{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T02:38:13Z","timestamp":1792809493249,"version":"4.5.0"},"reference-count":32,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>The authors sought to assess the utility of arterial spin labeling (ASL) perfusion 3T-MRI for the presurgical evaluation of poorly defined focal epilepsy in pediatric patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Pseudocontinuous ASL perfusion 3T-MRI was performed in 25 consecutive children with poorly defined focal epilepsy. ASL perfusion abnormalities were detected qualitatively by visual inspection and quantitatively by calculating asymmetry index (AI) maps and significant z-score cluster maps based on successfully operated cases. ASL results were prospectively compared to scalp EEG, structural 3T-MRI, FDG-PET, ictal\/interictal SPECT, magnetoencephalography (MEG), and intracranial recording results, as well as the final surgically proven epileptogenic zone (EZ) in operated patients who had at least 1 year of good (Engel class I\/II) seizure outcome and positive histopathology results.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Qualitative ASL perfusion abnormalities were found in 17\/25 cases (68%), specifically in 17\/20 MRI-positive cases (85.0%) and in none of the 5 MRI-negative cases. ASL was concordant with localizing scalp EEG findings in 66.7%, structural 3T-MRI in 90%, FDG-PET in 75%, ictal\/interictal SPECT in 62.5%, and MEG in 75% of cases, and with intracranial recording results in 40% of cases. Eleven patients underwent surgery; in all 11 cases the EZ was surgically proven by positive histopathology results and the patient having at least 1 year of good seizure outcome. ASL results were concordant with this final surgically proven EZ in 10\/11 cases (sensitivity 91%, specificity 50%). All 10 ASL-positive patients who underwent surgery had positive surgical pathology results and good long-term postsurgical seizure outcome at a mean follow-up of 39 months. Retrospective quantitative analysis based on significant z-score clusters found 1 true-positive result that was missed by qualitative analysis and 3 additional false-positive results (sensitivity 100%, specificity 23%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>ASL supports the hypothesis regarding the EZ in poorly defined focal epilepsy cases in children. Due to its convenience and noninvasive nature, the authors recommend that ASL be added routinely to the presurgical MRI evaluation of epilepsy. Future optimized quantitative methods may improve the diagnostic yield of this technique.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2020.7.peds20397","type":"journal-article","created":{"date-parts":[[2020,12,25]],"date-time":"2020-12-25T02:10:04Z","timestamp":1608862204000},"page":"243-252","source":"Crossref","is-referenced-by-count":22,"title":["The utility of arterial spin labeling in the presurgical evaluation of poorly defined focal epilepsy in children"],"prefix":"10.3171","volume":"27","author":[{"given":"Jack","family":"Lam","sequence":"first","affiliation":[{"name":"McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montr\u00e9al;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Tomaszewski","sequence":"additional","affiliation":[{"name":"McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montr\u00e9al;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guillaume","family":"Gilbert","sequence":"additional","affiliation":[{"name":"Philips Canada, MRI Research Department, Montr\u00e9al; and Departments of"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy T.","family":"Moreau","sequence":"additional","affiliation":[{"name":"McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montr\u00e9al;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie-Christine","family":"Guiot","sequence":"additional","affiliation":[{"name":"Adult and Pediatric Pathology,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steffen","family":"Albrecht","sequence":"additional","affiliation":[{"name":"Adult and Pediatric Pathology,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Pierre","family":"Farmer","sequence":"additional","affiliation":[{"name":"Pediatric Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Atkinson","sequence":"additional","affiliation":[{"name":"Pediatric Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Saint-Martin","sequence":"additional","affiliation":[{"name":"Pediatric Radiology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pia","family":"Wintermark","sequence":"additional","affiliation":[{"name":"Neonatology, McGill University Health Network, Montr\u00e9al, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boris","family":"Bernhardt","sequence":"additional","affiliation":[{"name":"McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montr\u00e9al;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylvain","family":"Baillet","sequence":"additional","affiliation":[{"name":"McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montr\u00e9al;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roy W. 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Childs Nerv Syst. 2016;32(12):2415\u20132422.27757571"},{"issue":"5","key":"b3","series-title":"J Neuroradiol","first-page":"283","article-title":"Presurgical evaluation of mesial temporal lobe epilepsy with multiple advanced MR techniques at 3T","volume":"42","author":"Eryurt B","year":"2015","unstructured":"Eryurt B, Oner AY, Ucar M,  Presurgical evaluation of mesial temporal lobe epilepsy with multiple advanced MR techniques at 3T. J Neuroradiol. 2015;42(5):283\u2013290.26024772"},{"issue":"5","key":"b4","series-title":"J Magn Reson Imaging","first-page":"1386","article-title":"Asymmetry of cerebral blood flow measured with three-dimensional pseudocontinuous arterial spin-labeling MR imaging in temporal lobe epilepsy with and without mesial temporal sclerosis","volume":"42","author":"Guo X","year":"2015","unstructured":"Guo X, Xu S, Wang G,  Asymmetry of cerebral blood flow measured with three-dimensional pseudocontinuous arterial spin-labeling MR imaging in temporal lobe epilepsy with and without mesial temporal sclerosis. J Magn Reson Imaging. 2015;42(5):1386\u20131397.25884243"},{"issue":"2-3","key":"b5","series-title":"Epilepsy Res","first-page":"183","article-title":"Usefulness of pulsed arterial spin labeling MR imaging in mesial temporal lobe epilepsy","volume":"82","author":"Lim YM","year":"2008","unstructured":"Lim YM, Cho YW, Shamim S,  Usefulness of pulsed arterial spin labeling MR imaging in mesial temporal lobe epilepsy. Epilepsy Res. 2008;82(2-3):183\u2013189.19041041"},{"issue":"3","key":"b6","series-title":"Magn Reson Med","first-page":"431","article-title":"Perfusion-weighted imaging of interictal hypoperfusion in temporal lobe epilepsy using FAIR-HASTE: comparison with H215O PET measurements","volume":"45","author":"Liu HL","year":"2001","unstructured":"Liu HL, Kochunov P, Hou J,  Perfusion-weighted imaging of interictal hypoperfusion in temporal lobe epilepsy using FAIR-HASTE: comparison with H215O PET measurements. Magn Reson Med. 2001;45(3):431\u2013435.11241700"},{"issue":"4","key":"b7","series-title":"Acta Radiol","first-page":"477","article-title":"pASL versus DSC perfusion MRI in lateralizing temporal lobe epilepsy","volume":"56","author":"Oner AY","year":"2015","unstructured":"Oner AY, Eryurt B, Ucar M,  pASL versus DSC perfusion MRI in lateralizing temporal lobe epilepsy. Acta Radiol. 2015;56(4):477\u2013481.24782571"},{"issue":"7","key":"b8","series-title":"AJNR Am J Neuroradiol","first-page":"1334","article-title":"Detection of mesial temporal lobe hypoperfusion in patients with temporal lobe epilepsy by use of arterial spin labeled perfusion MR imaging","volume":"22","author":"Wolf RL","year":"2001","unstructured":"Wolf RL, Alsop DC, Levy-Reis I,  Detection of mesial temporal lobe hypoperfusion in patients with temporal lobe epilepsy by use of arterial spin labeled perfusion MR imaging. AJNR Am J Neuroradiol. 2001;22(7):1334\u2013134111498422"},{"issue":"10","key":"b9","series-title":"Epilepsy Res","first-page":"1932","article-title":"Arterial spin labeling MRI: a step forward in non-invasive delineation of focal cortical dysplasia in children","volume":"108","author":"Blauwblomme T","year":"2014","unstructured":"Blauwblomme T, Boddaert N, Ch\u00e9maly N,  Arterial spin labeling MRI: a step forward in non-invasive delineation of focal cortical dysplasia in children. 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Magn Reson Med. 2015;73(1):102\u2013116."},{"key":"b11","series-title":"Neuroimage Clin","first-page":"126","article-title":"Measurement of brain perfusion in newborns: pulsed arterial spin labeling (PASL) versus pseudo-continuous arterial spin labeling (pCASL)","volume":"6","author":"Boudes E","year":"2014","unstructured":"Boudes E, Gilbert G, Leppert IR,  Measurement of brain perfusion in newborns: pulsed arterial spin labeling (PASL) versus pseudo-continuous arterial spin labeling (pCASL). Neuroimage Clin. 2014;6:126\u2013133.25379424"},{"issue":"3","key":"b12","series-title":"Transl Stroke Res","first-page":"224","article-title":"Increased brain perfusion persists over the first month of life in term asphyxiated newborns treated with hypothermia: does it reflect activated angiogenesis?","volume":"6","author":"Shaikh H","year":"2015","unstructured":"Shaikh H, Lechpammer M, Jensen FE,  Increased brain perfusion persists over the first month of life in term asphyxiated newborns treated with hypothermia: does it reflect activated angiogenesis? Transl Stroke Res. 2015;6(3):224\u2013233.25620793"},{"issue":"2","key":"b13","series-title":"FreeSurfer. Neuroimage.","first-page":"774","volume":"62","author":"Fischl B.","year":"2012","unstructured":"Fischl B. FreeSurfer. Neuroimage. 2012;62(2):774\u2013781.22248573"},{"issue":"2","key":"b14","series-title":"Neuroimage","first-page":"825","article-title":"Improved optimization for the robust and accurate linear registration and motion correction of brain images","volume":"17","author":"Jenkinson M","year":"2002","unstructured":"Jenkinson M, Bannister P, Brady M, Smith S. Improved optimization for the robust and accurate linear registration and motion correction of brain images. Neuroimage. 2002;17(2):825\u2013841.12377157"},{"issue":"3","key":"b15","series-title":"Neuroimage","first-page":"968","article-title":"An automated labeling system for subdividing the human cerebral cortex on MRI scans into gyral based regions of interest","volume":"31","author":"Desikan RS","year":"2006","unstructured":"Desikan RS, S\u00e9gonne F, Fischl B,  An automated labeling system for subdividing the human cerebral cortex on MRI scans into gyral based regions of interest. 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Epilepsia. 2011;52(1):158\u2013174."},{"issue":"1","key":"b18","series-title":"Brain Pathol","first-page":"26","article-title":"Mild malformation of cortical development with oligodendroglial hyperplasia in frontal lobe epilepsy: a new clinico-pathological entity","volume":"27","author":"Schurr J","year":"2017","unstructured":"Schurr J, Coras R, R\u00f6ssler K,  Mild malformation of cortical development with oligodendroglial hyperplasia in frontal lobe epilepsy: a new clinico-pathological entity. Brain Pathol. 2017;27(1):26\u201335.26748554"},{"issue":"10","key":"b19","series-title":"Epilepsia","first-page":"1722","article-title":"Long-term seizure outcome after resective surgery in patients evaluated with intracranial electrodes","volume":"53","author":"Bulacio JC","year":"2012","unstructured":"Bulacio JC, Jehi L, Wong C,  Long-term seizure outcome after resective surgery in patients evaluated with intracranial electrodes. 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