Non‐contrast
MRI
reliably captures perfusion abnormalities in status epilepticus
Lukas Machegger, Pilar Bosque‐Varela, Jürgen Steinbacher, Johannes Pfaff, Eugen Trinka, Giorgi Kuchukhidze Abstract
Objective
To determine whether non‐contrast pseudo‐continuous arterial spin labeling (pCASL) detects status epilepticus (SE)–related perfusion abnormalities and shows quantitative correspondence with dynamic susceptibility contrast (DSC) perfusion magnetic resonance imaging (MRI), and to compare single‐slice and volumetric approaches for asymmetry assessment.
Methods
Adult patients from a prospectively recruited single‐center SE cohort were included in this retrospective analysis when MRI was performed within 48 h after clinical SE onset and both pCASL and DSC perfusion sequences were available. Visual assessment was pCASL‐led, with corresponding DSC‐derived cerebral blood flow (CBF) and cerebral blood volume (CBV) maps subsequently evaluated. Perfusion asymmetry was quantified using mirrored contralateral reference regions. Single‐slice peak‐abnormality and volumetric segmentation approaches were applied to pCASL, DSC‐derived cerebral blood flow (CBF), and cerebral blood volume (CBV).
Results
Of 982 individuals with SE, 180 underwent MRI including pCASL and DSC within 48 h. pCASL‐led assessment identified SE‐related perfusion abnormalities in 75 of 180 (42%): hyperperfusion in 65, hypoperfusion in 6, and pCASL–DSC discordance in 4. Corresponding DSC abnormalities were present in 71 of 75 (95%). Thus, quantitative asymmetry analysis was performed in 71 unilateral evaluable cases. In the hyperperfusion subgroup, pCASL asymmetry correlated significantly with DSC‐derived CBF using both volumetric and single‐slice assessment ( ρ = .558 and ρ = .571, respectively; both p < .001), and with DSC‐derived CBV ( ρ = .495 and ρ = .374, respectively; p < .001 and p = .003). Single‐slice and volumetric pCASL asymmetry showed strong correspondence ( ρ = .773, p < .001). No significant difference was observed between single‐slice and volumetric pCASL asymmetry after correction for multiple comparisons.
Significance
Non‐contrast pCASL detected SE‐related peri‐ictal perfusion abnormalities and showed significant quantitative correspondence with DSC‐derived CBF and CBV in parenchymal hyperperfusion. Single‐slice pCASL asymmetry showed strong agreement with volumetric assessment, supporting its use as a pragmatic approach for clinically oriented evaluation.