Peri-ictal imaging abnormalities in non-convulsive status epilepticus - A systematic review and meta-analysis comparing magnetic resonance imaging and computed tomography perfusion

Sep 30, 2026

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Objective: Assess and compare peri-ictal abnormality detection rates using magnetic resonance imaging (MRI) and computed tomography perfusion (CTP) in non-convulsive status epilepticus (NCSE). Methods: Systematic search of five databases up to February 2025 included studies reporting peri-ictal MRI abnormalities (PMAs) or cerebral perfusion abnormalities (CPAs) in NCSE. Random-effects proportion meta-analyses with subgroup and meta-regression were used to compare modalities. Results: Nineteen studies (15 MRI, 4 CTP) included 562 MRI and 72 CTP patients. Pooled detection rate was 50.0% (MRI) versus 79.3% (CTP), with higher CTP odds and the top MRI sequence being arterial spin labeling. Conclusions: CTP detects more peri-ictal abnormalities than conventional MRI, supporting rapid diagnosis and workup, while MRI remains essential for etiology.

LanguageEnglish

CategoryHealthcare

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Abstract

Objective

Methods

Results

Conclusions

Introduction

Definition and diagnostic challenge of NCSE

Role of neuroimaging

Methods

Search strategy and study selection

DOI: 10.1111/epi.18604 RESEAR CH ARTICLE Peri-ictal imaging abnormalities in non-convulsive status epilepticus: A systematic review and meta-analysis comparing magnetic resonance imaging and computed tomography perfusion Pilar Bosque-Varela1,2 | Giorgi Kuchukhidze1,2 | Wiebke Hahn3 | Clara Jünemann3 | Lukas Machegger4 | Leona Möller3 | Johannes Pfaff4 | Eugen Trinka1,2,5 | Susanne Knake3 | Panagiota-Eleni Tsalouchidou3,6 1Department of Neurology, Christian Doppler University Hospital, Centre for Cognitive Neuroscience, Member of the European Reference Network EpiCARE, Paracelsus Medical University of Salzburg, Salzburg, Austria 2Neuroscience Institute, Christian Doppler University Hospital, Centre for Cognitive Neuroscience, Paracelsus Medical University of Salzburg, Salzburg, Austria 3Epilepsy Center Hessen, Department of Neurology, Philipps University Marburg, Marburg, Germany 4Department of Neuroradiology, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria 5Karl Landsteiner Institute for Clinical Neurosciences, Salzburg, Austria 6Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece Correspondence Panagiota-Eleni Tsalouchidou, Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece. [Email:](Email: pania.tsalouchidou@gmail.com)[ pania.tsalouchidou@gmail.com](Email: pania.tsalouchidou@gmail.com); [tsalouch@staff.uni-marburg.de](tsalouch@staff.uni-marburg.de) Abstract Objective: To assess and compare the detection rates of peri-ictal abnormalities using magnetic resonance imaging (MRI) and computed tomography perfusion (CTP) in patients with non-convulsive status epilepticus (NCSE) . Methods: We conducted a systematic literature search in five databases up to February 2025. Studies reporting peri-ictal MRI abnormalities (PMAs) or cerebral perfusion abnormalities (CPAs) in patients with NCSE were included. Metaanalyses of proportions were performed using a random-effects model. Subgroup analyses and meta-regression were used to compare detection rates across imaging modalities. Results: Nineteen studies were included (15 MRI, 4 CTP), comprising 562 patients for MRI and 72 for CTP. The pooled detection rate of peri-ictal abnormalities was 50.0%(95% confidence interval [CI]: 34.0%–65 .0%) for MRI and 79. 3%(95% CI: 54.3%–92.5%) for CTP. Among the MRI modalities, arterial spin labeling (ASL) demonstrated the highest detection rate at 88.8%(95% CI: 32.9%–99.2%) . CTP showed a significantly higher detection rate than MRI (χ2 = 3.97, p = 0.046); metaregression indicated increased odds of detection with CTP (odds ratio [OR] = 4.06, 95% CI: 0.97–16.99, p = 0.055) . No statistically significant difference was found between ASL and CTP (χ2 = 0.22, p = 0.636) . Conclusions: CTP demonstrates a higher detection rate than conventional MRI for peri-ictal abnormalities in patients with NCSE, supporting its utility in rapid diagnosis and differential workup. Among MRI sequences, ASL showed the highest detection rates, highlighting its potential role in the diagnostic assessment of NCSE. Although MRI remains essential for clarifying etiology, its effectiveness in detecting PMA is highly dependent on the sequences used. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2025 The Author(s). Epilepsia published by Wiley Periodicals LLC on behalf of International League Against Epilepsy. KEYWORDS arterial spin labeling, hyperperfusion, perfusion imaging, peri-ictal MRI abnormalities (PMAs), seizures, status epilepticus 1 | INTRODUCTION Status epilepticus (SE) is a medical emergency that can result in long-term consequences, including neuronal death, if not promptly recognized a

FAQs

What was the primary aim of the systematic review and meta-analysis?

To assess and compare detection rates of peri-ictal abnormalities using MRI versus computed tomography perfusion (CTP) in patients with non-convulsive status epilepticus (NCSE).

How were studies selected and how were detection rates analyzed?

A systematic search of five databases up to February 2025 was performed. Included studies reported peri-ictal MRI abnormalities (PMAs) or cerebral perfusion abnormalities (CPAs), and pooled detection rates were estimated with random-effects meta-analyses, including subgroup analyses and meta-regression.

Which modality and MRI sequence showed the highest detection rate?

CTP showed a higher pooled detection rate than conventional MRI. Among MRI sequences, arterial spin labeling (ASL) demonstrated the highest detection rate.

Sep 30, 2026

Uploaded by Mimi