F15. Factors associated with arterial spin labeling magnetic resonance imaging hyperperfusion in newborns with seizures

Abstract

Introduction Arterial spin labeling (ASL) magnetic resonance imaging (MRI) can identify seizure foci in studies of adults and children with epilepsy. Our previous case series described 107 newborns with continuous EEG (cEEG) confirmed seizures, of which 60 (56%) had increased cerebral blood flow (CBF). Of those with increased CBF, 29 (48%) were concordant with location of seizure onset. This study examines factors associated with ASL MRI increased CBF in newborns with seizures. Methods The CNMC Neonatal Neurocritical Care Service database was reviewed for all newborns presenting with seizures between January 2013 and March 2017 when MRI ASL was routinely performed. Newborns with seizure were defined as newborns with continuous EEG (cEEG) confirmed seizures. Brain MR imaging was performed using a 3T magnet. ASL images were acquired by pseudocontinuous ASL with segmented 3D fast spin-echo readout. A board certified pediatric neuroradiologist qualitatively reviewed and analyzed all MRIs and ASL data (MTW). Data analyzed: gestational age, gender, seizure etiology, semiology, age at time of seizure onset, seizure onset location, time interval between last seizure to MR imaging. The maximal hourly and total seizure burden prior to MRI was determined from EEG reports and was categorized as less than 7 seizures, 7 or more seizures or status epilepticus. Statistical analysis was performed using Mann-Whitney U and Fisher’s exact tests. Results Etiologies in the 60 patients with cEEG seizures and increased ASL MRI CBF were (n, %): HIE (21, 35), stroke (14, 23), intracranial infection (7, 12), brain malformation (6, 10), intracranial hemorrhage (4, 7), inborn error of metabolism (4, 7), epilepsy syndrome (1, 1), and unknown causes (3, 5). Median time from last seizure to ASL MRI was 35 h for those with increased CBF and 41 h for those without (p = 0.36). Of those with total seizure burden 7, ⩾ 7 and status epilepticus, 16/42, 34/52 and 10/13, respectively, had increased CBF. There was a good correlation between increasing seizure burden and increased CBF (p 7 in 38/76, ⩾ 7 in 12/18 and status epilepticus in 10/13). Conclusion In newborns with seizures, a high total seizure burden is associated with increased ASL MRI CBF. Duration from last cEEG seizure and MRI ASL was not associated with increased CBF in this cohort with little variation in timing of MRI after last seizure. Additional studies with shorter duration between last seizure and MRI ASL would be needed to determine the time course and persistence of ASL changes.