1.5特斯拉脉冲动脉自旋标记磁共振灌注成像在检测非惊厥性癫痫持续状态发作期血流灌注增加中的意义及局限性
Implications and limitations of magnetic resonance perfusion imaging with 1.5-Tesla pulsed arterial spin labeling in detecting ictal hyperperfusion during non-convulsive status epileptics.
作者信息
Goto Katsuhiro, Shimogawa Takafumi, Mukae Nobutaka, Shono Tadahisa, Fujiki Fujio, Tanaka Atsuo, Sakata Ayumi, Shigeto Hiroshi, Yoshimoto Koji, Morioka Takato
机构信息
Department of Neurosurgery, Harasanshin Hospital.
Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University.
出版信息
Surg Neurol Int. 2022 Apr 15;13:147. doi: 10.25259/SNI_841_2021. eCollection 2022.
BACKGROUND
Recent our reports showed that 3-T pseudocontinuous arterial spin labeling (3-T pCASL) magnetic resonance perfusion imaging with dual post labeling delay (PLD) of 1.5 and 2.5 s clearly demonstrated the hemodynamics of ictal hyperperfusion associated with non-convulsive status epilepticus (NCSE). We aimed to examine the utility of 1.5-T pulsed arterial spin labeling (1.5-T PASL), which is more widely available for daily clinical use, for detecting ictal hyperperfusion.
METHODS
We retrospectively analyzed the findings of 1.5-T PASL with dual PLD of 1.5 s and 2.0 s in six patients and compared the findings with ictal electroencephalographic (EEG) findings.
RESULTS
In patients 1 and 2, we observed the repeated occurrence of ictal discharges (RID) on EEG. In patient 1, with PLDs of 1.5 s and 2.0 s, ictal ASL hyperperfusion was observed at the site that matched the RID localization. In patient 2, the RID amplitude was extremely low, with no ictal ASL hyperperfusion. In patient 3 with lateralized periodic discharges (LPD), we observed ictal ASL hyperperfusion at the site of maximal LPD amplitude, which was apparent at a PLD of 2.0 s but not 1.5 sec. Among three patients with rhythmic delta activity (RDA) of frequencies <2.5 Hz (Patients 4-6), we observed obvious and slight increases in ASL signals in patients 4 and 5 with NCSE, respectively. However, there was no apparent change in ASL signals in patient 6 with possible NCSE.
CONCLUSION
The detection of ictal hyperperfusion on 1.5-T PASL might depend on the electrophysiological intensity of the epileptic ictus, which seemed to be more prominent on 1.5-T PASL than on 3-T pCASL. The 1.5-T PASL with dual PLDs showed the hemodynamics of ictal hyperperfusion in patients with RID and LPD. However, it may not be visualized in patients with extremely low amplitude RID or RDA (frequencies <2.5 Hz).
背景
我们最近的报告显示，采用1.5秒和2.5秒双标记后延迟（PLD）的3-T伪连续动脉自旋标记（3-T pCASL）磁共振灌注成像清晰地显示了与非惊厥性癫痫持续状态（NCSE）相关的发作期血流灌注情况。我们旨在研究1.5-T脉冲动脉自旋标记（1.5-T PASL，在日常临床中应用更广泛）检测发作期血流灌注增加的效用。
方法
我们回顾性分析了6例患者采用1.5秒和2.0秒双PLD的1.5-T PASL检查结果，并将其与发作期脑电图（EEG）结果进行比较。
结果
在患者1和患者2中，我们在EEG上观察到发作期放电反复出现（RID）。在患者1中，采用1.5秒和2.0秒的PLD时，在与RID定位相符的部位观察到发作期动脉自旋标记血流灌注增加。在患者2中，RID幅度极低，未观察到发作期动脉自旋标记血流灌注增加。在患有侧化周期性放电（LPD）的患者3中，我们在LPD最大幅度部位观察到发作期动脉自旋标记血流灌注增加，在2.0秒的PLD时明显，但在1.5秒时未观察到。在3例频率<2.5 Hz的节律性δ活动（RDA）患者（患者4 - 6）中，我们分别在患有NCSE的患者4和患者5中观察到动脉自旋标记信号明显和轻微增加。然而，在可能患有NCSE的患者6中，动脉自旋标记信号没有明显变化。
结论
1.5-T PASL上发作期血流灌注增加的检测可能取决于癫痫发作的电生理强度，这在1.5-T PASL上似乎比在3-T pCASL上更显著。具有双PLD的1.5-T PASL显示了患有RID和LPD患者的发作期血流灌注增加情况。然而，在RID幅度极低或RDA（频率<2.5 Hz）的患者中可能无法观察到。
Zotero 插件