TY - JOUR
T1 - Magnetic resonance imaging fingerprints of status epilepticus
T2 - A case-control study
AU - Bosque Varela, Pilar
AU - Tabaee Damavandi, Payam
AU - Machegger, Lukas
AU - Prüwasser, Tanja
AU - Zimmermann, Georg
AU - Oellerer, Andreas
AU - Steinbacher, Jürgen
AU - McCoy, Mark
AU - Pfaff, Johannes
AU - Trinka, Eugen
AU - Kuchukhidze, Giorgi
N1 - Varela. Damavandi, Prüwasser, Trinka, McCoy, Kuchukhidze: Department of Neurology, Christian Doppler University Hospital, member of the European Reference Network EpiCARE, Center for Cognitive Neuroscience, Paracelsus Medical University of Salzburg, Salzburg, Austria. Machegger, Oellerer, Steinbacher, Pfaff: Department of Neuroradiology, Christian Doppler University Hospital, Paracelsus Medical University of Salzburg, Salzburg, Austria. Zimmermann: Research and Innovation Management, Paracelsus Medical University, Salzburg, Austria. McCoy, Trinka, Kuchukhidze: Neuroscience Institute, Christian Doppler University Hospital, Salzburg, Austria
PY - 2024/6
Y1 - 2024/6
N2 - OBJECTIVE: Status epilepticus (SE) is frequently associated with peri-ictal magnetic resonance imaging (MRI) abnormalities (PMA). However, the anatomical distribution of these alterations has not been systematically studied. The aim of this study was to assess the localization patterns of PMA in patients with SE.METHODS: In this prospective case-control study, we compared the distribution and combinations of diffusion-restricted PMA to diffusion-restricted lesions caused by other neurological conditions. All patients of the SE group and the control group underwent MRI including a diffusion-weighted imaging sequence. Patients with SE were imaged within 48 h after its onset.RESULTS: We enrolled 201 patients (51 with SE and 150 controls). The most frequent locations of PMA in SE were cortex (25/51, 49%), followed by hippocampus (20/51, 39%) and pulvinar of thalamus (10/51, 20%). In the control group, the cortex was involved in 80 of 150 (53%), white matter in 53 of 150 (35%), and basal ganglia in 33 of 150 (22%). In the control group, the pulvinar of thalamus was never affected and hippocampal structures were rarely involved (7/150, 5%). Involvement of the pulvinar of thalamus and the hippocampus had high specificity for SE at 100% (95% confidence interval [CI] = 98-100) and 95% (95% CI = 91-98), respectively. The sensitivity, however, was low for both locations (pulvinar of thalamus: 20%, 95% CI = 10-33; hippocampus: 39%, 95% CI = 26-54).SIGNIFICANCE: Diffusion-restricted MRI lesions observed in the pulvinar of thalamus and hippocampus are strongly associated with SE. These changes may help physicians in diagnosing SE-related changes on MRI in an acute setting, especially in cases of equivocal clinical and electroencephalographic manifestations of SE.
AB - OBJECTIVE: Status epilepticus (SE) is frequently associated with peri-ictal magnetic resonance imaging (MRI) abnormalities (PMA). However, the anatomical distribution of these alterations has not been systematically studied. The aim of this study was to assess the localization patterns of PMA in patients with SE.METHODS: In this prospective case-control study, we compared the distribution and combinations of diffusion-restricted PMA to diffusion-restricted lesions caused by other neurological conditions. All patients of the SE group and the control group underwent MRI including a diffusion-weighted imaging sequence. Patients with SE were imaged within 48 h after its onset.RESULTS: We enrolled 201 patients (51 with SE and 150 controls). The most frequent locations of PMA in SE were cortex (25/51, 49%), followed by hippocampus (20/51, 39%) and pulvinar of thalamus (10/51, 20%). In the control group, the cortex was involved in 80 of 150 (53%), white matter in 53 of 150 (35%), and basal ganglia in 33 of 150 (22%). In the control group, the pulvinar of thalamus was never affected and hippocampal structures were rarely involved (7/150, 5%). Involvement of the pulvinar of thalamus and the hippocampus had high specificity for SE at 100% (95% confidence interval [CI] = 98-100) and 95% (95% CI = 91-98), respectively. The sensitivity, however, was low for both locations (pulvinar of thalamus: 20%, 95% CI = 10-33; hippocampus: 39%, 95% CI = 26-54).SIGNIFICANCE: Diffusion-restricted MRI lesions observed in the pulvinar of thalamus and hippocampus are strongly associated with SE. These changes may help physicians in diagnosing SE-related changes on MRI in an acute setting, especially in cases of equivocal clinical and electroencephalographic manifestations of SE.
U2 - 10.1111/epi.17949
DO - 10.1111/epi.17949
M3 - Original Article
C2 - 38507291
SN - 0013-9580
VL - 65
SP - 1620
EP - 1630
JO - EPILEPSIA
JF - EPILEPSIA
IS - 6
ER -