Arterial spin labeling imaging of epileptic seizures with and without status epilepticus: A descriptive study.

introductionImaging studies of patients after epileptic seizures have thus far been focused on status epilepticus (SE); resulting on a paucity of data on patients who do not progress to SE. This study retrospectively reviewed the magnetic resonance imaging (MRI) findings of patients after epileptic seizures, both with and without SE.

methodsThis descriptive retrospective cohort study was conducted between January 2019 and December 2022. The study consecutively included patients admitted with focal epileptic seizures who underwent MRI within 24 h of the seizure. The MRI findings in the three groups; patients with SE, non-convulsive status epilepticus, and a single seizure were examined. Special emphasis was placed on comparing arterial spin labeling (ASL) with other conventional sequences.

resultsAmong all 164 patients, abnormal findings on MRI were most frequently found on ASL, both in the cortex and thalamus. In ASL, hyperperfusion in the cortex and thalamus was found in 61.0% and 58.5% of patients, respectively. In the 89 patients with a single seizure, the frequency of hyperperfusion on ASL was 47.2% in the cortex and 50.6% in the thalamus, which were higher than those on DWI and FLAIR images. Hyperperfusion in ASL was more frequently found than hyperintensity in other sequences, regardless of whether they worse to SE or not.

conclusionSince epileptic seizures are frequently cured by the time patients reach the hospital, DWI and FLAIR imaging have not been able to provide sufficient support in this regard. However, ASL may be a promising assistant in this context.