Background: Accurate lateralization of the epileptogenic focus in temporal lobe epilepsy (TLE) is crucial. Pulsed arterial spin labeling (pASL) has the capability of quantifying local relative cerebral blood flow (rCBF) by measuring the inflow of electromagnetically labeled arterial blood into the target area, and can be used in the presurgical workup of refractory TLE.
Purpose: To evaluate pASL in detecting mesial temporal lobe (mTL) perfusion asymmetry for the lateralization of the epileptogenic focus in patients with refractory TLE and to compare it with dynamic susceptibility contrast enhanced (DSC) magnetic resonance imaging (MRI) technique.
Material And Methods: This study was approved by the local ethical committee, and written informed consent was obtained in each patient. Thirty-six patients with medically refractory TLE and 11 healthy volunteer was enrolled in this study. Following brain MRI, pASL and DSC perfusion were performed in all subjects at 3T. rCBF measurements with two different perfusion MRI technique were compared between the patient and healthy volunteers. Lateralization based on perfusion asymmetry index (AI) were also evaluated and compared with clinical lateralization.
Results: rCBF ratios measured in healthy volunteers by two different perfusion technique did not show any statistically significant difference. In TLE patients rCBF ratio of the ipsilateral (affected) side was found to be significantly lower than the contralateral (unaffected) side with both technique. The AI in the patient group was 8.86 ± 3.88 with pASL and 8.39 ± 4.06 with DSC. Correlation coefficient between clinical laterality and perfusion AI were 0.86 for pASL and 0.83 for DSC.
Conclusion: pASL can successfully detect interictal asymmetry in patients with TLE and can readily be combined with routine structural assessment for lateralization, providing an alternative to DSC perfusion.
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AJNR Am J Neuroradiol
January 2025
From the Department of Radiology, Medical Physics (MML, TJC), Department of Interventional Radiology (NS, GAC), Department of Surgery and Large Animal Studies (MAN), and the Department of Statistics (MG), University of Chicago, Chicago, IL, USA; Department of Anesthesiology (SPR), University of Illinois, Chicago, IL, USA; Department of Radiology (MSS), University of Massachusetts Chan Medical School, Worcester, MA, USA; Department of Radiology, Biomedical Engineering and Imaging Institute (Current affiliation MML), Icahn School of Medicine at Mount Sinai, New York, NY, USA; Mount Carmel Health Systems (Current affiliation GAC), Columbus, OH, USA.
Background And Purpose: In acute ischemic stroke, the amount of "local" CBF distal to the occlusion, i.e. all blood flow within a region whether supplied antegrade or delayed and dispersed through the collateral network, may contain valuable information regarding infarct growth rate and treatment response.
View Article and Find Full Text PDFDiagnostics (Basel)
December 2024
Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
: The accurate and early distinction of glioblastomas (GBMs) from single brain metastases (BMs) provides a window of opportunity for reframing treatment strategies enabling optimal and timely therapeutic interventions. We sought to leverage physiologically sensitive parameters derived from diffusion tensor imaging (DTI) and dynamic susceptibility contrast (DSC)-perfusion-weighted imaging (PWI) along with machine learning-based methods to distinguish GBMs from single BMs. : Patients with histopathology-confirmed GBMs ( = 62) and BMs ( = 26) and exhibiting contrast-enhancing regions (CERs) underwent 3T anatomical imaging, DTI and DSC-PWI prior to treatment.
View Article and Find Full Text PDFPLoS One
January 2025
Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Background: Glioblastoma is characterized by neovascularization and diffuse infiltration into the adjacent tissue. T2*-based dynamic susceptibility contrast (DSC) MR perfusion images provide useful measurements of the biomarkers associated with tumor perfusion. This study aimed to distinguish infiltrating tumors from vasogenic edema in glioblastomas using DSC-MR perfusion images.
View Article and Find Full Text PDFMagn Reson Imaging
December 2024
Department of Radiology and Diagnostic Imaging, Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz, Poland.
Background: Brain tumors exhibit diverse genetic landscapes and hemodynamic properties, influencing diagnosis and treatment outcomes.
Purpose: To explore the relationship between MRI perfusion metrics (rCBV, rCBF), genetic markers, and contrast enhancement patterns in gliomas, aiming to enhance diagnostic accuracy and inform personalized therapeutic strategies. Additionally, other radiological features, such as the T2/FLAIR mismatch sign, are evaluated for their predictive utility in IDH mutations.
AJNR Am J Neuroradiol
December 2024
From the Department of Diagnostic Medicine, Dell Medical School at The University of Texas at Austin, Austin, TX, USA (C.Y.H.), Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA (N.S., G.A., Q.W., P.C., M.A., J.G.P., B.R.G., P.R.T., G.D.H.), Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA (E.C., P.R.T., S.A.P.), Stark Neuroscience Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA (P.R.T., S.A.P.), and the Department of Radiology at Texas Children's Hospital, Houston, TX, USA (S.F.K.).
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