Obrazowanie perfuzji mózgu u dzieci z epilepsją w warunkach nagłych: czynniki kliniczne wpływające na przydatność diagnostyczną i optymalny czas badania

BACKGROUND: Determining focal seizure onset is often challenging in children, particularly in the emergency setting. We investigated the clinical utility of arterial spin labeling (ASL) perfusion imaging performed shortly after seizure termination in children with epilepsy. METHODS: Retrospective analysis was performed for children with epilepsy who presented with seizures to the emergency room and underwent ASL at Seoul National University Bundang Hospital between January 2018 and December 2024. Clinical factors including age, seizure duration, seizure semiology, time to ASL, and EEG results were analyzed for ASL positivity (either hypoperfusion or hyperperfusion). RESULTS: A total of 240 children were included. Mean age was 9.68 years (range 0.46-18 years). The median interval between seizure onset and ASL acquisition was 19.4 hours (range 1.33-163 hours). Positive ASL was observed in 42.5% of patients. Age 2-8 years, focal, and prolonged seizures were independently associated with positive ASL. ASL positivity was higher when ASL was acquired within 18 hours of seizure onset (45.5% vs. 31.1%, p = 0.033). Positive ASL was significantly associated with focal background abnormalities on EEG (57.5% vs. 35.9%, p = 0.002) and negatively associated with generalized interictal epileptiform discharges (45.4% vs. 25.7%, p = 0.03). Concordance between ASL and focal EEG abnormalities was 75.3%. Among 79 patients with ASL-positive focal epilepsy, hypoperfusion was more frequent when ASL was performed within 12 hours of seizure onset. CONCLUSIONS: ASL can be useful in rapidly identifying focal seizure in emergency setting. Timely acquisition of ASL is crucial as cerebral perfusion changes are often transient, with potentially shorter time for hypoperfusion.