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Updated: Aug 1, 2025
Author Spotlight: Noninvasive Cerebral Blood Flow Determination in Human Functional Brain Region for Diagnosis of Neurological Disorders
Published on: May 31, 2024
Alteration of intracranial blood perfusion in temporal lobe epilepsy, an arterial spin labeling study
Hossein Rahimzadeh1,2, Hadi Kamkar1,3, Narges Hoseini-Tabatabaei4
1Research Center for Molecular and Cellular Imaging, Advanced Medical Technologies and Equipment Institute (AMTEI), Tehran University of Medical Sciences, Tehran, Iran.
Background:
A critical necessity before surgical resection in mesial temporal lobe epilepsy (mTLE) is lateralizing the seizure focus in the temporal lobe. This study aimed to investigate the differences in perfusion pattern changes in right and left mTLE.
Methods:
42 mTLE patients (22 left and 20 right mTLE) and 14 controls were surveyed with pulsed arterial spin labeling at 3.0 T. The mean cerebral blood flow (CBF) and asymmetry index (AI) were calculated in the bilateral temporal lobe, amygdala, hippocampus, parahippocampus, and nine bilateral vascular territories ROIs. The alterations in whole-brain CBF were identified using statistical parametric mapping (SPM).
Results:
CBF decreased in ipsilateral sides in both epilepsy subcohorts, with right mTLE showing a significant difference in most ROIs while left mTLE exhibiting no significant change. CBF comparison of left mTLE and controls showed a significant drop in ROI analysis in left middle temporal and left intermediate posterior cerebral artery and in AI analysis in parahippocampus, distal anterior cerebral artery, distal middle cerebral artery, and intermediate anterior cerebral artery. CBF hypoperfusion was seen in ROI analysis in the left intermediate anterior cerebral artery, left middle temporal, right middle temporal, left superior temporal in the right mTLE compared to controls. Left mTLE CBF differed significantly from right mTLE CBF in right distal middle cerebral artery ROI and AI of proximal middle cerebral artery.
Conclusion:
Our result revealed that mTLE affects extratemporal regions and both mTLE subcohorts with different perfusion patterns, which may enhance the performance of preoperative MRI assessment in lateralization procedures.
Insights
Mesial temporal lobe epilepsy (mTLE) affects brain perfusion differently between right and left sides. These distinct perfusion patterns in mesial temporal lobe epilepsy may aid in preoperative MRI assessments for seizure focus lateralization.
Area of Science:
- Neuroimaging
- Epilepsy Research
- Cerebrovascular Physiology
Background:
- Accurate lateralization of the seizure focus is crucial for surgical resection in mesial temporal lobe epilepsy (mTLE).
- Understanding hemispheric differences in perfusion patterns is vital for improving preoperative diagnostic accuracy.
Purpose of the Study:
- To investigate and compare perfusion pattern changes in right versus left mesial temporal lobe epilepsy (mTLE).
- To identify potential imaging biomarkers for lateralizing seizure foci in mTLE patients.
Main Methods:
- Pulsed arterial spin labeling (ASL) MRI at 3.0 Tesla was used in 42 mTLE patients (22 left, 20 right) and 14 controls.
- Calculated mean cerebral blood flow (CBF) and asymmetry index (AI) in temporal lobe regions and vascular territories.
- Utilized statistical parametric mapping (SPM) to identify whole-brain CBF alterations.
Main Results:
- Reduced ipsilateral cerebral blood flow (CBF) was observed in both left and right mTLE groups.
- Right mTLE showed significant CBF differences in most regions compared to controls, while left mTLE had fewer significant changes.
- Specific regional hypoperfusion and asymmetry index alterations were identified distinguishing left and right mTLE, and mTLE from controls.
Conclusions:
- Mesial temporal lobe epilepsy (mTLE) impacts extratemporal regions, with distinct perfusion patterns observed between right and left mTLE subcohorts.
- These findings suggest that ASL-based perfusion analysis can enhance the preoperative MRI assessment for seizure focus lateralization in mTLE.
