Arterial spin labeling perfusion MRI applications in drug-resistant epilepsy and epileptic emergency

Epilepsy affects all age groups and is one of the most common and disabling neurological disorders worldwide. Drug-resistant epilepsy (DRE), status epilepticus (SE), and sudden unexpected death in epilepsy (SUDEP), which are associated with considerable healthcare costs and mortality, have always been difficult to address and become the focus of clinical research. The rapid identification of seizure onset and accurate localization of epileptic foci are crucial for the treatment and prognosis of people with DRE, SE, or near-SUDEP. However, most of the conventional neuroimaging techniques for assessing cerebral blood flow of people with epilepsy are restricted by time consumption, limited resolution, and ionizing radiation. Arterial spin labeling (ASL) is a newly powerful non-contrast magnetic resonance imaging technique that enables the quantitative evaluation of brain perfusion, characterized by its unique advantages of reproducibility and easy accessibility. Recent studies have demonstrated the potential advantages of ASL for the diagnosis and evaluation of epilepsy. Therefore, in this review, we discussed the complementary value of ASL in evaluating and characterizing the basic substrates underlying refractory epilepsy and epileptic emergencies.