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Fig. 5 | Egyptian Journal of Radiology and Nuclear Medicine

Fig. 5

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

Fig. 5

a–h A 27-year-old male patient with non-lesional right temporal lobe FIAE. The visual-based analysis of the axial PASL-MRI colour-coded cerebral perfusion map (a) reflects the hypoperfusion of the epileptogenic right temporal lobe (red arrows) and the contra-lateral right frontal lobe, which represented the cerebral area of seizure spread (white arrows) and the contra-lateral left thalamus (blue arrows). The estimated rCBF for the right and left temporal lobes was 49.76 and 67.98 ml/100 g/min, respectively, with ASLAI% of 30.95%. The estimated rCBF of the right and left frontal lobes was 73.56 and 59.78 ml/100 g/min, respectively, with ASLAI% of 20.67%, while the estimated rCBF of the right and left thalami was 70.04 and 65.69 ml/100 g/min, respectively, with ASLAI% of 6.41%. The MV 1H-MRS picture maps illustrating the studied ROIs in (b) (I–VI). The MRS spectra of the right and left temporal lobes (c and d, 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 right temporal lobe (c) in comparison to the contra-lateral left temporal lobe (d) with these ratios were: [NAA/(Cho + Cr) = 0.59 and 0.85 with %AF of 36.11%, MI/NAA = 0.72 and 0.35 with %AF of 34.58%, Glx/NAA = 1.66 and1.34 with %AF of 21.33% and Glx/Cr = 1.62 and 1.30 with %AF of 21.92%] for the right (c) and left (d) temporal lobes, respectively. On the other hand, the MRS spectra of the contra-lateral left frontal lobe (f) and the contra-lateral left thalamus (h) showed decreased MI/NAA and NAA/(Cho + Cr), as well as increased Glx/NAA and Glx/Cr ratios when compared to the ipsilateral frontal lobe (e) and thalamus (g). These ratios were [NAA/(Cho + Cr) = 0.72 and 0.67 with %AF of 7.19%, MI/NAA = 0.38 and 0.27 with %AF of 33.85%, Glx/NAA = 1.33 and 1.65 with %AF of 21.47% and Glx/Cr = 1.28 and 1.59, with %AF of 21.60%] for the right and left frontal lobes, respectively, while these ratios were [NAA/(Cho + Cr) = 0.71 and 0.58 with %AF of 20.16%, MI/NAA = 0.42 and 0.20 with %AF of 70.97%, Glx/ NAA = 1.30 and 1.55 with %AF of 8.77% and Glx/Cr = 1.27 and 1.52, with %AF of 8.96%] for the right and left thalami, respectively

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