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Egyptian Journal of Radiology and Nuclear Medicine
Fig. 3 | Egyptian Journal of Radiology and Nuclear Medicine

Fig. 3

From: Arterial spin-labelling and magnetic resonance spectroscopy as imaging biomarkers for detection of epileptogenic zone in non-lesional focal impaired awareness epilepsy

Fig. 3

a–i A 40-year-old male patient with non-lesional left temporal lobe FIAE. The visual-based analysis of the axial PASL-MRI colour-coded cerebral perfusion maps (a and b) reveals a focal hypoperfusion of the epileptogenic left temporal lobe (red arrows), the ipsilateral occipital lobe that represents the area of seizure spread (white arrows) and the ipsilateral thalamus (blue arrows). The estimated rCBF for the right and left temporal lobes was 69.78 and 50.03 ml/100 g/min, respectively, with ASLAI% of 32.97%, as well as that of the right and left occipital lobes was 71.22 and 66.82 ml/100 g/min., respectively, with ASLAI% of 6.37%, while the estimated rCBF of the right and left thalami was 68.89 and 62.19 ml/100 g/min, respectively, with ASLAI% of 9.50%. The MV 1H-MRS picture maps illustrating the studied ROIs in (c) (I–IV). The MRS spectra of the right and left temporal lobes (d and e, respectively), as well as the right and left occipital lobes (f and g, respectively), in addition to the right and left thalami (h and i, respectively), demonstrated increased MI/NAA, Glx/NAA and Glx/Cr, as well as decreased NAA/(Cho + Cr) ratios in the zone of epileptogenic activity in the left temporal lobe (e) in comparison to the contra-lateral temporal lobe (d), while the ipsilateral left occipital lobe (g) and the ipsilateral thalamus (i) showed decreased MI/NAA and NAA/(Cho + Cr), as well as increased Glx/NAA and Glx/Cr ratios, when compared to their corresponding contra-lateral regions. For the right and left temporal lobes, these ratios were [NAA/(Cho + Cr) = 0.72 and 0.65 with %AF of 10.22%, MI/NAA = 0.21 and 1.07 with %AF of 13.44%, Glx/NAA = 1.25 and 1.61 with %AF of 25.17% and Glx/Cr = 1.22 and 1.50 with %AF of 20.58%]. For the right and left occipital lobes, these ratios were [NAA/(Cho + Cr) = 0.72 and 0.67; with %AF of 7.25%, MI/NAA = 0.38 and 0.27 with; %AF of 72.13%, Glx/NAA = 1.33 and 1.65 with %AF of 21.48% and Glx/Cr = 1.30 and 1.59, with %AF of 20.07%]. For the right and left thalami, these ratios were [NAA/(Cho + Cr) = 0.71 and 0.61 with %AF of 15.15%, MI/NAA = 0.40 and 0.19 with %AF of 71.18%, Glx/ NAA = 1.31 and 1.57 with %AF of 18.06% and Glx/Cr = 1.29 and 1.54, with %AF of 17.67%]

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