Pragmatic computerised perfusion diagnostics for non-convulsive status epilepticus: a prospective observational study

Area of Science:

• Neurology
• Radiology
• Emergency Medicine

Background:

• Non-convulsive status epilepticus (NCSE) is a neurological emergency often misdiagnosed due to delayed or unavailable electroencephalography (EEG).
• Current diagnostic criteria, such as the Salzburg criteria, may not always accurately identify NCSE.

Purpose of the Study:

• To evaluate the diagnostic accuracy of CT perfusion (CTP) imaging, specifically hyperperfusion, in identifying NCSE.
• To compare the efficacy of CTP hyperperfusion against Salzburg criteria for NCSE diagnosis.
• To determine the potential role of CTP in a pragmatic emergency diagnostic workflow for NCSE.

Main Methods:

• Consecutive patients with suspected seizures underwent CTP and EEG between January 2021 and March 2023.
• Independent experts blinded to patient status adjudicated NCSE diagnosis using a reference standard including all clinical, lab, imaging, EEG, and therapeutic data.
• Sensitivity, specificity, accuracy, and predictive values were calculated for CTP hyperperfusion and Salzburg criteria.

Main Results:

• CTP hyperperfusion demonstrated good accuracy for NCSE diagnosis (AUROC 0.79).
• CTP hyperperfusion exhibited a high negative predictive value (NPV 0.97) for NCSE.
• Agreement between EEG and CTP was observed in 16 out of 21 NCSE cases.

Conclusions:

• CTP hyperperfusion can be a valuable tool in emergency settings for rapidly ruling out NCSE.
• The high NPV of CTP hyperperfusion supports its implementation in fast-track diagnostic pathways.
• Further validation studies are recommended to assess CTP's real-world application in NCSE diagnosis.