title: Cerebral perfusion alterations in epileptic patients during peri-ictal and post-ictal phase: PASL vs DSC-MRI.
abstract: Non-invasive pulsed arterial spin labeling (PASL) MRI is a method to study brain perfusion that does not require the administration of a contrast agent, which makes it a valuable diagnostic tool as it reduces cost and side effects. The purpose of the present study was to establish the viability of PASL as an alternative to dynamic susceptibility contrast (DSC-MRI) and other perfusion imaging methods in characterizing changes in perfusion patterns caused by seizures in epileptic patients. We evaluated 19 patients with PASL. Of these, the 9 affected by high-frequency seizures were observed during the peri-ictal period (within 5hours since the last seizure), while the 10 patients affected by low-frequency seizures were observed in the post-ictal period. For comparison, 17/19 patients were also evaluated with DSC-MRI and CBF/CBV. PASL imaging showed focal vascular changes, which allowed the classification of patients in three categories: 8 patients characterized by increased perfusion, 4 patients with normal perfusion and 7 patients with decreased perfusion. PASL perfusion imaging findings were comparable to those obtained by DSC-MRI. Since PASL is a) sensitive to vascular alterations induced by epileptic seizures, b) comparable to DSC-MRI for detecting perfusion asymmetries, c) potentially capable of detecting time-related perfusion changes, it can be recommended for repeated evaluations, to identify the epileptic focus, and in follow-up and/or therapy-response assessment.
authors.affiliation: Department of Pathology and Diagnostics, Unit of Neuroradiology, University Hospital Verona, Verona, Italy. francesca.pizzini@ospedaleuniverona.it
authors.forename: Francesca B
authors.initials: FB
authors.lastname: Pizzini
authors.forename: Paolo
authors.initials: P
authors.lastname: Farace
authors.forename: Paolo
authors.initials: P
authors.lastname: Manganotti
authors.forename: Giada
authors.initials: G
authors.lastname: Zoccatelli
authors.forename: Luigi G
authors.initials: LG
authors.lastname: Bongiovanni
authors.forename: Xavier
authors.initials: X
authors.lastname: Golay
authors.forename: Alberto
authors.initials: A
authors.lastname: Beltramello
authors.forename: Antonio
authors.initials: A
authors.lastname: Osculati
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bertini
authors.forename: Paolo F
authors.initials: PF
authors.lastname: Fabene
mesh_terms: D000328:Adult; D001783:Blood Flow Velocity; D001931:Brain Mapping / Q000379:methods*; D002560:Cerebrovascular Circulation; D004827:Epilepsy / Q000175:diagnosis* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D055815:Young Adult