Seizure onset zone localization using postictal hypoperfusion detected by arterial spin labelling MRI
Seizure onset zone localization using postictal hypoperfusion detected by arterial spin labelling MRI
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DOI：
10.1093/brain/awx241
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发表时间：
2017-11-01
期刊：
影响因子：
14.5
通讯作者：
Federico, Paolo
中科院分区：
文献类型：
--
作者：
Gaxiola-Valdez, Ismael;Singh, Shaily;Federico, Paolo
癫痫发作后的神经功能障碍是一个公认的现象。已经提出了几种可能的机制来解释发作后功能障碍，脑血流的改变是一种可能性。这些血管紊乱可能是持久的，并局限于参与癫痫发作产生和传播的脑区，这得到了动物和人类研究的支持。因此，测量癫痫发作后期的灌注变化可能有助于定位癫痫发作区。动脉自旋标记是一种非侵入性、快速和可重复的磁共振成像技术，可测量脑灌注。为此，我们测量了耐药性局灶性癫痫患者的发作后灌注，这些患者被收治到我们的监护室进行术前评估。前瞻性招募了21例患者，并在习惯性癫痫发作的90分钟内进行了动脉自旋标记扫描。患者在发作间期也接受了类似的扫描，在他们至少24小时没有癫痫发作后。对获得的扫描进行减影，以确定明显的发作后低灌注区域。将最大灌注不足的位置与假定的癫痫发作区进行比较，以评估一致性。此外，这种技术的定位价值进行了比较，其他结构和功能成像方式。在15/21例患者（71.4%）中观察到发作后灌注减少415个单位（ml/100 g/l）。在12/15例（80%）患者中，灌注不足的位置与假定的癫痫发作区的位置部分或完全一致。该技术优于其他神经成像方式，在52%的病例中与结构磁共振成像相似或优于结构磁共振成像，在60%的病例中与发作单光子发射计算机断层扫描相似或优于结构磁共振成像，在71%的病例中与发作间期正电子发射断层扫描相似或优于结构磁共振成像。根据非侵入性数据，在癫痫发作区可辨别的患者中获得了更好的动脉自旋标记结果。因此，这项技术是一种安全，非侵入性和相对便宜的工具来检测发作后灌注不足，可以提供有用的数据，以定位癫痫发作区。这种技术可以纳入电池的常规调查的术前评估耐药局灶性癫痫患者。
Neurological dysfunction following epileptic seizures is a well-recognized phenomenon. Several potential mechanisms have been suggested to explain postictal dysfunction, with alteration in cerebral blood flow being one possibility. These vascular disturbances may be long lasting and localized to brain areas involved in seizure generation and propagation, as supported by both animal and human studies. Therefore, measuring perfusion changes in the postictal period may help localize the seizure onset zone. Arterial spin labelling is a non-invasive, rapid and reproducible magnetic resonance imaging technique that measures cerebral perfusion. To this end, we measured postictal perfusion in patients with drug resistant focal epilepsy who were admitted to our seizure-monitoring unit for presurgical evaluation. Twenty-one patients were prospectively recruited and underwent arterial spin labelling scanning within 90 min of a habitual seizure. Patients also underwent a similar scan in the interictal period, after they were seizure-free for at least 24 h. The acquired scans were subtracted to identify the areas of significant postictal hypoperfusion. The location of the maximal hypoperfusion was compared to the presumed seizure onset zone to assess for concordance. Also, the localizing value of this technique was compared to other structural and functional imaging modalities. Postictal perfusion reductions of 415 units (ml/100 g/l) were seen in 15/21 patients (71.4%). In 12/15 (80%) of these patients, the location of the hypoperfusion was partially or fully concordant with the location of the presumed seizure onset zone. This technique compared favourably to other neuroimaging modalities, being similar or superior to structural magnetic resonance imaging in 52% of cases, ictal single-photon emission computed tomography in 60% of cases and interictal positron emission tomography in 71% of cases. Better arterial spin labelling results were obtained in patients in whom the seizure onset zone was discernible based on non-invasive data. Thus, this technique is a safe, non-invasive and relatively inexpensive tool to detect postictal hypoperfusion that may provide useful data to localize the seizure onset zone. This technique may be incorporated into the battery of conventional investigations for presurgical evaluation of patients with drug resistant focal epilepsy.