Fig. 6

a–d A 35-year-old female patient with non-lesional left parietal lobe FIAE. The visual-based analysis of the axial PASL-MRI colour-coded cerebral perfusion map (a) demonstrated 2 mirrored focal hypoperfusion areas in the right and left parietal lobes, which represented a mirror focus of cerebral area of seizure spread (blue arrows) and the focal epileptogenic zone (red arrows), respectively, and exhibited cool blue colour, according to the colour scale, reflecting the associated decrease in the rCBF. Additionally, based on the colour-coded spectrum, a cortical and subcortical relative hypoperfusion with associated decrease in the rCBF of the left parietal region is seen displaying green and dark yellow colours (white arrows), when compared to the normal perfusion pattern of the corresponding contra-lateral cortical and subcortical right parietal lobe that tinted with red and yellow colours (yellow arrows). The estimated rCBF for the right and left parietal lobes was 78.68 and 57.91 ml/100 g/min, respectively, with ASLAI% of 30.41%. The MV 1H-MRS picture maps illustrating the studied ROIs of both parietal lobes, were obtained at a long TE of 144 ms (b) and short TE of 35 ms. The MV 1H-MRS spectra of the left parietal lobe (d) demonstrated the zone of focal epileptogenic activity with increased MI/NAA, Glx/NAA and Glx/Cr, as well as, decreased NAA/(Cho + Cr) ratios, while the MV 1H-MRS spectra of the right parietal lobe (c) demonstrated a mirror focus of cerebral area of seizure spread with decreased MI/NA and NAA/(Cho + Cr), as well as increased Glx/NAA and Glx/Cr ratios. For the right and left parietal lobes (c and d, respectively), these ratios were [NAA/(Cho + Cr) = 0.66 and 0.46 with %AF of 35.71%, MI/NAA = 0.69 and 0.83 with %AF of 18.42%, Glx/ NAA = 1.31 and1.49 with %AF of 12.86% and Glx/Cr = 1.29 and 1.45 with %AF of 11.68%]