The initial use of arterial spin labeling perfusion and diffusion-weighted magnetic resonance images in the diagnosis of nonconvulsive partial status epileptics
The initial use of arterial spin labeling perfusion and diffusion-weighted magnetic resonance images in the diagnosis of nonconvulsive partial status epileptics
复制标题
DOI：
10.1016/j.eplepsyres.2016.12.008
复制
发表时间：
2017-01-01
影响因子：
2.2
通讯作者：
Iihara, Koji
中科院分区：
文献类型：
--
作者：
Shimogawa, Takafumi;Morioka, Takato;Iihara, Koji
背景：在诊断非惊厥性癫痫持续状态（NCSE）时，捕获持续的脑电图（EEG）结果是金标准；然而，如果没有连续的脑电图监测设备，这实际上是困难的。磁共振成像（MRI）主要应用于紧急情况，包括弥散加权成像（DWI）和动脉自旋标记灌注MRI （ASL）。最近的报道描述了癫痫激活的皮层可以获得临界点MRI表现，包括ASL的临界点高灌注和DWI上的皮层细胞毒性水肿高强度。我们展示了头部MRI表现的特点和临床价值。方法：15例确诊为NCSE的患者（8例为复杂部分性癫痫持续状态（SE）， 7例为细微性SE），经MRI和脑电图确认。随访进行MRI和重复常规脑电图检查。结果：11例（73%）患者在DWI和ASL上均有起始点MRI表现，4例（27%）患者在没有DWI表现的情况下，ASL上发现起始点高灌注。在所有10例癫痫性病变患者中，病变与头部MRI发现的定位之间存在紧密的地形关系。在其他5例患者中，关键的MRI结果有助于证明非病变性老年癫痫NCSE的病理生理机制，或“新生”额部起源的NCSE作为情境相关的NCSE。头侧MRI表现通常是短暂的；然而，在三个病例中，即使脑电图结果完全改善，它们仍然存在。结论：本研究清楚地表明，ASL和DWI的初步应用可以帮助诊断部分NCSE， MRI和EEG的联合应用可以记录每个患者的病理生理机制。(C) 2016 Elsevier B.V.版权所有
Background: In the diagnosis of nonconvulsive status epilepticus (NCSE), capture of ongoing ictal electroencephalographic (EEG) findings is the gold standard; however, this is practically difficult without continuous EEG monitoring facilities. Magnetic resonance imaging (MRI), including diffusion -weighted imaging (DWI) and perfusion MRI with arterial spin labeling (ASL), have been applied mainly in emergency situations. Recent reports have described that ictal MRI findings, including ictal hyperperfusion on ASL and cortical hyperintensity of cytotoxic edema on DWI, can be obtained from epileptically activated cortex. We demonstrate the characteristics and clinical value of ictal MRI findings.Methods: Fifteen patients diagnosed as having NCSE (eight had complex partial status epilepticus (SE) and seven subtle SE) who underwent an initial MRI and subsequent EEG confrmation, participated in this study. Follow-up MRI and repeated routine EEG were performed.Results: In 11 patients (73%), ictal MRI findings were obtained on both DWI and ASL, while in four (27%) patients, ictal hyperperfusion was found on ASL without any DWI findings being obtained. In all 10 patients with an epileptogenic lesion, there was a tight topographical relationship between the lesion and the localization of ictal MRI findings. In the other five patients, ictal MRI findings were useful to demonstrate the pathophysiological mechanism of NCSE of non-lesional elderly epilepsy, or 'de novo' NCSE of frontal origin as situation-related NCSE. Ictal MRI findings are generally transient; however, in three cases they still persisted, even though ictal EEG findings had completely improved.Conclusion: The present study clearly demonstrates that the initial use of ASL and DWI could help to diagnose partial NCSE and also combined use of the MRI and EEG allows documentation of the pathophysiological mechanism in each patient.(C) 2016 Elsevier B.V. All rights reserved.