Arterial Spin Labelling Perfusion is a Valuable Tool for Diagnosis and Prognostication of Status Epilepticus

Background: Status epilepticus (SE), characterized by prolonged, self-sustained seizures, is a medical emergency associated with high mortality, requiring immediate diagnosis and treatment. This study aimed to evaluate the sensitivity and prognostic value of arterial spin labelling (ASL) in a large group of SE patients and compare them with those of other magnetic resonance (MR) sequences, including dynamic susceptibility contrast (DSC) perfusion imaging. Methods: We retrospectively collected data of patients with SE in a tertiary center between September 2016 and March 2020. For comparison, patients with self-limiting seizures were included. MR images were visually assessed, and the sensitivity for the detection of SE and prognostication was compared among multi-delay ASL, DSC, fluid-attenuated inversion recovery (FLAIR), and diffusion-weighted imaging (DWI). Findings: We included 51 SE patients and 46 patients with self-limiting seizures. Relevant changes in ASL signals were observed in 90·2% (46/51) of SE patients, a percentage higher than those for DSC, FLAIR, and DWI. ASL was the most sensitive and accurate method for initial differentiation between SE and self-limiting seizures. The sensitivity of ASL for detecting refractory SE (89·5%) or estimating poor outcomes (100%) was higher than those of other MR protocols or electroencephalography and comparable to those of clinical prognostic scores. Interpretation: In a large patient population, ASL showed considerable capability to detect SE and a better prognostic value than other MR sequences. ASL may be valuable for the initial evaluation of SE patients. Funding: This work was supported by National Research Foundation of Korea (NRF) grants funded by the Korean government (MSIT; Ministry of Science and ICT) (NRF-2018M3A9E8023853, NRF-2018R1C1B6006145, NRF-2019R1A5A2026045, and NRF-2019R1I1A1A01064291). Declaration of Interest: None to declare. Ethical Approval: This retrospective study was approved by the Institutional Review Board of Ajou University Hospital (IRB no. AJIRB-MED-MDB- 20-114), and the requirement to obtain informed consent was waived.