Accuracy of arterial spin labeling magnetic resonance imaging (MRI) perfusion in detecting the epileptogenic zone in patients with drug-resistant neocortical epilepsy: comparison with electrophysiological data, structural MRI, SISCOM and FDG-PET.
OBJECTIVE
Locating the epileptogenic zone (EZ) in patients with neocortical epilepsy presents major challenges. Our aim was to assess the accuracy of arterial spin labeling (ASL), an emerging non-invasive magnetic resonance imaging (MRI) perfusion technique, to locate the EZ in patients with drug-resistant neocortical epilepsy.


METHODS
Twenty-five consecutive patients with neocortical epilepsy referred to our epilepsy unit for pre-surgical evaluation underwent a standardized assessment including video-electroencephalography (EEG) monitoring, structural MRI, subtraction ictal single-photon emission computed tomography co-registered to MRI (SISCOM) and fluorodeoxyglucose positron emission tomography (FDG-PET) studies. An ASL sequence was included in the MRI studies. Areas of hypoperfusion or hyperperfusion on ASL were classified into 15 anatomic-functional cortical regions; these regional cerebral blood flow maps were compared with the EZ determined by the other tests and the strength of concordance was assessed with the kappa coefficient.


RESULTS
Of the 25 patients [16 (64%) women; mean age 32.4 (±13.8) years], 18 (72%) had lesions on structural MRI. ASL abnormalities were seen in 15 (60%) patients (nine hypoperfusion, six hyperperfusion). ASL had a very good concordance with FDG-PET (k = 0.84), a good concordance with structural MRI (k = 0.76), a moderate concordance with video-EEG monitoring (k = 0.53) and a fair concordance with SISCOM (k = 0.28).


CONCLUSIONS
Arterial spin labeling might help to confirm the location and extent of the EZ in the pre-surgical workup of patients with drug-resistant neocortical epilepsy.
Institute of Neurosciences, Hospital Clinic, Barcelona, Spain.
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Sierra-Marcos
Institute of Neurosciences, Hospital Clinic, Barcelona, Spain.
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Carreño
Image Diagnosis Center, Hospital Clinic, Barcelona, Spain.|Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Barcelona, Spain.
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Setoain
Image Diagnosis Center, Hospital Clinic, Barcelona, Spain.
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López-Rueda
Institute of Neurosciences, Hospital Clinic, Barcelona, Spain.
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Aparicio
Institute of Neurosciences, Hospital Clinic, Barcelona, Spain.
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Donaire
Image Diagnosis Center, Hospital Clinic, Barcelona, Spain.|Medical Image Core Facility, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.
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Bargalló
D000328:Adult; D000069279:Drug Resistant Epilepsy / Q000175:diagnosis*; D004569:Electroencephalography; D004827:Epilepsy / Q000175:diagnosis*; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000592:standards*; D008279:Magnetic Resonance Imaging / Q000592:standards*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D019579:Neocortex / Q000503:physiopathology*; D049268:Positron-Emission Tomography; D013113:Spin Labels; D015899:Tomography, Emission-Computed, Single-Photon
D013113:Spin Labels
ASL; MRI; PET; SISCOM; neocortical epilepsy; perfusion