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Chapter 35 - Diffusion and perfusion MR imaging in seizure disorders

from Section 5 - Seizure disorders

Published online by Cambridge University Press:  05 March 2013

By
Konstantinos Arfanakis  and
Bruce P. Hermann
Edited by
Jonathan H. Gillard ,
Adam D. Waldman  and
Peter B. Barker
Jonathan H. Gillard
Affiliation:
University of Cambridge
Adam D. Waldman
Affiliation:
Imperial College London
Peter B. Barker
Affiliation:
The Johns Hopkins University School of Medicine
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Summary

Introduction

Conventional, anatomical MR imaging (MRI) has been widely used for the detection of brain tissue volume changes caused by chronic seizures, and for diagnosis of brain lesions that result in seizure activity. However, seizures are often not associated with lesions or volume changes visible in conventional MRI. In contrast, diffusion and perfusion MRI are sensitive to the physiological changes that take place in brain tissue ictally, postictally, and interictally. This chapter provides an in-depth discussion of the application of both diffusion and perfusion MRI in seizure disorders. The changes in perfusion (cerebral blood flow [CBF], cerebral blood volume [CBV]) and diffusion (apparent diffusion coefficient [ADC], fractional anisotropy [FA]) that occur in ictogenic regions or globally in the brain are described, and diffusion and perfusion MRI are evaluated as methods to localize seizure focus. Finally, mechanisms that may be responsible for the changes that occur in perfusion and diffusion of brain tissue in seizure disorders are examined.

Perfusion MRI in seizure disorders

The techniques

Positron emission tomography (PET) and single-photon emission computed tomography (SPECT) have been used to identify focal changes in regional CBF in patients with epilepsy.[1,2] However, the low spatial and temporal resolution of PET and SPECT and the ionizing radiation emitted from the nuclear medicine tracers are major concerns. The development of MR perfusion techniques has offered higher spatial and temporal resolution without the use of ionizing radiation.[3,4] Perfusion MRI has been applied in several studies of cerebral ischemia,[5] brain tumors,[6] and functional brain mapping.[7] The techniques are based on exogenous or endogenous tracers. In the method based on exogenous tracers, a paramagnetic agent such as gadolinium-diethylenetriaminepentaacetic acid (Gd-DTPA) is injected, and the resulting decrease and subsequent recovery of the MR signal is used to estimate perfusion.[8,9] In the method using endogenous tracers, the spins of arterial water are non-invasively labeled using radiofrequency pulses, and the regional accumulation of the label is measured by comparison with an image acquired without labeling (arterial spin-labeling, [ASL]).[10]

Type
Chapter
Information
Clinical MR Neuroimaging
Physiological and Functional Techniques
 , pp. 546 - 560
Publisher: Cambridge University Press
Print publication year: 2009

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