Diagnostic Usefulness of Arterial Spin Labeling in MR-Negative or Equivocal Children With New-Onset Seizures
Abstract number :
2.200
Submission category :
5. Neuro Imaging / 5B. Functional Imaging
Year :
2018
Submission ID :
501820
Source :
www.aesnet.org
Presentation date :
12/2/2018 4:04:48 PM
Published date :
Nov 5, 2018, 18:00 PM
Authors :
Yun Jeong Lee, Kyungpook National University School of Medicine, Kyungpook National University Hospital; Su-Kyung Hwang, Kyungpook National University School of Medicine, Kyungpook National University Hospital; So Mi Lee, Kyungpook National University S
Rationale: Arterial spine labeling (ASL) perfusion-weighted magnetic resonance imaging (MRI) is the non-invasive measurements of cerebral blood flow, recently employed in locating the seizure focus in patients with epilepsy. The aim of this study is to evaluate cerebral blood flow in peri-ictal state and identify its utility for seizure localization in magnetic resonance (MR)-negative or equivocal pediatric patients. Methods: Electroencephalopgraphy (EEG), structural MRI, and ASL were performed in forty-three patients to evaluate for new-onset seizures and localize the seizure focus with semiology and clinical information. In all the patients, structural MRI showed normal or equivocal findings confirmed by a radiologist. Areas of hypo- or hyper-perfusion on ASL sequence were compared with the clinical seizure foci determined by EEG and clinical symptom. The strength of concordance was assessed with the kappa coefficient. Results: Of the 43 patients {26 (61.9%) female; mean age 6.1 years (0.9~16.2 years)}, focal seizure and generalized seizure was classified in 36 patients and in 7 patients, respectively. ASL abnormalities were seen in 25 (58.1%) patients. In 36 patients with focal seizure, 24 (66.7%) patients showed ASL abnormalities; hypoperfusion in 21 patients, hyperperfusion in 3 patients. Nineteen of 36 patients with focal seizure (52.8%) showed abnormal perfusion of ASL in the same areas with clinical seizure foci. Of the 18 patients showing ASL change and epileptiform discharges on EEG, ASL abnormalities were concordant with epileptiform discharges on EEG in 13 patients (72.2%). ASL acquisition within one day from seizure onset was significantly associated with abnormal ASL finding (p = 0.047) and concordance (p = 0.008). The overall concordance between ASL and clinical seizure focus revealed moderate agreement (k = 0.542). Conclusions: Our result suggests that ASL sequence is useful to provide information about perfusion status and diagnostic clues in localizing the seizure focus in epileptic patients with negative or equivocal MR. Since ASL technique is easily accessible and non-invasive measurement, the combined use of ASL with EEG and structural MRI may play an important role in the evaluation of pediatric epilepsy. Funding: All authors have no relevant financial or non-financial relationships to disclose.