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.

BACKGROUND: To investigate the asymmetry of quantitative cerebral blood flow (CBF) values in interictal temporal lobe epilepsy (TLE) patients with (TLE-MTS) and without (TLE-no) mesial temporal sclerosis.

METHODS: Twenty-six TLE patients (14 TLE-MTS/12 TLE-no) and 22 controls were studied with a three-dimensional whole-brain pseudocontinuous arterial spin-labeling technique at 3.0 Tesla. Regions of interest were placed at the bilateral hippocampal heads, amygdalas and temporal lobes to get the average regional cerebral blood flow (rCBF) and calculate asymmetry indices (AIs). Statistical parametric mapping detected the whole-brain CBF changes of the two subgroups (right-sided).

RESULTS: AIs of the hippocampus and amygdala in TLE-MTS and AIs of hippocampus in TLE-no were significantly different versus controls (P < 0.001, P = 0.001, and P = 0.013). The lateralizing sensitivity increased to 96.154% by combining structural MRI and AIs of rCBF with optimal cutoff values. Hypoperfusion regions in the right TLE-MTS mainly clustered in the bilateral temporal lobes, frontal lobes, insular lobes, and left caudate nucleus. The right TLE-no showed hypoperfusion in the bilateral temporal lobes, frontal lobes, right insular lobe, parietal lobe, occipital lobe, and caudate nucleus.

CONCLUSION: Asymmetry of CBF in the TLE-MTS and TLE-no is different and improves MRI performance in lateralizing the TLE.