Usefulness of arterial spin labeling perfusion as an initial evaluation of status epilepticus

Abstract

This study aimed to evaluate the sensitivity and prognostic value of arterial spin labeling (ASL) in a large group of status epilepticus (SE) patients and compare them with those of other magnetic resonance (MR) sequences, including dynamic susceptibility contrast (DSC) perfusion imaging. We retrospectively collected data of patients with SE in a tertiary center between September 2016 and March 2020. MR images were visually assessed, and the sensitivity for the detection of SE and prognostication was compared among multi-delay ASL, DSC, fluid-attenuated inversion recovery (FLAIR), and diffusion-weighted imaging (DWI). We included 51 SE patients and 46 patients with self-limiting seizures for comparison. Relevant changes in ASL were observed in 90.2% (46/51) of SE patients, a percentage higher than those for DSC, FLAIR, and DWI. ASL was the most sensitive method for initial differentiation between SE and self-limiting seizures. The sensitivity of ASL for detecting refractory SE (89.5%) or estimating poor outcomes (100%) was higher than those of other MR protocols or electroencephalography and comparable to those of clinical prognostic scores, although the specificity of ASL was very low as 9.4% and 15.6%, respectively. ASL showed a better ability to detect SE and predict the prognosis than other MR sequences, therefore it can be valuable for the initial evaluation of patients with SE.

Focality in Febrile Seizures: A Retrospective Assessment Using Arterial Spin Labeling MRI

“…20 This study demonstrated that relevant changes in ASL were observed in 90% of patients with status epilepticus, while only 41% of patients had self-limiting seizures. 20 Our findings are also consistent with findings that prolonged seizures are more likely to be focal. 16,21 Strong correlations between focality and prolonged duration have been reported in FS.…”

“…Our results are consistent with those of a previous study that compared ASL perfusion between status epilepticus and self-limiting seizures. 20 This study demonstrated that relevant changes in ASL were observed in 90% of patients with status epilepticus, while only 41% of patients had self-limiting seizures. 20 Our findings are also consistent with findings that prolonged seizures are more likely to be focal.…”

Putting the Neuro in Neurovascular Coupling

“…Recent advances in arterial spin labeling (ASL) have made it feasible to measure blood vessel diameter using MRI, which is advantageous over ictal SPECT in that it requires no radioactive dyes and is high resolution. Indeed, a newly published retrospective study 7 and several recent papers [8][9][10] support the notion that ASL MRI is useful for establishing prognosis and localizing a focus in patients with epilepsy, although the predictive power of ASL depended on how soon after a seizure images were acquired.…”

Multidelay ASL of the pediatric brain

“…94 In patients with status epilepticus, ongoing seizure activity may yield lead to diffuse cerebral hyperperfusion with excitotoxic complications. 95,96 In patients with chronic epilepsy, MDASL can be helpful for longitudinal CBF quantification to assess treatment response (both medical and surgical).…”