS One, 11, pp.e0160495~ (2016)
- Long B, "Clinical mimics : an emergency medicine-focused review of stroke mimics", J Emerg Med, 52, pp.176~183 (2017)
- Kim BS, "Capability of arterial spin labeling MR imaging in localizing seizure focus in clinical seizure activity", Eur J Radiol, 85, pp.1295~1303 (2016)
- Brown GG, "Measurement of cerebral perfusion with arterial spin labeling : part 2. Applications", J Int Neuropsychol Soc, 13, pp.526~538 (2007)
- Deibler AR, "Arterial spin-labeling in routine clinical practice, part 3 : hyperperfusion patterns", AJNR Am J Neuroradiol, 29, pp.1428~1435 (2008)