International Journal of Clinical Research

Objective To acquire cerebral blood flow (CBF) images of epilepsy patients after seizures using magnetic resonance 3D arterial spin labeling (3DASL) technology, extract CBF values of 90 brain regions based on the standard Automated Anatomical Labeling (AAL) template via relevant software, and combine these data with electroencephalography (EEG) results to preliminarily explore the value of magnetic resonance 3DASL technology in localizing epileptogenic foci. Methods A retrospective analysis was conducted on 20 patients diagnosed with epilepsy in the outpatient and inpatient departments of the Second Affiliated Hospital of Baotou Medical College between January 2023 and May 2024. All patients had complete EEG and magnetic resonance 3DASL examination results within 3 days after symptom onset. A control group of 20 subjects was also recruited. The SPM12 software based on the MATLAB R2021b platform was used to convert CBF images from DICOM format to NifTI format, and to normalize the CBF images to the standard space of the Montreal Neurological Institute (MNI). All data were normalized using the “Mean Division” method with DPABI software, followed by spatial smoothing of the normalized images (full width at half maximum [FWHM] = 8 mm). Finally, the CBF values of 90 gray matter brain regions based on the AAL template were extracted from the smoothed CBF images using DPABI software. The threshold for hyperperfusion was defined as the mean CBF value of the control group plus 1.5 times the standard deviation (Mean + 1.5SD). For each subject in the patient group, brain regions with CBF values exceeding this threshold were identified as hyperperfusion regions. Consistency analysis was then performed between these hyperperfusion regions and the regions of abnormal EEG discharges. Results The CBF value of the left hippocampus in the control group was significantly higher than that in the patient group (p<0.05). In contrast, the CBF values of the control group in the left precentral gyrus, left orbital superior frontal gyrus, right orbital superior frontal gyrus, left orbital middle frontal gyrus, right orbital middle frontal gyrus, left opercular inferior frontal gyrus, left triangular inferior frontal gyrus, left orbital inferior frontal gyrus, left orbital internal superior frontal gyrus, right orbital internal superior frontal gyrus, and left postcentral gyrus were significantly lower than those in the patient group (p<0.05). There was a high consistency between the hyperperfusion brain regions in the patient group and the regions of abnormal EEG discharges (κ=0.857). Conclusion 3DASL can detect local perfusion abnormalities in the early stage after epileptic seizures. The spatial distribution of these abnormalities shows high consistency with the regions of abnormal EEG discharges, suggesting that 3DASL may serve as an auxiliary localization index in multimodal evaluation.

Epilepsy;ASL;EEG