Diagnostic usefulness of arterial spin labeling in MR negative children with new onset seizures. (February 2019)

• Record Type: Journal Article
• Authors: Lee, So Mi; Kwon, Soonhak; Lee, Yun Jeong
• Is Part Of: Seizure. Volume 65(2019)
• Page Start: 151
• Page End: 158
• Publication Date: 2019-02
• Subjects: ASL arterial spine labeling -- CBF cerebral blood flow -- CI confidence interval -- ECTS epilepsy with centrotemporal spike -- EEG electroencephalogram -- FCD focal cortical dysplasia -- iEEG intracranial electroencephalogram -- MR magnetic resonance -- MRI magnetic resonance imaging -- ORs odds ratios -- PET positron emission tomography -- SPECT single photon emission computed tomography -- SISCOM subtracted ictal single photon emission computed tomography co-registered with magnetic resonance imaging; Arterial spin labeling -- Magnetic resonance imaging -- Children -- New onset seizures; Epilepsy -- Periodicals; Epilepsy -- Periodicals; Seizures -- Periodicals; Épilepsie -- Périodiques; Electronic journals; Electronic journals; 616.853
• DOI: 10.1016/j.seizure.2019.01.024
• Languages: English
• ISSNs: 1059-1311

Abstract

Highlights: We assessed the utility of ASL in children with new onset seizures and negative MR. Among the 43 patients, 58.1% of patients showed perfusion change on ASL. The concordance showed a moderate agreement between ASL and seizure focus. Time from seizure onset to ASL acquisition was associated with concordance. ASL can be a beneficial tool to localize seizure focus in pediatric epilepsy. Abstract: Purpose: Arterial spine labeling (ASL) magnetic resonance imaging (MRI) is the non-invasive measurement of cerebral blood flow that can localize the seizure focus in patients with epilepsy. The aim of this study was to identify its utility for localizing the seizure focus in children with no structural lesion on MRI. Methods: Forty-three consecutive children who underwent electroencephalography (EEG) and structural MRI, along with ASL for evaluation of newly developed seizures, were included. ASL abnormalities were classified as hypo/hyperperfusion, based on visual assessment, and compared with the seizure focus determined by clinical information and EEG. Results: Among the 43 patients (M 17: F 26, mean age, 6.3 ± 3.3 years), the seizure type was focal in 36 patients and generalized in seven patients. Twenty-five (58.1%) patients showed perfusion change. Out of 36 patients with focal seizure, 24 (66.7%) showed ASL abnormalities, and 19 (52.8%) showed concordance between ASL and clinical focus. Out of seven patients with generalized seizure, only one patient showed ASL abnormalities. The overall concordance revealed moderate agreement ( k = 0.542). ASL acquisition within one day from seizure onset was the only significant associating factor with the concordance between the two ( p = 0. 014). Conclusion: To our knowledge, this is the first study to assess the usefulness of ASL MRI to assist in localizing the seizure focus in MR-negative children with new onset seizures. The combined use of ASL with EEG and structural MRI may play an important role in the evaluation of pediatric epilepsy.