Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland.
Department of Neurology, Highfield MR Center, Medical University of Vienna, Vienna, Austria.
Curr Opin Neurol. 2019 Aug;32(4):530-538. doi: 10.1097/WCO.0000000000000704.
Imaging constitutes one of the key pillars in the diagnostic workup after a first seizure as well as for the presurgical workup in epilepsy. The role of imaging in emergency situations, mainly to support the adequate diagnosis, as well as its role in planning of noninvasive image-guided therapies is less well established. Here, we provide an overview on peri-ictal imaging findings to support differential diagnosis in emergency situations and describe recent attempts toward minimal invasive therapy in the treatment of epilepsy and its comorbidities based on a combination of imaging techniques with ultrasound.
Peri-ictal perfusion changes can differentiate ictal stroke mimics from acute ischemic stroke if focal areas of increased perfusion are depicted by computed tomography or MRI. Postictal perfusion patterns in patients with persisting neurological symptoms are frequently normal and do not reach enough diagnostic sensitivity to differentiate between stroke and its mimics. Noninvasive magnetic resonance-techniques as arterial spin labeling may provide a higher sensitivity, especially in combination with diffusion-weighted and susceptibility-weighted MRI. Imaging guided focused ultrasound (FUS) bears the potential to ablate epileptogenic tissue and allows suppression of epileptic activity. Imaging guided blood-brain-barrier opening with FUS offers new options for local drug administration.
MRI should be considered the method of choice in the differential diagnosis of peri-ictal imaging findings and their differential diagnosis. A combination of various MRI techniques with FUS opens new avenues for treatment of epilepsy.
在首次癫痫发作后的诊断性检查以及癫痫的术前检查中，影像学是一个关键的组成部分。影像学在急诊中的作用，主要是支持充分的诊断，以及在规划非侵入性图像引导治疗中的作用，尚未得到充分确立。在这里，我们提供了发作期影像学表现的概述，以支持急诊中的鉴别诊断，并描述了最近尝试将影像学技术与超声相结合，用于治疗癫痫及其合并症的微创治疗。
如果 CT 或 MRI 显示局部灌注增加，则发作期灌注变化可将癫痫发作样发作与急性缺血性中风区分开来。持续存在神经症状的患者的发作后灌注模式通常正常，其诊断敏感性不足以区分中风及其模拟物。动脉自旋标记等非侵入性磁共振技术可能具有更高的敏感性，尤其是与弥散加权和磁化率加权 MRI 相结合时。影像学引导的聚焦超声（FUS）具有消融致痫组织和抑制癫痫活动的潜力。影像学引导的 FUS 血脑屏障开放为局部药物给药提供了新的选择。
在发作期影像学表现及其鉴别诊断的鉴别诊断中，应考虑 MRI 为首选方法。各种 MRI 技术与 FUS 的结合为癫痫的治疗开辟了新的途径。
