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Magnetic Resonance Imaging Quantification of Pulmonary Perfusion using Calibrated Arterial Spin Labeling
Published on: May 30, 2011
Brain perfusion imaging by arterial spin labeling predicts postsurgical seizure freedom in pediatric focal lesional
Antonio Giulio Gennari1,2, Luca Gaito1, Dorottya Cserpan1
1Department of Neuropediatrics, University Children's Hospital Zurich, Zurich, Switzerland.
Insights
Arterial spin labeling (ASL) perfusion imaging helps identify the seizure-causing area in children with epilepsy. Including ASL in surgical planning improves seizure freedom after operations for focal cortical dysplasia or tumors.
Area of Science:
- Pediatric Neurology
- Neuroradiology
- Epilepsy Surgery
Background:
- Pharmacoresistant focal lesional epilepsy in children, often caused by focal cortical dysplasia (FCD) or low-grade epilepsy-associated tumors (LEATs), presents significant treatment challenges.
- Accurate delineation of the epileptogenic zone is crucial for successful surgical resection and improved post-operative seizure control.
Purpose of the Study:
- To evaluate if integrating arterial spin labeling (ASL) perfusion imaging into presurgical planning enhances seizure outcomes in pediatric patients with pharmacoresistant focal lesional epilepsy.
- To determine the correlation between ASL-derived perfusion abnormalities and postsurgical seizure freedom.
Main Methods:
- Retrospective analysis of MRI scans from 18 children with FCD- or LEAT-associated pharmacoresistant epilepsy.
- Presurgical ASL imaging and pre-/postsurgical structural MRI were analyzed for lesion completeness and ASL perfusion changes.
- DICE similarity scores and residue ratio assessed resection accuracy, correlated with seizure outcomes.
Main Results:
- Seventy-eight percent of patients achieved seizure freedom; 72% had complete lesion resection.
- Complete inclusion of perfusion changes within the resection cavity correlated significantly with seizure freedom (p=.009).
- Higher alignment of perfusion changes with the resection cavity (DICE score) was associated with seizure freedom (p=.043); larger residual perfusion volumes correlated with seizure recurrence (p=.008).
Conclusions:
- Arterial spin labeling (ASL) perfusion imaging aids in better defining the epileptogenic zone in pediatric focal lesional epilepsy.
- Integrating ASL into presurgical planning may improve postsurgical seizure outcomes.
- ASL is a valuable complementary tool for surgical planning in this patient population.
Objective:
This study was undertaken to determine whether integrating arterial spin labeling (ASL) perfusion imaging into presurgical planning improves postsurgical seizure outcomes in children with pharmacoresistant focal lesional epilepsy associated with focal cortical dysplasia (FCD) or low-grade epilepsy-associated tumors (LEATs).
Methods:
We retrospectively analyzed magnetic resonance imaging (MRI) scans from 18 children (median age = 4.8 years, interquartile range = 1.9-11.5) who underwent resection for FCD- or LEAT-associated pharmacoresistant epilepsy, with at least 1 year of follow-up. All patients underwent presurgical ASL imaging along with pre- and postsurgical structural MRI. Image postprocessing, including segmentation and coregistration, assessed the completeness of resection of the anatomical lesion and ASL-derived perfusion changes. DICE similarity scores measured the alignment of pre- to postsurgical segmentations, and the residue ratio assessed the percentage of presurgical segmentation remaining postresection. These metrics were then correlated with postsurgical seizure outcomes.
Results:
Fourteen (78%) patients achieved seizure freedom, and 13 (72%) had complete lesion resection. Qualitative analysis showed that complete inclusion of the perfusion changes within the resection cavity significantly correlated with seizure freedom (p = .009), whereas complete resection of the anatomical lesion did not (p = .57). Quantitative analysis indicated that higher alignment of the perfusion changes with the resection cavity, measured by the DICE score, was significantly associated with seizure freedom (p = .043), whereas alignment between lesion and resection was not (p = .44). Larger residual perfusion volumes significantly correlated with seizure recurrence (p = .008).
Significance:
Incorporating ASL perfusion imaging into presurgical evaluation may better delineate the epileptogenic zone, potentially improving postsurgical seizure outcomes. These findings support ASL as a valuable complementary tool in surgical planning for pharmacoresistant pediatric focal lesional epilepsy.
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