Interictal EEG spikes increase perfusion in low-grade epilepsy-associated tumors: a pediatric arterial spin labeling study.

IF 9.7 1区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Radiologia Medica Pub Date : 2024-11-12 DOI:10.1007/s11547-024-01923-7

Antonio Giulio Gennari, Giulio Bicciato, Santo Pietro Lo Biundo, Raimund Kottke, Dorottya Cserpan, Ruth Tuura O'Gorman, Georgia Ramantani

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引用次数: 0

Abstract

Purpose: Arterial spin labeling (ASL), a noninvasive magnetic resonance (MRI) perfusion sequence, holds promise in the presurgical evaluation of pediatric lesional epilepsy patients, including those with low-grade epilepsy-associated tumors (LEATs). The interpretation of ASL-derived perfusion patterns, however, presents challenges. Our study aims to elucidate these perfusion changes in children with LEATs, exploring their correlations with clinical, electroencephalography (EEG), and anatomical MRI findings.

Material and methods: Our cohort included 15 children with LEAT-associated focal lesional epilepsy who underwent single-delay pseudo-continuous ASL imaging; eight were imaged under sedation. We assessed perfusion images both qualitatively and quantitatively, focusing on LEAT-related perfusion changes, as indicated by the asymmetry index (AI) and regional cerebral blood flow (rCBF).

Results: ASL revealed LEAT-related perfusion changes in all but two patients: 12 LEATs were hypoperfused and one was hyperperfused relative to the contralateral brain parenchyma (CBP). LEATs showed significantly lower perfusion compared to CBP (median: 38.7 vs. 59.1 mL/100 g/min for LEAT and CBP, respectively; p value = 0.004, Wilcoxon-Mann-Whitney), regardless of sedation. Notably, elevated AI and rCBF values correlated with interictal spikes on EEG (median: -0.008 and 0.84 vs -0.27 and 0.58, respectively), but not to other clinical, EEG, or MRI variables (p value = 0.036, Wilcoxon-Mann-Whitney).

Conclusions: By highlighting the connection between LEAT and brain perfusion, and by correlating perfusion characteristics and epileptogenicity, our research enhanced our understanding of pediatric epilepsy associated with LEATs. Also, by proving the robustness of these findings to sedation we confirmed the importance of adding ASL to epilepsy protocols to as a valuable tool to supplement anatomical imaging.

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发作间期脑电图尖峰增加低度癫痫相关肿瘤的灌注：一项儿科动脉自旋标记研究。

目的：动脉自旋标记（ASL）是一种无创磁共振（MRI）灌注序列，有望用于小儿病灶性癫痫患者（包括低级别癫痫相关肿瘤（LEATs）患者）的术前评估。然而，ASL衍生灌注模式的解释却面临挑战。我们的研究旨在阐明LEATs患儿的这些灌注变化，探讨它们与临床、脑电图（EEG）和解剖磁共振成像结果的相关性：我们的队列包括15名接受单延时伪连续ASL成像的LEAT相关局灶性病变癫痫患儿；其中8名患儿是在镇静状态下接受成像的。我们对灌注图像进行了定性和定量评估，重点关注LEAT相关的灌注变化，如不对称指数（AI）和区域脑血流（rCBF）所示：除两名患者外，其他所有患者的 ASL 均显示出与 LEAT 相关的灌注变化：相对于对侧脑实质（CBP），12 例 LEAT 脑灌注不足，1 例高灌注。与 CBP 相比，LEAT 的灌注量明显较低（中位数为 38.7，而 CBP 为 59.1）：无论镇静与否，LEAT 和 CBP 的灌注量分别为 38.7 mL/100 g/min 和 59.1 mL/100 g/min；P 值 = 0.004，Wilcoxon-Mann-Whitney）。值得注意的是，AI和rCBF值的升高与脑电图上的发作间期尖峰相关（中位数：分别为-0.008和0.84 vs -0.27和0.58），但与其他临床、脑电图或磁共振成像变量无关（P值=0.036，Wilcoxon-Mann-Whitney）：通过强调LEAT与脑灌注之间的联系以及灌注特征与致痫性之间的相关性，我们的研究增进了我们对与LEAT相关的小儿癫痫的了解。此外，通过证明这些发现对镇静剂的稳健性，我们证实了在癫痫治疗方案中加入 ASL 的重要性，它是补充解剖成像的重要工具。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Radiologia Medica 医学-核医学

CiteScore

14.10

自引率

7.90%

发文量

133

审稿时长

4-8 weeks

期刊介绍： Felice Perussia founded La radiologia medica in 1914. It is a peer-reviewed journal and serves as the official journal of the Italian Society of Medical and Interventional Radiology (SIRM). The primary purpose of the journal is to disseminate information related to Radiology, especially advancements in diagnostic imaging and related disciplines. La radiologia medica welcomes original research on both fundamental and clinical aspects of modern radiology, with a particular focus on diagnostic and interventional imaging techniques. It also covers topics such as radiotherapy, nuclear medicine, radiobiology, health physics, and artificial intelligence in the context of clinical implications. The journal includes various types of contributions such as original articles, review articles, editorials, short reports, and letters to the editor. With an esteemed Editorial Board and a selection of insightful reports, the journal is an indispensable resource for radiologists and professionals in related fields. Ultimately, La radiologia medica aims to serve as a platform for international collaboration and knowledge sharing within the radiological community.