Abstract
Arterial spin labeling (ASL) is an MRI technique measuring brain perfusion using magnetically labeled blood as a tracer. The clinical utility of ASL for presurgical evaluation in non-lesional epilepsy as compared with the quantitative analysis of interictal [18F] fluorodeoxyglucose PET (FDG-PET) was studied. In 10 patients (4 female; median age 29 years) who underwent a complete presurgical evaluation followed by surgical resection, the presurgical FDG-PET and ASL scans were compared with the resection masks using asymmetry index (AI) maps. The positive predictive value (PPV) and sensitivity (SEN), were calculated from the number of voxels inside the mask (true positive), and outside the mask (false positive). The comparison of the PPVs showed better PPV in 6 patients using ASL and in 2 patients with PET. SEN was better in 4 patients using ASL and in 5 patients with PET. According to the Wilcoxon signed rank test for PPV (p = 0.74) and for SEN (p = 0.43), these methods have similar predictive power. ASL is a useful method for presurgical evaluation in non-lesional epilepsy. The main benefits of ASL over PET are that it avoids radiation exposure for patients, and it offers lower costs, higher availability, and better time efficiency.
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Data Availability
The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.
Abbreviations
- ASL:
-
Arterial spin labelling
- PET:
-
Positron emission tomography
- AI:
-
Asymmetry index
- CBF:
-
Cerebral blood flow
- TLE:
-
Temporal lobe epilepsy
- ROI:
-
Region of interest
- MRI:
-
Magnetic resonance imaging
- PPV:
-
Positive predictive value
- SEN:
-
Sensitivity
References
Alsop DC, Detre JA, Golay X et al (2015) Recommended implementation of arterial spin-labeled perfusion MRI for clinical applications: A consensus of the ISMRM perfusion study group and the European consortium for ASL in dementia. Magn Reson Med 73:102–116. https://doi.org/10.1002/mrm.25197
Blauwblomme T, Boddaert N, Chémaly N et al (2014) Arterial Spin Labeling MRI: a step forward in non-invasive delineation of focal cortical dysplasia in children. Epilepsy Res 108:1932–1939. https://doi.org/10.1016/j.eplepsyres.2014.09.029
Eryurt B, Oner AY, Ucar M et al (2015) Presurgical evaluation of mesial temporal lobe epilepsy with multiple advanced MR techniques at 3T. J Neuroradiol 42:283–290. https://doi.org/10.1016/j.neurad.2015.04.002
Fink GR, Pawlik G, Stefan H et al (1996) Temporal lobe epilepsy: Evidence for interictal uncoupling of blood flow and glucose metabolism in temporomesial structures. J Neurol Sci 137:28–34. https://doi.org/10.1016/0022-510X(95)00323-T
Galazzo IB, Storti SF, Felice AD et al (2015) Patient-specific detection of cerebral blood flow alterations as assessed by arterial spin labeling in drug-resistant epileptic patients. PLoS ONE 10:e0123975. https://doi.org/10.1371/journal.pone.0123975
Galazzo IB, Mattoli MV, Pizzini FB et al (2016) Cerebral metabolism and perfusion in MR-negative individuals with refractory focal epilepsy assessed by simultaneous acquisition of 18F-FDG PET and arterial spin labeling. NeuroImage Clin 11:648–657. https://doi.org/10.1016/j.nicl.2016.04.005
Kashyap R, Dondi M, Paez D, Mariani G (2013) Hybrid imaging worldwide—challenges and opportunities for the developing world: a report of a technical meeting organized by IAEA. Semin Nucl Med 43:208–223. https://doi.org/10.1053/j.semnuclmed.2013.02.001
Kim BS, Lee S-T, Yun TJ et al (2016) Capability of arterial spin labeling MR imaging in localizing seizure focus in clinical seizure activity. Eur J Radiol 85:1295–1303. https://doi.org/10.1016/j.ejrad.2016.04.015
Kojan M, Doležalová I, Koriťáková E et al (2018) Predictive value of preoperative statistical parametric mapping of regional glucose metabolism in mesial temporal lobe epilepsy with hippocampal sclerosis. Epilepsy Behav 79:46–52. https://doi.org/10.1016/j.yebeh.2017.11.014
Lee SM, Kwon S, Lee YJ (2019) Diagnostic usefulness of arterial spin labeling in MR negative children with new onset seizures. Seizure 65:151–158. https://doi.org/10.1016/j.seizure.2019.01.024
Li X, Wang D, Auerbach EJ et al (2015) Theoretical and experimental evaluation of multi-band EPI for high-resolution whole brain pCASL Imaging. Neuroimage 106:170–181. https://doi.org/10.1016/j.neuroimage.2014.10.029
Lim Y-M, Cho Y-W, Shamim S et al (2008) Usefulness of pulsed arterial spin labeling MR imaging in mesial temporal lobe epilepsy. Epilepsy Res 82:183–189. https://doi.org/10.1016/j.eplepsyres.2008.08.001
Maldjian JA, Laurienti PJ, Kraft RA, Burdette JH (2003) An automated method for neuroanatomic and cytoarchitectonic atlas-based interrogation of fMRI data sets. Neuroimage 19:1233–1239. https://doi.org/10.1016/S1053-8119(03)00169-1
Mutsaerts HJMM, Petr J, Groot P et al (2020) ExploreASL: an image processing pipeline for multi-center ASL perfusion MRI studies. Neuroimage. https://doi.org/10.1016/j.neuroimage.2020.117031
Rathore C, Dickson JC, Teotónio R et al (2014) The utility of 18F-fluorodeoxyglucose PET (FDG PET) in epilepsy surgery. Epilepsy Res 108:1306–1314. https://doi.org/10.1016/j.eplepsyres.2014.06.012
Signorini M, Paulesu E, Friston K et al (1999) Rapid Assessment of regional cerebral metabolic abnormalities in single subjects with quantitative and nonquantitative [18F]FDG PET: a clinical validation of statistical parametric mapping. Neuroimage 9:63–80. https://doi.org/10.1006/nimg.1998.0381
Soma T, Momose T, Takahashi M et al (2012) Usefulness of extent analysis for statistical parametric mapping with asymmetry index using inter-ictal FGD-PET in mesial temporal lobe epilepsy. Ann Nucl Med 26:319–326. https://doi.org/10.1007/s12149-012-0573-8
Sone D, Maikusa N, Sato N et al (2019) Similar and differing distributions between 18F-FDG-PET and arterial spin labeling imaging in temporal lobe epilepsy. Front Neurol. https://doi.org/10.3389/fneur.2019.00318
Wang Y-H, An Y, Fan X-T et al (2018) 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 Clin 19:824–830. https://doi.org/10.1016/j.nicl.2018.06.008
Wolf RL, Alsop DC, Levy-Reis I et al (2001) Detection of mesial temporal lobe hypoperfusion in patients with temporal lobe epilepsy by use of arterial spin labeled perfusion MR imaging. AJNR Am J Neuroradiol 22:1334–1341
Wolf RL, Detre JA (2007) Clinical Neuroimaging Using Arterial Spin-Labeled Perfusion MRI. Neurother J Am Soc Exp Neurother 4:346–359. https://doi.org/10.1016/j.nurt.2007.04.005
Funding
Supported by Ministry of Health of the Czech Republic, Grant No. 17-32292AZV. All rights reserved; MH CZ – DRO (MMCI, 00209805), LO 1413. We acknowledge the core facility CF MAFIL, supported by the Czech-BioImaging large RI project (LM2018129 funded by MEYS CR), for their support with obtaining scientific data presented in this paper.
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Kojan, M., Gajdoš, M., Říha, P. et al. Arterial Spin Labeling is a Useful MRI Method for Presurgical Evaluation in MRI-Negative Focal Epilepsy. Brain Topogr 34, 504–510 (2021). https://doi.org/10.1007/s10548-021-00833-5
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DOI: https://doi.org/10.1007/s10548-021-00833-5