Usefulness of pulsed arterial spin labeling MR imaging in mesial temporal lobe epilepsy

• Published in: Epilepsy research Vol. 82; no. 2-3; pp. 183 - 189
• Main Authors: Lim, Young-Min, Cho, Yong-Won, Shamim, Sadat, Solomon, Jeffrey, Birn, Rasmus, Luh, Wen Ming, Gaillard, William D., Ritzl, Eva K., Theodore, William H.
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier B.V 01.12.2008; Elsevier
• Subjects: Adolescent; Adult; Algorithms; Anticonvulsants. Antiepileptics. Antiparkinson agents; Arterial spin labeling; Biological and medical sciences; Cerebral blood flow; Cerebrovascular Circulation; Echo-Planar Imaging - methods; Electroencephalography; Epilepsy, Temporal Lobe - diagnostic imaging; Epilepsy, Temporal Lobe - pathology; Epilepsy, Temporal Lobe - physiopathology; Epilepsy, Temporal Lobe - surgery; Feasibility Studies; Female; H215O PET; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Hippocampus - pathology; Hippocampus - physiopathology; Hippocampus - surgery; Humans; Imaging, Three-Dimensional - methods; Magnetic Resonance Angiography - methods; Magnetic resonance imaging; Male; Medical sciences; Middle Aged; Nervous system (semeiology, syndromes); Neurology; Neuropharmacology; Oxygen Radioisotopes; Pharmacology. Drug treatments; Positron-Emission Tomography; Sclerosis; Subtraction Technique; Temporal Lobe - blood supply; Temporal Lobe - diagnostic imaging; Temporal lobe epilepsy; Young Adult; Temporal lobe epilepsy; Magnetic resonance imaging; Cerebral blood flow; H215O PET; Arterial spin labeling; H 2 15O PET; Nervous system diseases; Central nervous system; Complex partial epilepsy; Nuclear magnetic resonance imaging; Cerebral disorder; Blood flow; Encephalon; H2150 PET; Central nervous system disease; Spin labeling; Hemodynamics; Positron emission tomography; Emission tomography
• ISSN: 0920-1211; 1872-6844; 1872-6844
• DOI: 10.1016/j.eplepsyres.2008.08.001

Arterial spin labeling (ASL) is a developing magnetic resonance imaging (MRI) method for noninvasive measurement of cerebral blood flow (CBF). The purpose of this study was to evaluate the usefulness of ASL for detecting interictal temporal hypoperfusion in temporal lobe epilepsy (TLE). ASL-derived CBF measurements were compared with those derived from H215O positron emission tomography (PET). 11 normal controls and 10 patients with medically intractable TLE were studied. Pulsed ASL (PASL) with quantitative imaging of perfusion using a single subtraction, second version (QUIPSS II) was performed in all subjects and H215O PET was performed in patients. Regional CBF values in the mesial and lateral temporal lobes were measured utilizing quantitative analysis of perfusion images. A perfusion asymmetry index (AI) was calculated for each region. In patients, mean CBF in the mesial temporal lobe was not significantly different between PASL and H215O PET, and ipsilateral mesial temporal CBF was lower than contralateral CBF with both techniques. PASL detected significant mesial temporal perfusion asymmetry agreeing with EEG laterality in four patients. H215O PET found ipsilateral interictal hypoperfusion in three. Both scans found unilateral hypoperfusion in one patient with bilateral EEG discharges. Pulsed ASL may be a promising approach to detecting interictal hypoperfusion in TLE. This method has potential as a clinical alternative to H215O PET due to noninvasiveness and easy accessibility.