The utility of arterial spin labeling in the presurgical evaluation of poorly defined focal epilepsy in children

OBJECTIVEThe authors sought to assess the utility of arterial spin labeling (ASL) perfusion 3T-MRI for the presurgical evaluation of poorly defined focal epilepsy in pediatric patients.METHODSPseudocontinuous ASL perfusion 3T-MRI was performed in 25 consecutive children with poorly defined focal epilepsy. ASL perfusion abnormalities were detected qualitatively by visual inspection and quantitatively by calculating asymmetry index (AI) maps and significant z-score cluster maps based on successfully operated cases. ASL results were prospectively compared to scalp EEG, structural 3T-MRI, FDG-PET, ictal/interictal SPECT, magnetoencephalography (MEG), and intracranial recording results, as well as the final surgically proven epileptogenic zone (EZ) in operated patients who had at least 1 year of good (Engel class I/II) seizure outcome and positive histopathology results.RESULTSQualitative ASL perfusion abnormalities were found in 17/25 cases (68%), specifically in 17/20 MRI-positive cases (85.0%) and in none of the 5 MRI-negative cases. ASL was concordant with localizing scalp EEG findings in 66.7%, structural 3T-MRI in 90%, FDG-PET in 75%, ictal/interictal SPECT in 62.5%, and MEG in 75% of cases, and with intracranial recording results in 40% of cases. Eleven patients underwent surgery; in all 11 cases the EZ was surgically proven by positive histopathology results and the patient having at least 1 year of good seizure outcome. ASL results were concordant with this final surgically proven EZ in 10/11 cases (sensitivity 91%, specificity 50%). All 10 ASL-positive patients who underwent surgery had positive surgical pathology results and good long-term postsurgical seizure outcome at a mean follow-up of 39 months. Retrospective quantitative analysis based on significant z-score clusters found 1 true-positive result that was missed by qualitative analysis and 3 additional false-positive results (sensitivity 100%, specificity 23%).CONCLUSIONSASL supports the hypothesis regarding the EZ in poorly defined focal epilepsy cases in children. Due to its convenience and noninvasive nature, the authors recommend that ASL be added routinely to the presurgical MRI evaluation of epilepsy. Future optimized quantitative methods may improve the diagnostic yield of this technique.

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Arterial Spin Labeling is a Useful MRI Method for Presurgical Evaluation in MRI-Negative Focal Epilepsy

Brain Topography ◽

10.1007/s10548-021-00833-5 ◽

2021 ◽

Author(s):

Martin Kojan ◽

Martin Gajdoš ◽

Pavel Říha ◽

Irena Doležalová ◽

Zdeněk Řehák ◽

...

Keyword(s):

Arterial Spin Labeling ◽

Focal Epilepsy ◽

Spin Labeling ◽

Presurgical Evaluation

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New interinstitutional, multimodal presurgical evaluation protocol associated with improved seizure freedom for poorly defined cases of focal epilepsy in children

Journal of Neurosurgery Pediatrics ◽

10.3171/2021.6.peds218 ◽

2021 ◽

pp. 1-9

Author(s):

Solon Schur ◽

Jeremy T. Moreau ◽

Hui Ming Khoo ◽

Andreas Koupparis ◽

Elisabeth Simard Tremblay ◽

...

Keyword(s):

Focal Epilepsy ◽

Seizure Freedom ◽

Presurgical Evaluation ◽

3T Mri ◽

Evaluation Strategy ◽

New Strategy ◽

The Difference ◽

Highly Correlated ◽

Intracranial Recording

OBJECTIVE In an attempt to improve postsurgical seizure outcomes for poorly defined cases (PDCs) of pediatric focal epilepsy (i.e., those that are not visible or well defined on 3T MRI), the authors modified their presurgical evaluation strategy. Instead of relying on concordance between video-electroencephalography and 3T MRI and using functional imaging and intracranial recording in select cases, the authors systematically used a multimodal, 3-tiered investigation protocol that also involved new collaborations between their hospital, the Montreal Children’s Hospital, and the Montreal Neurological Institute. In this study, the authors examined how their new strategy has impacted postsurgical outcomes. They hypothesized that it would improve postsurgical seizure outcomes, with the added benefit of identifying a subset of tests contributing the most. METHODS Chart review was performed for children with PDCs who underwent resection following the new strategy (i.e., new protocol [NP]), and for the same number who underwent treatment previously (i.e., preprotocol [PP]); ≥ 1-year follow-up was required for inclusion. Well-defined, multifocal, and diffuse hemispheric cases were excluded. Preoperative demographics and clinical characteristics, resection volumes, and pathology, as well as seizure outcomes (Engel class Ia vs > Ia) at 1 year postsurgery and last follow-up were reviewed. RESULTS Twenty-two consecutive NP patients were compared with 22 PP patients. There was no difference between the two groups for resection volumes, pathology, or preoperative characteristics, except that the NP group underwent more presurgical evaluation tests (p < 0.001). At 1 year postsurgery, 20 of 22 NP patients and 10 of 22 PP patients were seizure free (OR 11.81, 95% CI 2.00–69.68; p = 0.006). Magnetoencephalography and PET/MRI were associated with improved postsurgical seizure outcomes, but both were highly correlated with the protocol group (i.e., independent test effects could not be demonstrated). CONCLUSIONS A new presurgical evaluation strategy for children with PDCs of focal epilepsy led to improved postsurgical seizure freedom. No individual presurgical evaluation test was independently associated with improved outcome, suggesting that it may be the combined systematic protocol and new interinstitutional collaborations that makes the difference rather than any individual test.

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Cerebral metabolism and perfusion in MR-negative individuals with refractory focal epilepsy assessed by simultaneous acquisition of 18 F-FDG PET and arterial spin labeling

NeuroImage Clinical ◽

10.1016/j.nicl.2016.04.005 ◽

2016 ◽

Vol 11 ◽

pp. 648-657 ◽

Cited By ~ 25

Author(s):

Ilaria Boscolo Galazzo ◽

Maria Vittoria Mattoli ◽

Francesca Benedetta Pizzini ◽

Enrico De Vita ◽

Anna Barnes ◽

...

Keyword(s):

Fdg Pet ◽

Arterial Spin Labeling ◽

Focal Epilepsy ◽

Cerebral Metabolism ◽

Spin Labeling ◽

Simultaneous Acquisition

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Presurgical evaluation and postoperative seizure-outcome in children and adolescents with intracranial tumors and drug resistant focal epilepsy

Neuropediatrics ◽

10.1055/s-0031-1274074 ◽

2011 ◽

Vol 42 (S 01) ◽

Author(s):

T Hartlieb ◽

T Pieper ◽

S Kessler-Uberti ◽

HC Eitel ◽

T Getzinger ◽

...

Keyword(s):

Children And Adolescents ◽

Focal Epilepsy ◽

Seizure Outcome ◽

Drug Resistant ◽

Intracranial Tumors ◽

Presurgical Evaluation ◽

Postoperative Seizure

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Pulsed-arterial-spin-labeling perfusion 3T MRI following single seizure: A first case report study

Epilepsy Research ◽

10.1016/j.eplepsyres.2008.06.009 ◽

2008 ◽

Vol 81 (2-3) ◽

pp. 225-227 ◽

Cited By ~ 18

Author(s):

Francesca Pizzini ◽

Paolo Farace ◽

Tiziano Zanoni ◽

Stefano Magon ◽

Alberto Beltramello ◽

...

Keyword(s):

Case Report ◽

Arterial Spin Labeling ◽

Spin Labeling ◽

3T Mri ◽

First Case

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Comparison between simultaneously acquired arterial spin labeling and 18F-FDG PET in mesial temporal lobe epilepsy assisted by a PET/MR system and SEEG

NeuroImage Clinical ◽

10.1016/j.nicl.2018.06.008 ◽

2018 ◽

Vol 19 ◽

pp. 824-830 ◽

Cited By ~ 7

Author(s):

Yi-He Wang ◽

Yang An ◽

Xiao-Tong Fan ◽

Jie Lu ◽

Lian-Kun Ren ◽

...

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Fdg Pet ◽

Arterial Spin Labeling ◽

Spin Labeling ◽

Mesial Temporal Lobe Epilepsy ◽

Mesial Temporal Lobe ◽

18F Fdg

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Similar and Differing Distributions Between 18F-FDG-PET and Arterial Spin Labeling Imaging in Temporal Lobe Epilepsy

Frontiers in Neurology ◽

10.3389/fneur.2019.00318 ◽

2019 ◽

Vol 10 ◽

Cited By ~ 1

Author(s):

Daichi Sone ◽

Norihide Maikusa ◽

Noriko Sato ◽

Yukio Kimura ◽

Miho Ota ◽

...

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Fdg Pet ◽

Arterial Spin Labeling ◽

Spin Labeling ◽

18F Fdg

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Cortical Dyplasia: Complete Resection Correlates with Outcome…But, Complete Resection of What?

Epilepsy Currents ◽

10.1111/j.1535-7511.2009.01306.x ◽

2009 ◽

Vol 9 (4) ◽

pp. 100-102 ◽

Cited By ~ 2

Author(s):

Theodore H. Schwartz

Keyword(s):

Fdg Pet ◽

Pediatric Patients ◽

Focal Cortical Dysplasia ◽

Cortical Dysplasia ◽

Seizure Outcome ◽

Type I ◽

Type Ii ◽

Presurgical Evaluation ◽

Mri Scans

Incomplete Resection of Focal Cortical Dysplasia Is the Main Predictor of Poor Postsurgical Outcome. Krsek P, Maton B, Jayakar P, Dean P, Korman B, Rey G, Dunoyer C, Pacheco-Jacome E, Morrison G, Ragheb J, Vinters HV, Resnick T, Duchowny M. Neurology 2009;72(3):217–223. BACKGROUND: Focal cortical dysplasia (FCD) is recognized as the major cause of focal intractable epilepsy in childhood. Various factors influencing postsurgical seizure outcome in pediatric patients with FCD have been reported. OBJECTIVE: To analyze different variables in relation to seizure outcome in order to identify prognostic factors for selection of pediatric patients with FCD for epilepsy surgery. METHODS: A cohort of 149 patients with histologically confirmed mild malformations of cortical development or FCD with at least 2 years of postoperative follow-up was retrospectively studied; 113 subjects had at least 5 years of postoperative follow-up. Twenty-eight clinical, EEG, MRI, neuropsychological, surgical, and histopathologic parameters were evaluated. RESULTS: The only significant predictor of surgical success was completeness of surgical resection, defined as complete removal of the structural MRI lesion (if present) and the cortical region exhibiting prominent ictal and interictal abnormalities on intracranial EEG. Unfavorable surgical outcomes are mostly caused by overlap of dysplastic and eloquent cortical regions. There were nonsignificant trends toward better outcomes in patients with normal intelligence, after hemispherectomy and with FCD type II. Other factors such as age at seizure onset, duration of epilepsy, seizure frequency, associated pathologies including hippocampal sclerosis, extent of EEG and MRI abnormalities, as well as extent and localization of resections did not influence outcome. Twenty-five percent of patients changed Engel's class of seizure outcome after the second postoperative year. CONCLUSIONS: The ability to define and fully excise the entire region of dysplastic cortex is the most powerful variable influencing outcome in pediatric patients with focal cortical dysplasia. FDG-PET/MRI Coregistration Improves Detection of Cortical Dysplasia in Patients with Epilepsy. Salamon N, Kung J, Shaw SJ, Koo J, Koh S, Wu JY, Lerner JT, Sankar R, Shields WD, Engel J Jr, Fried I, Miyata H, Yong WH, Vinters HV, Mathern GW. Neurology 2008;71(20):1594–1601. OBJECTIVE: Patients with cortical dysplasia (CD) are difficult to treat because the MRI abnormality may be undetectable. This study determined whether fluorodeoxyglucose (FDG)-PET/MRI coregistration enhanced the recognition of CD in epilepsy surgery patients. METHODS: Patients from 2004–2007 in whom FDG-PET/MRI coregistration was a component of the presurgical evaluation were compared with patients from 2000–2003 without this technique. For the 2004–2007 cohort, neuroimaging and clinical variables were compared between patients with mild Palmini type I and severe Palmini type II CD. RESULTS: Compared with the 2000–2003 cohort, from 2004–2007 more CD patients were detected, most had type I CD, and fewer cases required intracranial electrodes. From 2004–2007, 85% of type I CD cases had normal non–University of California, Los Angeles (UCLA) MRI scans. UCLA MRI identified CD in 78% of patients, and 37% of type I CD cases had normal UCLA scans. EEG and neuroimaging findings were concordant in 52% of type I CD patients, compared with 89% of type II CD patients. FDG-PET scans were positive in 71% of CD cases, and type I CD patients had less hypometabolism compared with type II CD patients. Postoperative seizure freedom occurred in 82% of patients, without differences between type I and type II CD cases. CONCLUSIONS: Incorporating fluorodeoxyglucose-PET/MRI coregistration into the multimodality presurgical evaluation enhanced the noninvasive identification and successful surgical treatment of patients with cortical dysplasia (CD), especially for the 33% of patients with nonconcordant findings and those with normal MRI scans from mild type I CD.

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