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Tada Y, Fujihara T, Shimada K, Yamamoto N, Yamazaki H, Izumi Y, Harada M, Kanematsu Y, Takagi Y. Seizure types associated with negative arterial spin labeling and positive diffusion-weighted imaging on peri-ictal magnetic resonance imaging. J Neurol Sci 2022; 436:120223. [DOI: 10.1016/j.jns.2022.120223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/23/2022] [Accepted: 03/03/2022] [Indexed: 11/15/2022]
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2
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Buch K, Hakimelahi R, Locascio JJ, Bolar DS, Gonzalez RG, Schaefer PW. Clinical utility of arterial spin labeling perfusion images in the emergency department for the work-up of stroke-like symptoms. Neuroradiology 2021; 64:925-934. [PMID: 34664110 DOI: 10.1007/s00234-021-02835-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/11/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the utility of ASL in evaluating patients presenting to the ED with stroke-like symptoms. METHODS ASL and DWI images from 526 consecutive patients presenting to the ED with acute stroke symptoms were retrospectively reviewed. DWI images were evaluated for volume of restricted diffusion using ABC/2. ASL maps were evaluated for decreased, normal, or increased signal. The volume of decreased ASL signal was calculated using the same ABC/2 technique. The volume of decreased ASL signal was correlated with the volume of DWI signal abnormality to identify cases of mismatch (DWI:ASL ratio > 1.8) and to correlate this mismatch with infarct growth on imaging follow-up. NIHSS, length of hospital stay, mRS, and future admission for acute stroke-like symptoms were recorded. Correlations between ASL abnormalities and clinical parameters were evaluated using a two-tailed t-test. RESULTS Of the 526 patients presenting with acute stroke symptoms, 136 patients had an abnormal ASL scan and 388 patients had a normal ASL scan. Of the 136 patients with abnormal ASL, 84 patients had low ASL signal with 79 of these being related to acute infarcts. Elevated ASL signal was seen in 52 patients, of which 30 of these patients had reperfusion hyperemia related to acute infarctions. ASL had a negative predictive value of 94% for evaluating patients with acute ischemic stroke. A subset of patients with abnormal ASL scans with a discharge diagnosis of acute infarction were found to have an ASL:DWI mismatch (ratio > 1.8) and demonstrated significant lesion growth on follow-up imaging (57%). This included some patients who exhibited low ASL signal before development of diffusion restriction (infarction). CONCLUSION In patients presenting to the ED with acute stroke symptoms, ASL provides information not available with DWI alone. The NPV of ASL for evaluating patients with acute ischemia was 94%.
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Affiliation(s)
- Karen Buch
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Gray 241 G, Boston, MA, 02114, USA.
| | - Reza Hakimelahi
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Gray 241 G, Boston, MA, 02114, USA
| | - Joseph J Locascio
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Divya S Bolar
- Department of Radiology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - R Giliberto Gonzalez
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Gray 241 G, Boston, MA, 02114, USA
| | - Pamela W Schaefer
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Gray 241 G, Boston, MA, 02114, USA
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3
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Perera T, Gaxiola-Valdez I, Singh S, Peedicail J, Sandy S, Lebel RM, Li E, Milne-Ives M, Szostakiwskyj J, Federico P. Localizing the seizure onset zone by comparing patient postictal hypoperfusion to healthy controls. J Neurosci Res 2020; 98:1517-1531. [PMID: 32476173 DOI: 10.1002/jnr.24646] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 04/23/2020] [Accepted: 05/03/2020] [Indexed: 11/10/2022]
Abstract
Arterial spin labeling (ASL) MRI can provide seizure onset zone (SOZ) localizing information in up to 80% of patients. Clinical implementation of this technique is limited by the need to obtain two scans per patient: a postictal scan that is subtracted from an interictal scan. We aimed to determine whether it is possible to limit the number of ASL scans to one per patient by comparing patient postictal ASL scans to baseline scans of 100 healthy controls. Eighteen patients aged 20-55 years underwent ASL MRI <90 min after a seizure and during the interictal period. Each postictal cerebral blood flow (CBF) map was statistically compared to average baseline CBF maps from 100 healthy controls (pvcASL; patient postictal CBF vs. control baseline CBF). The pvcASL maps were compared to subtraction ASL maps (sASL; patient baseline CBF minus patient postictal CBF). Postictal CBF reductions from pvcASL and sASL maps were seen in 17 of 18 (94.4%) and 14 of 18 (77.8%) patients, respectively. Maximal postictal hypoperfusion seen in pvcASL and sASL maps was concordant with the SOZ in 10 of 17 (59%) and 12 of 14 (86%) patients, respectively. In seven patients, both pvcASL and sASL maps showed similar results. In two patients, sASL showed no significant hypoperfusion, while pvcASL showed significant hypoperfusion concordant with the SOZ. We conclude that pvcASL is clinically useful and although it may have a lower overall concordance rate than sASL, pvcASL does provide localizing or lateralizing information for specific cases that would be otherwise missed through sASL.
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Affiliation(s)
- Tefani Perera
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Seaman Family MR Research Centre, University of Calgary, Calgary, AB, Canada
| | - Ismael Gaxiola-Valdez
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Seaman Family MR Research Centre, University of Calgary, Calgary, AB, Canada
| | - Shaily Singh
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Joseph Peedicail
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sherry Sandy
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - R Marc Lebel
- GE Healthcare, Calgary, Calgary, AB, Canada.,Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Emmy Li
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Seaman Family MR Research Centre, University of Calgary, Calgary, AB, Canada
| | - Madison Milne-Ives
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Seaman Family MR Research Centre, University of Calgary, Calgary, AB, Canada
| | | | - Paolo Federico
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Seaman Family MR Research Centre, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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4
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Shirozu N, Morioka T, Tokunaga S, Shimogawa T, Inoue D, Arihiro S, Sakata A, Mukae N, Haga S, Iihara K. Comparison of pseudocontinuous arterial spin labeling perfusion MR images and time-of-flight MR angiography in the detection of periictal hyperperfusion. eNeurologicalSci 2020; 19:100233. [PMID: 32181377 PMCID: PMC7062933 DOI: 10.1016/j.ensci.2020.100233] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 02/28/2020] [Accepted: 03/03/2020] [Indexed: 12/02/2022] Open
Abstract
Background Magnetic resonance imaging (MRI), including perfusion MRI with three-dimensional pseudocontinuous arterial spin labeling (ASL) and diffusion-weighted imaging (DWI), are applied in the periictal (including ictal and postictal) detection of circulatory and metabolic consequences associated with epilepsy. Our previous report revealed that periictal hyperperfusion can firstly be detected on ASL, and cortical hyperintensity of cytotoxic edema secondarily obtained on DWI from an epileptically activated cortex. Although magnetic resonance angiography (MRA) using three-dimensional time-of-flight is widely used to evaluate arterial circulation, few MRA studies have investigated the detection of periictal hyperperfusion. Methods To compare the ability of ASL and MRA to detect the periictal hyperperfusion on visual inspection, we retrospectively selected 23 patients who underwent ASL and MRA examination on both periictal and interictal periods. Patients were divided into the following three groups according to periictal ASL/DWI findings: positive ASL and DWI findings (n = 13, ASL+/DWI+ group), positive ASL and negative DWI findings (n = 5, ASL+/DWI- group), and negative ASL and DWI findings (n = 5, ASL-/DWI- group). Results Periictal hyperperfusion on MRA was detected in 6 out of 13 patients (46.2%) in the ASL+/DWI+ group, but not in all patients in the ASL+/DWI- and ASL-/DWI- groups. Furthermore, in 5 out of these 6 patients, the diagnosis of periictal MRA hyperperfusion could not be made without referring to interictal MRA and/or periictal ASL findings, because the periictal MRA findings were so minute. Conclusion The minimum requirement for the development of periictal MRA hyperperfusion is that its epileptic event is intense enough to induce the uncoupling between metabolism and circulation, with the induction of glutamate excitotoxity, and severe cytotoxic edema on DWI. ASL is vastly superior to MRA in the detection of periictal hyperperfusion. ASL is superior to MRA in the detection of periictal hyperperfusion. Marked DWI hyperintensity is required to develop the MRA hyperperfusion.
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Affiliation(s)
- Noritoshi Shirozu
- Department of Neurosurgery, Kyushu Rosai Hospital, 1-1 Sonekitamachi, Kokura Minami-Ku, Kitakyushu, Japan.,Department of Neurosurgery, Graduate School of Medical Sciences, Kyusyu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
| | - Takato Morioka
- Department of Neurosurgery, Kyushu Rosai Hospital, 1-1 Sonekitamachi, Kokura Minami-Ku, Kitakyushu, Japan.,Department of Neurosurgery, Fukuoka Children's Hospital, 5-1-1 Kashiiteriha, Higashi-ku, Fukuoka, Japan
| | - So Tokunaga
- Department of Neurosurgery, Kyushu Rosai Hospital, 1-1 Sonekitamachi, Kokura Minami-Ku, Kitakyushu, Japan.,Department of Neurosurgery, Graduate School of Medical Sciences, Kyusyu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
| | - Takafumi Shimogawa
- Department of Neurosurgery, Kyushu Rosai Hospital, 1-1 Sonekitamachi, Kokura Minami-Ku, Kitakyushu, Japan.,Department of Neurosurgery, Graduate School of Medical Sciences, Kyusyu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
| | - Daisuke Inoue
- Department of Neurosurgery, Kyushu Rosai Hospital, 1-1 Sonekitamachi, Kokura Minami-Ku, Kitakyushu, Japan
| | - Shoji Arihiro
- Department of Cerebrovascular Disease, Kyushu Rosai Hospital, 1-1 Sonekitamachi, Kokura Minami-Ku, Kitakyushu, Japan
| | - Ayumi Sakata
- Department of Clinical Chemistry and Laboratory Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
| | - Nobutaka Mukae
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyusyu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
| | - Sei Haga
- Department of Neurosurgery, Kyushu Rosai Hospital, 1-1 Sonekitamachi, Kokura Minami-Ku, Kitakyushu, Japan
| | - Koji Iihara
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyusyu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
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5
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Larkin JR, Simard MA, Khrapitchev AA, Meakin JA, Okell TW, Craig M, Ray KJ, Jezzard P, Chappell MA, Sibson NR. Quantitative blood flow measurement in rat brain with multiphase arterial spin labelling magnetic resonance imaging. J Cereb Blood Flow Metab 2019; 39:1557-1569. [PMID: 29498562 PMCID: PMC6681434 DOI: 10.1177/0271678x18756218] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 12/01/2017] [Accepted: 12/22/2017] [Indexed: 11/29/2022]
Abstract
Cerebral blood flow is an important parameter in many diseases and functional studies that can be accurately measured in humans using arterial spin labelling (ASL) MRI. However, although rat models are frequently used for preclinical studies of both human disease and brain function, rat CBF measurements show poor consistency between studies. This lack of reproducibility is due, partly, to the smaller size and differing head geometry of rats compared to humans, as well as the differing analysis methodologies employed and higher field strengths used for preclinical MRI. To address these issues, we have implemented, optimised and validated a multiphase pseudo-continuous ASL technique, which overcomes many of the limitations of rat CBF measurement. Three rat strains (Wistar, Sprague Dawley and Berlin Druckrey IX) were used, and CBF values validated against gold-standard autoradiography measurements. Label positioning was found to be optimal at 45°, while post-label delay was optimised to 0.55 s. Whole brain CBF measures were 109 ± 22, 111 ± 18 and 100 ± 15 mL/100 g/min by multiphase pCASL, and 108 ± 12, 116 ± 14 and 122 ± 16 mL/100 g/min by autoradiography in Wistar, SD and BDIX cohorts, respectively. Tumour model analysis shows that the developed methods also apply in disease states. Thus, optimised multiphase pCASL provides robust, reproducible and non-invasive measurement of CBF in rats.
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Affiliation(s)
- James R Larkin
- Department of Oncology, Cancer Research
UK & Medical Research Council Oxford Institute for Radiation Oncology,
University of Oxford, Oxford, UK
| | - Manon A Simard
- Department of Oncology, Cancer Research
UK & Medical Research Council Oxford Institute for Radiation Oncology,
University of Oxford, Oxford, UK
| | - Alexandre A Khrapitchev
- Department of Oncology, Cancer Research
UK & Medical Research Council Oxford Institute for Radiation Oncology,
University of Oxford, Oxford, UK
| | - James A Meakin
- Wellcome Centre for Integrative
Neuroimaging, FMRIB Division, University of Oxford, John Radcliffe Hospital,
Headington, Oxford, UK
| | - Thomas W Okell
- Wellcome Centre for Integrative
Neuroimaging, FMRIB Division, University of Oxford, John Radcliffe Hospital,
Headington, Oxford, UK
| | - Martin Craig
- Institute of Biomedical Engineering,
University of Oxford, Oxford, UK
| | - Kevin J Ray
- Department of Oncology, Cancer Research
UK & Medical Research Council Oxford Institute for Radiation Oncology,
University of Oxford, Oxford, UK
| | - Peter Jezzard
- Wellcome Centre for Integrative
Neuroimaging, FMRIB Division, University of Oxford, John Radcliffe Hospital,
Headington, Oxford, UK
| | | | - Nicola R Sibson
- Department of Oncology, Cancer Research
UK & Medical Research Council Oxford Institute for Radiation Oncology,
University of Oxford, Oxford, UK
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6
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Nagesh C, Kumar S, Menon R, Thomas B, Radhakrishnan A, Kesavadas C. The Imaging of Localization Related Symptomatic Epilepsies: The Value of Arterial Spin Labelling Based Magnetic Resonance Perfusion. Korean J Radiol 2018; 19:965-977. [PMID: 30174487 PMCID: PMC6082755 DOI: 10.3348/kjr.2018.19.5.965] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 03/19/2018] [Indexed: 11/15/2022] Open
Abstract
Accurate identification of the epileptogenic zone is an important prerequisite in presurgical evaluation of refractory epilepsy since it affects seizure-free outcomes. Apart from structural magnetic resonance imaging (sMRI), delineation has been traditionally done with electroencephalography and nuclear imaging modalities. Arterial spin labelling (ASL) sequence is a non-contrast magnetic resonance perfusion technique capable of providing similar information. Similar to single-photon emission computed tomography, its utility in epilepsy is based on alterations in perfusion linked to seizure activity by neurovascular coupling. In this article, we discuss complementary value that ASL can provide in the evaluation and characterization of some basic substrates underlying epilepsy. We also discuss the role that ASL may play in sMRI negative epilepsy and acute scenarios such as status epilepticus.
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Affiliation(s)
- Chinmay Nagesh
- Department of Imaging Sciences & Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences & Technology (SCTIMST), Trivandrum 695011, India
| | - Savith Kumar
- Department of Imaging Sciences & Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences & Technology (SCTIMST), Trivandrum 695011, India
| | - Ramshekhar Menon
- Comprehensive Epilepsy Centre, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences & Technology (SCTIMST), Trivandrum 695011, India
| | - Bejoy Thomas
- Department of Imaging Sciences & Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences & Technology (SCTIMST), Trivandrum 695011, India
| | - Ashalatha Radhakrishnan
- Comprehensive Epilepsy Centre, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences & Technology (SCTIMST), Trivandrum 695011, India
| | - Chandrasekharan Kesavadas
- Department of Imaging Sciences & Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences & Technology (SCTIMST), Trivandrum 695011, India
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7
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Won J, Choi DS, Hong SJ, Shin HS, Baek HJ, Choi HC, Kim M, Kim RB. Crossed cerebellar hyperperfusion in patients with seizure-related cerebral cortical lesions: an evaluation with arterial spin labelling perfusion MR imaging. Radiol Med 2018; 123:843-850. [PMID: 30006765 DOI: 10.1007/s11547-018-0921-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 07/09/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE Crossed cerebellar (CC) diaschisis refers to a decrease in cerebellar perfusion in the presence of contralateral supratentorial lesions. Most of the previous studies have examined stroke patients. In contrast to strokes, seizure-related cerebral cortical lesions (SCCLs) usually show hyperperfusion, and therefore, cerebellar perfusion patterns are expected to be different from those of strokes. With arterial spin labelling (ASL), we evaluated the cerebellar perfusion status in patients with SCCLs. MATERIALS AND METHODS Using a search of the recent database over the last 31 months, 26 patients were enrolled in this study. The inclusion criteria were as follows: (1) a history of seizures, (2) MR examination taken within 24 h from the last seizure, (3) the presence of SCCLs on T2/FLAIR or DWI, (4) hyperperfusion in the corresponding areas of SCCLs on ASL, and (5) no structural abnormality in the cerebellum. The perfusion status in the contralateral cerebellum was evaluated and categorized as hyper-, iso- and hypoperfusion. The asymmetric index (AI) of cerebellar perfusion was calculated by ROI measurement of the signal intensity on ASL. RESULTS The mean time between the last seizure and MR examinations was 5 h 30 min. CC hyperperfusion was observed in 17 patients (65.4%), hypoperfusion in 7 (26.9%) and isoperfusion in 2 (7.7%). Regarding the location of SCCLs, CC hyperperfusion was more frequent (71.4 vs. 58.3%), and the mean AI was higher (42.0 vs. 11.5) when the lesion involved the frontal lobe. CONCLUSIONS In patients with SCCLs, CC hyperperfusion occurred more often than hypo- and isoperfusion, especially when the lesions involved the frontal lobe.
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Affiliation(s)
- Jungho Won
- Department of Radiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, 90 Chilam-dong, Jinju, 660-702, Republic of Korea
| | - Dae Seob Choi
- Department of Radiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, 90 Chilam-dong, Jinju, 660-702, Republic of Korea. .,Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.
| | - Seok Jin Hong
- Department of Radiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, 90 Chilam-dong, Jinju, 660-702, Republic of Korea
| | - Hwa Seon Shin
- Department of Radiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, 90 Chilam-dong, Jinju, 660-702, Republic of Korea
| | - Hye Jin Baek
- Department of Radiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, 90 Chilam-dong, Jinju, 660-702, Republic of Korea
| | - Ho Cheol Choi
- Department of Radiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, 90 Chilam-dong, Jinju, 660-702, Republic of Korea
| | - Minjung Kim
- Department of Neurology, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Rock Bum Kim
- Department of Preventive Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
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8
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Takahara K, Morioka T, Shimogawa T, Haga S, Kameda K, Arihiro S, Sakata A, Mukae N, Iihara K. Hemodynamic state of periictal hyperperfusion revealed by arterial spin-labeling perfusion MR images with dual postlabeling delay. eNeurologicalSci 2018; 12:5-18. [PMID: 30229134 PMCID: PMC6141304 DOI: 10.1016/j.ensci.2018.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 06/20/2018] [Indexed: 01/07/2023] Open
Abstract
Background Magnetic resonance imaging (MRI), including perfusion MRI with arterial spin labeling (ASL) and diffusion-weighted imaging (DWI), are applied in the periictal detection of circulatory and metabolic consequences associated with epilepsy. Although previous report revealed that prolonged ictal hyperperfusion on ASL can be firstly detected and cortical hyperintensity of cytotoxic edema on DWI secondarily obtained from an epileptically activated cortex, the hemodynamic state of the periictal hyperperfusion has not been fully demonstrated. Methods study-1 We retrospectively analyzed the relationship between seizure manifestations and the development of periictal MRI findings, in Case 1 with symptomatic partial epilepsy, who underwent repeated periictal ASL/DWI examination for three epileptic ictuses (one examination for each ictus). Study-2: We evaluated the hemodynamic state of periictal hyperperfusion with the ASL technique using a dual postlabeling delay (PLD) of 1.5 and 2.5 s in nine patients, according to the presence or absence of the localized epileptogenic lesion (EL) on conventional 3 T-MRI, who were divided into Group EL+ (six patients) and Group EL- (three patients). Results Study-1 confirmed that the stratified representation of the periictal MRI findings depends on the time interval between the ictal cessation and MRI examination in addition to the magnitude and duration of the epileptic activity. In Study-2, two types of periictal hyperperfusion were noted. In all six Group EL+ patients, periictal ASL findings showed "fast flow type". Markedly increased ASL signals were noted at the epileptically activated cortex, having a tight topographical relationship with EL, on ASL with a PLD of 1.5 s, which is decreased on ASL with a PLD of 2.5 s. In all three Group EL- patients, periictal ASL findings showed "gradual flow type", which is characterized by gradual signal increase of the epileptically activated cortex on ASL with a PLD of 1.5 and 2.5 s. Conclusion We confirmed that ASL hyperperfusion is superior to DWI in the periictal detection of epileptic events. ASL with dual PLD offers the ability to document two types of hemodynamics of periictal hyperperfusion.
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Key Words
- ASL, arterial spin labeling
- ATA, arterial transit artifact
- ATT, arterial transit time
- Arterial spin labeling
- CBF, cerebral blood flow
- CT, computed tomography
- Cytotoxic edema
- DWI, diffusion-weighted imaging
- Diffusion-weighted image
- EEG, electroencephalography
- EL, epileptogenic lesion
- FLAIR, fluid attenuated inversion recovery
- Ictal hyperperfusion
- MRI, magnetic resonance imaging
- PLD, postlabeling delay
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Affiliation(s)
- Kenta Takahara
- Department of Neurosurgery, Kyushu Rosai Hospital, 1-1 Sonekitamachi, Kokura Minami-Ku, Kitakyushu, Japan.,Department of Neurosurgery, Graduate School of Medical Sciences, Kyusyu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
| | - Takato Morioka
- Department of Neurosurgery, Kyushu Rosai Hospital, 1-1 Sonekitamachi, Kokura Minami-Ku, Kitakyushu, Japan.,Department of Neurosurgery, Fukuoka Children's Hospital, 5-1-1 Kashiiteriha, Higashi-ku, Fukuoka, Japan
| | - Takafumi Shimogawa
- Department of Neurosurgery, Kyushu Rosai Hospital, 1-1 Sonekitamachi, Kokura Minami-Ku, Kitakyushu, Japan.,Department of Neurosurgery, Graduate School of Medical Sciences, Kyusyu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan.,Department of Neurosurgery, Fukuoka Children's Hospital, 5-1-1 Kashiiteriha, Higashi-ku, Fukuoka, Japan
| | - Sei Haga
- Department of Neurosurgery, Kyushu Rosai Hospital, 1-1 Sonekitamachi, Kokura Minami-Ku, Kitakyushu, Japan
| | - Katsuharu Kameda
- Department of Neurosurgery, Kyushu Rosai Hospital, 1-1 Sonekitamachi, Kokura Minami-Ku, Kitakyushu, Japan
| | - Shoji Arihiro
- Department of Cerebrovascular Disease, Kyushu Rosai Hospital, 1-1 Sonekitamachi, Kokura Minami-Ku, Kitakyushu, Japan
| | - Ayumi Sakata
- Department of Clinical Chemistry and Laboratory Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
| | - Nobutaka Mukae
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyusyu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
| | - Koji Iihara
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyusyu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
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9
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Zhao Y, Li X, Zhang K, Tong T, Cui R. The Progress of Epilepsy after Stroke. Curr Neuropharmacol 2018; 16:71-78. [PMID: 28606039 PMCID: PMC5771387 DOI: 10.2174/1570159x15666170613083253] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/14/2017] [Accepted: 05/02/2017] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Epilepsy is the second most common disease caused by multiple factors and characterized by an excessive discharge of certain neurons in the nervous system. Cerebrovascular disease, including stroke, is viewed as the most common cause of epilepsy in the elderly population, accounting for 30%-50% of the newly diagnosed cases of epilepsy cases in this age group. METHODS Data were collected from Web of Science, Medline, Pubmed, Scopus, through searching of these keywords: "Stroke" and "epilepsy". RESULTS Depending on the underlying cerebrovascular disease, 3%-30% of patients after stroke may develop post-stroke epilepsy (PSE), which has a negative effect on stroke prognosis and the quality of life. CONCLUSION In this review, we summarized new aspects emerging from research into PSE, including definition, epidemiology, risk factors, mechanism, accessory examination and treatment strategies for post-stroke epilepsy, which will enrich our knowledge of this disorder.
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Affiliation(s)
- Yinghao Zhao
- Department of Thoracic Surgery, the Second Hospital of Jilin University; Jilin Provincial Key Laboratory on Molecular and Chemical Genetic, Changchun, Jilin, P.R. China
| | - Xiangyan Li
- Center of Chinese Medicine and Bio-Engineering Research and Development, Changchun University of Chinese Medicine, The Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, Jilin, P.R. China
| | - Kun Zhang
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetic, the Second Hospital of Jilin University, 218 Ziqiang Street, Changchun130041, P.R. China
| | - Ti Tong
- Department of Thoracic Surgery, the Second Hospital of Jilin University; Jilin Provincial Key Laboratory on Molecular and Chemical Genetic, Changchun, Jilin, P.R. China
| | - Ranji Cui
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetic, the Second Hospital of Jilin University, 218 Ziqiang Street, Changchun130041, P.R. China
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10
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Gaxiola-Valdez I, Singh S, Perera T, Sandy S, Li E, Federico P. Seizure onset zone localization using postictal hypoperfusion detected by arterial spin labelling MRI. Brain 2017; 140:2895-2911. [PMID: 29053782 DOI: 10.1093/brain/awx241] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 08/03/2017] [Indexed: 11/15/2022] Open
Abstract
Neurological dysfunction following epileptic seizures is a well-recognized phenomenon. Several potential mechanisms have been suggested to explain postictal dysfunction, with alteration in cerebral blood flow being one possibility. These vascular disturbances may be long lasting and localized to brain areas involved in seizure generation and propagation, as supported by both animal and human studies. Therefore, measuring perfusion changes in the postictal period may help localize the seizure onset zone. Arterial spin labelling is a non-invasive, rapid and reproducible magnetic resonance imaging technique that measures cerebral perfusion. To this end, we measured postictal perfusion in patients with drug resistant focal epilepsy who were admitted to our seizure-monitoring unit for presurgical evaluation. Twenty-one patients were prospectively recruited and underwent arterial spin labelling scanning within 90 min of a habitual seizure. Patients also underwent a similar scan in the interictal period, after they were seizure-free for at least 24 h. The acquired scans were subtracted to identify the areas of significant postictal hypoperfusion. The location of the maximal hypoperfusion was compared to the presumed seizure onset zone to assess for concordance. Also, the localizing value of this technique was compared to other structural and functional imaging modalities. Postictal perfusion reductions of >15 units (ml/100 g/l) were seen in 15/21 patients (71.4%). In 12/15 (80%) of these patients, the location of the hypoperfusion was partially or fully concordant with the location of the presumed seizure onset zone. This technique compared favourably to other neuroimaging modalities, being similar or superior to structural magnetic resonance imaging in 52% of cases, ictal single-photon emission computed tomography in 60% of cases and interictal positron emission tomography in 71% of cases. Better arterial spin labelling results were obtained in patients in whom the seizure onset zone was discernible based on non-invasive data. Thus, this technique is a safe, non-invasive and relatively inexpensive tool to detect postictal hypoperfusion that may provide useful data to localize the seizure onset zone. This technique may be incorporated into the battery of conventional investigations for presurgical evaluation of patients with drug resistant focal epilepsy.
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Affiliation(s)
- Ismael Gaxiola-Valdez
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,Seaman Family MR Research Centre, University of Calgary, Calgary, Canada
| | - Shaily Singh
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Tefani Perera
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,Seaman Family MR Research Centre, University of Calgary, Calgary, Canada
| | - Sherry Sandy
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Emmy Li
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,Seaman Family MR Research Centre, University of Calgary, Calgary, Canada.,Department of Neuroscience, University of Calgary, Calgary, Canada
| | - Paolo Federico
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,Seaman Family MR Research Centre, University of Calgary, Calgary, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.,Department of Neuroscience, University of Calgary, Calgary, Canada.,Department of Radiology, University of Calgary, Calgary, Canada
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11
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Haller S, Zaharchuk G, Thomas DL, Lovblad KO, Barkhof F, Golay X. Arterial Spin Labeling Perfusion of the Brain: Emerging Clinical Applications. Radiology 2017; 281:337-356. [PMID: 27755938 DOI: 10.1148/radiol.2016150789] [Citation(s) in RCA: 323] [Impact Index Per Article: 46.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Arterial spin labeling (ASL) is a magnetic resonance (MR) imaging technique used to assess cerebral blood flow noninvasively by magnetically labeling inflowing blood. In this article, the main labeling techniques, notably pulsed and pseudocontinuous ASL, as well as emerging clinical applications will be reviewed. In dementia, the pattern of hypoperfusion on ASL images closely matches the established patterns of hypometabolism on fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) images due to the close coupling of perfusion and metabolism in the brain. This suggests that ASL might be considered as an alternative for FDG, reserving PET to be used for the molecular disease-specific amyloid and tau tracers. In stroke, ASL can be used to assess perfusion alterations both in the acute and the chronic phase. In arteriovenous malformations and dural arteriovenous fistulas, ASL is very sensitive to detect even small degrees of shunting. In epilepsy, ASL can be used to assess the epileptogenic focus, both in peri- and interictal period. In neoplasms, ASL is of particular interest in cases in which gadolinium-based perfusion is contraindicated (eg, allergy, renal impairment) and holds promise in differentiating tumor progression from benign causes of enhancement. Finally, various neurologic and psychiatric diseases including mild traumatic brain injury or posttraumatic stress disorder display alterations on ASL images in the absence of visualized structural changes. In the final part, current limitations and future developments of ASL techniques to improve clinical applicability, such as multiple inversion time ASL sequences to assess alterations of transit time, reproducibility and quantification of cerebral blood flow, and to measure cerebrovascular reserve, will be reviewed. © RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Sven Haller
- From Affidea Centre Diagnostique Radiologique de Carouge, Clos de la Fonderie 1, 1227 Carouge, Switzerland (S.H.); Dept of Surgical Sciences, Div of Radiology, Uppsala Univ, Sweden (S.H.); Dept of Neuroradiology, Univ Hosp Freiburg, Germany (S.H.); Faculty of Medicine Univ of Geneva, Switzerland (S.H.); Dept of Radiology, Stanford Univ, Stanford, Calif (G.Z.); Univ College London, Inst of Neurology, London, England (D.L.T., X.G.); Dept of Diagnostic and Interventional Neuroradiology, Geneva Univ Hosps,Switzerland (K.O.L.); Dept of Radiology & Nuclear Medicine and PET Research, VU Univ Medical Ctr, Amsterdam, the Netherlands (F.B.); and Insts of Neurology and Healthcare Engineering, Univ College London, England (F.B.)
| | - Greg Zaharchuk
- From Affidea Centre Diagnostique Radiologique de Carouge, Clos de la Fonderie 1, 1227 Carouge, Switzerland (S.H.); Dept of Surgical Sciences, Div of Radiology, Uppsala Univ, Sweden (S.H.); Dept of Neuroradiology, Univ Hosp Freiburg, Germany (S.H.); Faculty of Medicine Univ of Geneva, Switzerland (S.H.); Dept of Radiology, Stanford Univ, Stanford, Calif (G.Z.); Univ College London, Inst of Neurology, London, England (D.L.T., X.G.); Dept of Diagnostic and Interventional Neuroradiology, Geneva Univ Hosps,Switzerland (K.O.L.); Dept of Radiology & Nuclear Medicine and PET Research, VU Univ Medical Ctr, Amsterdam, the Netherlands (F.B.); and Insts of Neurology and Healthcare Engineering, Univ College London, England (F.B.)
| | - David L Thomas
- From Affidea Centre Diagnostique Radiologique de Carouge, Clos de la Fonderie 1, 1227 Carouge, Switzerland (S.H.); Dept of Surgical Sciences, Div of Radiology, Uppsala Univ, Sweden (S.H.); Dept of Neuroradiology, Univ Hosp Freiburg, Germany (S.H.); Faculty of Medicine Univ of Geneva, Switzerland (S.H.); Dept of Radiology, Stanford Univ, Stanford, Calif (G.Z.); Univ College London, Inst of Neurology, London, England (D.L.T., X.G.); Dept of Diagnostic and Interventional Neuroradiology, Geneva Univ Hosps,Switzerland (K.O.L.); Dept of Radiology & Nuclear Medicine and PET Research, VU Univ Medical Ctr, Amsterdam, the Netherlands (F.B.); and Insts of Neurology and Healthcare Engineering, Univ College London, England (F.B.)
| | - Karl-Olof Lovblad
- From Affidea Centre Diagnostique Radiologique de Carouge, Clos de la Fonderie 1, 1227 Carouge, Switzerland (S.H.); Dept of Surgical Sciences, Div of Radiology, Uppsala Univ, Sweden (S.H.); Dept of Neuroradiology, Univ Hosp Freiburg, Germany (S.H.); Faculty of Medicine Univ of Geneva, Switzerland (S.H.); Dept of Radiology, Stanford Univ, Stanford, Calif (G.Z.); Univ College London, Inst of Neurology, London, England (D.L.T., X.G.); Dept of Diagnostic and Interventional Neuroradiology, Geneva Univ Hosps,Switzerland (K.O.L.); Dept of Radiology & Nuclear Medicine and PET Research, VU Univ Medical Ctr, Amsterdam, the Netherlands (F.B.); and Insts of Neurology and Healthcare Engineering, Univ College London, England (F.B.)
| | - Frederik Barkhof
- From Affidea Centre Diagnostique Radiologique de Carouge, Clos de la Fonderie 1, 1227 Carouge, Switzerland (S.H.); Dept of Surgical Sciences, Div of Radiology, Uppsala Univ, Sweden (S.H.); Dept of Neuroradiology, Univ Hosp Freiburg, Germany (S.H.); Faculty of Medicine Univ of Geneva, Switzerland (S.H.); Dept of Radiology, Stanford Univ, Stanford, Calif (G.Z.); Univ College London, Inst of Neurology, London, England (D.L.T., X.G.); Dept of Diagnostic and Interventional Neuroradiology, Geneva Univ Hosps,Switzerland (K.O.L.); Dept of Radiology & Nuclear Medicine and PET Research, VU Univ Medical Ctr, Amsterdam, the Netherlands (F.B.); and Insts of Neurology and Healthcare Engineering, Univ College London, England (F.B.)
| | - Xavier Golay
- From Affidea Centre Diagnostique Radiologique de Carouge, Clos de la Fonderie 1, 1227 Carouge, Switzerland (S.H.); Dept of Surgical Sciences, Div of Radiology, Uppsala Univ, Sweden (S.H.); Dept of Neuroradiology, Univ Hosp Freiburg, Germany (S.H.); Faculty of Medicine Univ of Geneva, Switzerland (S.H.); Dept of Radiology, Stanford Univ, Stanford, Calif (G.Z.); Univ College London, Inst of Neurology, London, England (D.L.T., X.G.); Dept of Diagnostic and Interventional Neuroradiology, Geneva Univ Hosps,Switzerland (K.O.L.); Dept of Radiology & Nuclear Medicine and PET Research, VU Univ Medical Ctr, Amsterdam, the Netherlands (F.B.); and Insts of Neurology and Healthcare Engineering, Univ College London, England (F.B.)
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12
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Miyaji Y, Kawabata Y, Joki H, Seki S, Mori K, Kamide T, Tamase A, Shima H, Nomura M, Kitamura Y, Tanaka F. Late Seizures after Stroke in Clinical Practice: The Prevalence of Non-convulsive Seizures. Intern Med 2017; 56:627-630. [PMID: 28321060 PMCID: PMC5410470 DOI: 10.2169/internalmedicine.56.7162] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective The prevalence of the non-convulsive type of late seizure after stroke is unknown. The aim of the present study was to clarify the characteristics of late seizure in clinical practice, mainly focusing on the prevalence of non-convulsive seizure. Methods A total of 178 consecutive patients who were admitted and diagnosed with late seizure after stroke were retrospectively enrolled, and the data of 127 patients for whom the complete seizure was observed by a bystander were analyzed. Clinical information was obtained from the medical records and nursing notes. Results A non-convulsive seizure was observed in 37 patients (29%). A focal seizure and its secondary generalization accounted for 79% of the seizure types. Status epilepticus was observed in 60 patients (47%), including 11 patients (9%) without convulsion. The patients with non-convulsive seizures were significantly younger than those with convulsive seizures, but there were no other significant differences between the two groups with respect to sex, classification or the lesion of stroke. Conclusion There was a high rate of non-convulsive seizures in patients with late seizure after stroke. A non-convulsive seizure may be caused by any type or location of preceding stroke. More attention is needed in the differential diagnosis of neurological deterioration after stroke.
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Affiliation(s)
- Yosuke Miyaji
- Department of Neurology and Stroke Medicine, Yokohama Sakae Kyosai Hospital, Japan
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13
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Nomura M, Tamase A, Kamide T, Mori K, Seki S, Iida Y, Suzuki KI, Aoki T, Hirano KI, Takahashi M, Kawabata Y, Nakano T, Taguchi H. Post-ischaemic hyperperfusion in traumatic middle cerebral artery dissection detected by arterial spin labelling of magnetic resonance imaging. Neuroradiol J 2016; 29:350-5. [PMID: 27549149 DOI: 10.1177/1971400916665370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We report a patient with a traumatic middle cerebral artery dissection, which showed hyperperfusion in the territory supplied by the left middle cerebral artery. A 45-year-old man experienced speech disturbance and motor weakness in his right hemibody on the day following mild head trauma. His symptoms worsened on the fourth day. Magnetic resonance imaging showed narrowing in the left M1 portion of the middle cerebral artery. Angiography showed narrowing and dilatation in the left middle cerebral artery trunk. The lesion was diagnosed as a dissection of the middle cerebral artery. Arterial spin labelling of magnetic resonance imaging and single photon emission computed tomography showed increased cerebral blood flow in the left temporal region compared with the right. The patient was treated conservatively and the symptoms gradually improved. The hyperperfusion observed on arterial spin labelling and single photon emission computed tomography gradually improved and disappeared on the 25th day. This is the first reported case of traumatic middle cerebral artery dissection, which showed post-ischaemic hyperperfusion in the territory of the affected artery. To detect hyperperfusion in the brain, arterial spin labelling is a useful technique.
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Affiliation(s)
- Motohiro Nomura
- Department of Neurosurgery, Kanto Rosai Hospital, Japan Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Japan
| | - Akira Tamase
- Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Japan
| | - Tomoya Kamide
- Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Japan
| | - Kentaro Mori
- Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Japan
| | - Syunsuke Seki
- Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Japan
| | - Yu Iida
- Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Japan
| | | | - Takae Aoki
- Department of Radiology, Yokohama Sakae Kyosai Hospital, Japan
| | - Ken-Ichi Hirano
- Department of Radiology, Yokohama Sakae Kyosai Hospital, Japan
| | | | - Yuichi Kawabata
- Department of Neurology, Yokohama Sakae Kyosai Hospital, Japan
| | - Tatsu Nakano
- Department of Neurology, Yokohama Sakae Kyosai Hospital, Japan
| | - Hiroki Taguchi
- Department of Neurosurgery, Taguchi Neurosurgical Clinic, Japan
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14
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Nakae Y, Kudo Y, Yamamoto R, Dobashi Y, Kawabata Y, Ikeda S, Yokoyama M, Higashiyama Y, Doi H, Johkura K, Tanaka F. Relationship between cortex and pulvinar abnormalities on diffusion-weighted imaging in status epilepticus. J Neurol 2015; 263:127-32. [PMID: 26530510 DOI: 10.1007/s00415-015-7948-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 10/16/2015] [Accepted: 10/16/2015] [Indexed: 01/23/2023]
Abstract
The aim of this study was to analyze the pattern of magnetic resonance diffusion-weighted imaging (DWI) findings in status epilepticus in terms of clinical characteristics. Participants comprised 106 patients with status epilepticus who were admitted to our hospital and underwent DWI. Forty-five patients (42.5 %) showed abnormal findings on DWI and were divided into two groups, comprising 26 patients (24.5 %) with cortex lesions alone and 19 patients (17.9 %) with cortex and pulvinar lesions in the same hemisphere. A long duration of status epilepticus (>120 min) tended to be more prevalent among patients with cortex and pulvinar lesions (57.9 %) than among patients with cortex lesions alone (30.8 %) by univariate and multivariate analyses. Todd's palsy tended to be more frequent in patients with abnormalities on DWI (24/45, 53.3 %) than in patients with normal DWI (21/61, 34.4 %). Six of the 26 patients with cortex lesions alone (23.1 %) had taken anti-epileptic drugs before the attack compared to none of the 19 patients with both cortex and pulvinar lesions. The trend toward a longer duration of status epilepticus in patients with both cortex and pulvinar lesions favors a spreading pattern of seizure discharge from cortex to pulvinar via cortico-pulvinar pathways, and anti-epileptic drugs might, to some extent, prevent spreading of seizure discharge from cortex to pulvinar. In addition, existence of high-intensity areas on DWI at the onset of epilepsy may be a predictive factor for the occurrence of Todd's palsy.
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Affiliation(s)
- Yoshiharu Nakae
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan.,Department of Neurology, Hiratsuka Kyosai Hospital, Hiratsuka, Japan
| | - Yosuke Kudo
- Department of Neurology, Hiratsuka Kyosai Hospital, Hiratsuka, Japan
| | - Ryoo Yamamoto
- Department of Neurology, Hiratsuka Kyosai Hospital, Hiratsuka, Japan
| | - Yuichi Dobashi
- Department of Neurology, Hiratsuka Kyosai Hospital, Hiratsuka, Japan
| | - Yuichi Kawabata
- Department of Neurology, Hiratsuka Kyosai Hospital, Hiratsuka, Japan
| | - Shingo Ikeda
- Department of Neurology, Hiratsuka Kyosai Hospital, Hiratsuka, Japan
| | - Mutsumi Yokoyama
- Department of Neurology, Hiratsuka Kyosai Hospital, Hiratsuka, Japan
| | - Yuichi Higashiyama
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Hiroshi Doi
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Ken Johkura
- Department of Neurology, Hiratsuka Kyosai Hospital, Hiratsuka, Japan
| | - Fumiaki Tanaka
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan.
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15
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Matsuura K, Maeda M, Okamoto K, Araki T, Miura Y, Hamada K, Kanamaru K, Tomimoto H. Usefulness of arterial spin-labeling images in periictal state diagnosis of epilepsy. J Neurol Sci 2015; 359:424-9. [PMID: 26478131 DOI: 10.1016/j.jns.2015.10.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 09/15/2015] [Accepted: 10/05/2015] [Indexed: 11/18/2022]
Abstract
PURPOSE Arterial spin-labeling (ASL) perfusion MRI, a noninvasive method of assessing cerebral blood flow, is becoming a diagnostic tool of epilepsy. This study was undertaken to evaluate the diagnostic validity of ASL in patients with status epilepticus (SE) in a periictal state. METHOD Twenty cases with SE were studied. Patients were imaged at a 3T MRI including ASL and diffusion-weighted imaging (DWI), and were also examined using electroencephalography (EEG). The abnormal findings of ASL were compared with those obtained from DWI and EEG. RESULT Focal hyperperfusion was found in the cortical territory of 13 cases (65%). In 10 of those 13 cases, the ASL hyperperfusion region corresponded to DWI high intensity and EEG abnormality. Two cases showed hyperperfusion corresponding to EEG abnormalities in ASL despite the absence of high intensity in DWI. The remaining single case showed hyperperfusion in ASL despite the absence of high intensity in DWI and EEG abnormalities. Hyperperfusion in the subcortical territory was observed in the ipsilateral thalamus in three cases and in the contralateral cerebellum in one case. CONCLUSION Our results suggest that ASL is a useful tool to diagnose status epilepticus and localization of the epilepsy focus.
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Affiliation(s)
- Keita Matsuura
- Department of Neurology, Suzuka Kaisei Hospital, Mie 513-8505, Japan; Department of Neurology, Graduate School of Medicine, Mie University, Mie 514-8507, Japan.
| | - Masayuki Maeda
- Department of Advanced Diagnostic Imaging, Graduate School of Medicine, Mie University, Mie 514-8507, Japan
| | - Keisuke Okamoto
- Department of Clinical Laboratory, Kinan Hospital, Mie 519-5293, Japan
| | - Tomohiro Araki
- Department of Neurosurgery, Suzuka Kaisei Hospital, Mie 513-8505, Japan
| | - Yoichi Miura
- Department of Neurosurgery, Suzuka Kaisei Hospital, Mie 513-8505, Japan
| | - Kazuhide Hamada
- Department of Neurosurgery, Kuwana West Medical Center, Mie 511-0819, Japan
| | - Kenji Kanamaru
- Department of Neurosurgery, Suzuka Kaisei Hospital, Mie 513-8505, Japan
| | - Hidekazu Tomimoto
- Department of Neurology, Graduate School of Medicine, Mie University, Mie 514-8507, Japan
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16
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Sierra-Marcos A, Carreño M, Setoain X, López-Rueda A, Aparicio J, Donaire A, Bargalló N. 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. Eur J Neurol 2015; 23:160-7. [DOI: 10.1111/ene.12826] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 07/06/2015] [Indexed: 11/28/2022]
Affiliation(s)
| | - M. Carreño
- Institute of Neurosciences; Hospital Clinic; Barcelona Spain
| | - X. Setoain
- Image Diagnosis Center; Hospital Clinic; Barcelona Spain
- Centro de Investigación Biomédica en Red en Bioingeniería; Biomateriales y Nanomedicina (CIBER-BBN); Barcelona Spain
| | - A. López-Rueda
- Image Diagnosis Center; Hospital Clinic; Barcelona Spain
| | - J. Aparicio
- Institute of Neurosciences; Hospital Clinic; Barcelona Spain
| | - A. Donaire
- Institute of Neurosciences; Hospital Clinic; Barcelona Spain
| | - N. Bargalló
- 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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17
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Miyaji Y, Kawabata Y, Joki H, Seki S, Mori K, Kamide T, Tamase A, Nomura M, Kitamura Y, Tanaka F. Arterial spin-labeling magnetic resonance imaging for diagnosis of early seizure after stroke. J Neurol Sci 2015; 354:127-8. [PMID: 25982502 DOI: 10.1016/j.jns.2015.04.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 04/23/2015] [Accepted: 04/28/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Yosuke Miyaji
- Department of Neurology and Stroke Medicine, Yokohama Sakae Kyosai Hospital, Yokohama, Japan.
| | - Yuichi Kawabata
- Department of Neurology and Stroke Medicine, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Hideto Joki
- Department of Neurology and Stroke Medicine, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Shunsuke Seki
- Department of Neurosurgery and Stroke Medicine, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Kentaro Mori
- Department of Neurosurgery and Stroke Medicine, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Tomoya Kamide
- Department of Neurosurgery and Stroke Medicine, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Akira Tamase
- Department of Neurosurgery and Stroke Medicine, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Motohiro Nomura
- Department of Neurosurgery and Stroke Medicine, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Yoshihisa Kitamura
- Department of Neurosurgery and Stroke Medicine, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Fumiaki Tanaka
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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