pASL versus DSC perfusion MRI in lateralizing temporal lobe epilepsy

Öner, Ali Yusuf; Eryurt, Bulent; Uçar, Murat; Capraz, Irem; Kurt, Gökhan; Bilir, Erhan; Tali, Turgut

doi:10.1177/0284185114531128

Cited by 21 publications

(22 citation statements)

References 16 publications

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“…Blauwblomme et al further examined interictal cerebral perfusion deficits in children with focal cortical dysplasia by means of pCASL and FDG‐PET and reported concordance (i.e., colocalized abnormalities) in 5 of 6 (83%) cases . Recently, Oner et al evaluated ASL and DSC in detecting perfusion asymmetry for lateralization of seizure focus in refractory TLE (n = 36) and found similar asymmetry indices and similar correlations with clinical lateralization using the two imaging techniques . Details of these studies are presented in Table .…”

Section: Comparative Studies Between Asl and Pet/spect/dsc/dcementioning

confidence: 99%

“…There are few ASL comparative studies in other neurological disorders such as epilepsy. It has been shown that ASL has a value in detecting perfusion deficits for localization or lateralization of seizure focus . In patients with drug‐resistant temporal lobe epilepsy (TLE) (n = 10), it was found that the mean CBF values in the mesial temporal lobe of ASL and 15 O‐water PET were not significantly different, ASL and FDG‐PET data were correlated and they were also correlated with the electrophysiological data (n = 3) .…”

Section: Comparative Studies Between Asl and Pet/spect/dsc/dcementioning

confidence: 99%

“…It has been shown that ASL has a value in detecting perfusion deficits for localization or lateralization of seizure focus. [90][91][92][93][94] In patients with drug-resistant temporal lobe epilepsy (TLE) (n 5 10), it was found that the mean CBF values in the mesial temporal lobe of ASL and 15 O-water PET were not significantly different, 90 ASL and FDG-PET data were correlated and they were also correlated with the electrophysiological data (n 5 3). 91 In another study, Storti et al found that seizure source (in the interictal phase) was associated with colocalized regional hypoperfusion and hypometabolism in four of six (67%) patients.…”

Section: Ad and Other Neurodegenerative Diseasesmentioning

confidence: 99%

“…93 Recently, Oner et al evaluated ASL and DSC in detecting perfusion asymmetry for lateralization of seizure focus in refractory TLE (n 5 36) and found similar asymmetry indices and similar correlations with clinical lateralization using the two imaging techniques. 94 Details of these studies are presented in Table 2.…”

Section: Ad and Other Neurodegenerative Diseasesmentioning

confidence: 99%

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How far is arterial spin labeling MRI from a clinical reality? Insights from arterial spin labeling comparative studies in Alzheimer's disease and other neurological disorders

Zhang

2015

Magnetic Resonance Imaging

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C linical imaging such as FDG-PET and SPECT has been well established in the diagnosis of Alzheimer's disease (AD) and other neurological disorders, but the diagnostic value of arterial spin labeling (ASL) MRI, a relatively new noninvasive imaging technique, has not been validated or confirmed. Comparative studies that compared ASL with FDG-PET, 15 O-water-PET, SPECT, dynamic susceptibility contrast-enhanced (DSC), or dynamic contrast-enhanced (DCE) MRI are important to reveal the concordance and discordance between ASL and these clinical imaging tests. This paper reviews such studies in healthy subjects and patients with AD or other neurological disorders. These comparative studies have demonstrated that ASL and FDG-PET/ 15O-water-PET had overall concordance and regional variability in healthy subjects, and the regional hypoperfusion that ASL depicted in diseases such as AD was largely concordant with the abnormalities identified by FDG-PET/ SPECT (the diagnostic performance was comparable), which suggests that ASL may have a similar diagnostic value as FDG-PET/SPECT. In addition, there are mixed findings in ASL cerebral blood flow (CBF) measurements compared with 15 O-water-PET, and ASL may be less sensitive than DSC (or DCE) in the diagnosis of neurological disorders such as stroke. Studies with large samples are needed to further validate the diagnostic value of ASL and its CBF measurement. Furthermore, it is necessary to optimize and standardize ASL parameters and explore new techniques to overcome the limitations of ASL and make it a clinical imaging alternative to invasive FDG-PET/SPECT/DSC/ DCE in the diagnosis of AD and other neurological disorders.IT IS OFTEN difficult to differentiate early-stage Alzheimer's disease (AD) from other neurodegenerative dementias or mild cognitive impairment (MCI).1 MRI, FDG-PET, and SPECT have been the major clinical imaging tests used for the diagnosis of dementia. FDG-PET or SPECT uses radioactive tracers to image glucose metabolism or brain perfusion. Since reductions in cerebral glucose uptake and brain perfusion often precede brain atrophy, measures of FDG-PET/SPECT can serve as early biomarkers for preclinical or mild AD. 2 FDG-PET/SPECT imaging in neurodegenerative disorders is based on the coupling of neural activity and glucose metabolism to reduced regional cerebral blood flow (CBF) 3 due to the synchronization of cerebral metabolic demands to regional blood supply. Thus, spatial patterns of regional CBF in perfusion imaging tend to mirror FDG-PET glucose metabolism results unless neurovascular coupling is compromised. 4In addition, CBF measurements are important in the assessment of AD and other neurological disorders such as stroke.15 O-water-PET (PET imaging with 15 O-water tracer) is considered a gold standard for quantifying CBF. 5 The diagnostic value of PET View this article online at wileyonlinelibrary.com.

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Section: Comparative Studies Between Asl and Pet/spect/dsc/dcementioning

confidence: 99%

Section: Comparative Studies Between Asl and Pet/spect/dsc/dcementioning

confidence: 99%

Section: Ad and Other Neurodegenerative Diseasesmentioning

confidence: 99%

Section: Ad and Other Neurodegenerative Diseasesmentioning

confidence: 99%

See 2 more Smart Citations

How far is arterial spin labeling MRI from a clinical reality? Insights from arterial spin labeling comparative studies in Alzheimer's disease and other neurological disorders

Zhang

2015

Magnetic Resonance Imaging

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“…Despite the differences in techniques, both ASL and DSC have been used to lateralize temporal lobe epilepsy without the need for radioactive agents. 36…”

Section: Perfusion Imagingmentioning

confidence: 99%

Imaging for Epilepsy Surgery

Chavakula

Cosgrove

2017

Semin Neurol

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Approximately 20 to 30% of patients with epilepsy are considered drug refractory, 1 defined by the International League Against Epilepsy (ILAE) as the persistence of seizures despite adequate trials of two well-tolerated and appropriately chosen anti-epileptic drugs (AEDs) under the supervision of an experienced neurologist over the course of at least 1 year. 2 This population represents the potential pool of candidates for surgical treatment, but not all of these patients are amenable to resective surgery. Successful surgical intervention for epilepsy requires a thorough investigation to identify those patients with clearly localizable epileptic foci, with the goal being freedom from seizure with no permanent neurologic deficits.The goal of any presurgical evaluation in a patient with drug-resistant epilepsy is to identify a localized region of epileptic cortex and subsequently resect or disconnect that abnormal cortex. The initial investigation relies on a detailed clinical history and neurologic exam with consultation of both the patient and family members who have witnessed the seizures of the patient. The presence of auras, semiology, and timing of seizures are vital pieces of knowledge that inform seizure onset localization. Signs and symptoms, suggestive of a focal seizure onset, are further investigated through long-term video electroencephalogram (EEG) monitoring. Additional testing may include behavioral evaluation and neuropsychological testing. Various neuroimaging techniques are also employed to identify structural and/or metabolic abnormalities that may be the source of the seizures. 3 In the perfect scenario, all data streams are concordant with ictal EEG, confirming that the clinical seizures do indeed arise from a clearly identified cortical region. However, in many cases, there remains some level of discordance in the functional and anatomic seizure localizations, and in these situations, invasive intracranial investigation with implanted electrodes may also be necessary to determine the precise zone of seizure onset.Most focal epilepsy arises in the temporal lobe, notably the mesial temporal lobe, followed by the frontal, parietal, and occipital lobes. 4 In some cases, the epileptic zone is multilobar or even panhemispheric. In cases of clear cut mesial temporal sclerosis (MTS), between 65 and 85% of patients are cured of epilepsy following resection. 5,6 Surgical success is much less predictable when bilateral MTS is present or when no identifiable temporal lobe lesion exists. This is even true in the extratemporal epilepsies. The most important predictor of a favorable surgical outcome is the identification of a clear cut structural lesion that is consistent with the clinical semiology of the seizures and the ictal EEG onset. 7 Therefore, advanced neuroimaging techniques have become increasingly important in identifying and defining epileptogenic lesions that might previously have gone undetected. Keywords AbstractSuccessful epilepsy surgery requires accurate localization of the zone of seiz...

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Localizing the seizure onset zone by comparing patient postictal hypoperfusion to healthy controls

Perera

Gaxiola‐Valdez

Singh

et al. 2020

J of Neuroscience Research

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Arterial spin labeling (ASL) MRI can provide seizure onset zone (SOZ) localizing information in up to 80% of patients. Clinical implementation of this technique is limited by the need to obtain two scans per patient: a postictal scan that is subtracted from an interictal scan. We aimed to determine whether it is possible to limit the number of ASL scans to one per patient by comparing patient postictal ASL scans to baseline scans of 100 healthy controls. Eighteen patients aged 20–55 years underwent ASL MRI <90 min after a seizure and during the interictal period. Each postictal cerebral blood flow (CBF) map was statistically compared to average baseline CBF maps from 100 healthy controls (pvcASL; patient postictal CBF vs. control baseline CBF). The pvcASL maps were compared to subtraction ASL maps (sASL; patient baseline CBF minus patient postictal CBF). Postictal CBF reductions from pvcASL and sASL maps were seen in 17 of 18 (94.4%) and 14 of 18 (77.8%) patients, respectively. Maximal postictal hypoperfusion seen in pvcASL and sASL maps was concordant with the SOZ in 10 of 17 (59%) and 12 of 14 (86%) patients, respectively. In seven patients, both pvcASL and sASL maps showed similar results. In two patients, sASL showed no significant hypoperfusion, while pvcASL showed significant hypoperfusion concordant with the SOZ. We conclude that pvcASL is clinically useful and although it may have a lower overall concordance rate than sASL, pvcASL does provide localizing or lateralizing information for specific cases that would be otherwise missed through sASL.

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pASL versus DSC perfusion MRI in lateralizing temporal lobe epilepsy

Abstract: pASL can successfully detect interictal asymmetry in patients with TLE and can readily be combined with routine structural assessment for lateralization, providing an alternative to DSC perfusion.

Cited by 21 publications

References 16 publications

How far is arterial spin labeling MRI from a clinical reality? Insights from arterial spin labeling comparative studies in Alzheimer's disease and other neurological disorders

How far is arterial spin labeling MRI from a clinical reality? Insights from arterial spin labeling comparative studies in Alzheimer's disease and other neurological disorders

Imaging for Epilepsy Surgery

Localizing the seizure onset zone by comparing patient postictal hypoperfusion to healthy controls

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