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Published on: June 23, 2023
Cerebral perfusion alterations in epileptic patients during peri-ictal and post-ictal phase: PASL vs DSC-MRI
Francesca B Pizzini1, Paolo Farace, Paolo Manganotti
1Department of Pathology and Diagnostics, Unit of Neuroradiology, University Hospital Verona, Verona, Italy. francesca.pizzini@ospedaleuniverona.it
Abstract:
Non-invasive pulsed arterial spin labeling (PASL) MRI is a method to study brain perfusion that does not require the administration of a contrast agent, which makes it a valuable diagnostic tool as it reduces cost and side effects. The purpose of the present study was to establish the viability of PASL as an alternative to dynamic susceptibility contrast (DSC-MRI) and other perfusion imaging methods in characterizing changes in perfusion patterns caused by seizures in epileptic patients. We evaluated 19 patients with PASL. Of these, the 9 affected by high-frequency seizures were observed during the peri-ictal period (within 5hours since the last seizure), while the 10 patients affected by low-frequency seizures were observed in the post-ictal period. For comparison, 17/19 patients were also evaluated with DSC-MRI and CBF/CBV. PASL imaging showed focal vascular changes, which allowed the classification of patients in three categories: 8 patients characterized by increased perfusion, 4 patients with normal perfusion and 7 patients with decreased perfusion. PASL perfusion imaging findings were comparable to those obtained by DSC-MRI. Since PASL is a) sensitive to vascular alterations induced by epileptic seizures, b) comparable to DSC-MRI for detecting perfusion asymmetries, c) potentially capable of detecting time-related perfusion changes, it can be recommended for repeated evaluations, to identify the epileptic focus, and in follow-up and/or therapy-response assessment.
Insights
Non-invasive pulsed arterial spin labeling (PASL) MRI effectively detects brain perfusion changes in epilepsy patients. This method is comparable to dynamic susceptibility contrast MRI for identifying seizure-related vascular alterations.
Area of Science:
- Neuroimaging
- Epilepsy Research
- Cerebrovascular Physiology
Background:
- Epileptic seizures cause significant alterations in brain perfusion.
- Current perfusion imaging methods like dynamic susceptibility contrast MRI (DSC-MRI) often require contrast agents, posing limitations.
- Non-invasive techniques are sought for evaluating perfusion changes in epilepsy.
Purpose of the Study:
- To assess the viability of non-invasive pulsed arterial spin labeling (PASL) MRI as an alternative to DSC-MRI for characterizing perfusion changes in epileptic patients.
- To compare PASL findings with DSC-MRI and cerebral blood flow/volume (CBF/CBV) measurements.
- To determine if PASL can identify focal vascular changes associated with seizures.
Main Methods:
- Nineteen epilepsy patients were evaluated using PASL MRI.
- Patients were categorized based on seizure frequency (high vs. low) and observation period (peri-ictal vs. post-ictal).
- Seventeen patients also underwent DSC-MRI for comparative analysis of perfusion parameters.
Main Results:
- PASL imaging revealed focal vascular changes in epilepsy patients.
- Patients were classified into three perfusion categories: increased (8), normal (4), and decreased (7).
- PASL findings demonstrated comparability to DSC-MRI in detecting perfusion asymmetries and alterations.
Conclusions:
- Non-invasive PASL MRI is sensitive to vascular alterations induced by epileptic seizures.
- PASL is a viable alternative to DSC-MRI for detecting perfusion asymmetries and changes.
- PASL is recommended for repeated evaluations, epileptic focus identification, and therapy response assessment due to its non-invasive nature and comparability to DSC-MRI.
