Impact of an optimized epilepsy surgery imaging protocol for focal epilepsy: A monocentric prospective study

Abstract

Objective To evaluate in a real clinical scenario the impact of the ILAE‐recommended “Harmonized neuroimaging of epilepsy structural sequences”‐ HARNESS protocol in patients affected by focal epilepsy. Methods We prospectively enrolled focal epilepsy patients who underwent a structural brain MRI between 2020 and 2021 at Modena University Hospital. For all patients, MRIs were: (a) acquired according to the HARNESS‐MRI protocol (H‐MRI); (b) reviewed by the same neuroradiology team. MRI outcomes measures were: the number of positive (diagnostic) and negative MRI; the type of radiological diagnosis classified in: (1) Hippocampal Sclerosis; (2) Malformations of cortical development (MCD); (3) Vascular malformations; (4) Glial scars; (5) Low‐grade epilepsy‐associated tumors; (6) Dual pathology. For each patient we verified for previous MRI (without HARNESS protocol, noH‐MRI) and the presence of clinical information in the MRI request form. Then the measured outcomes were reviewed and compared as appropriate. Results A total of 131 patients with H‐MRI were included in the study. 100 patients out from this cohort had at least one previous noH‐MRI scan. Of those, 92/100 were acquired at the same Hospital than H‐MRI and 71/92 on a 3T scanner. The HARNESS protocol revealed 81 (62%) positive and 50 (38%) negative MRI, and MCD was the most common diagnosis (60%). Among the entire pool of 100 noH‐MRI, 36 resulted positive with a significant difference (p < .001) compared to H‐MRI. Similar findings were observed when accounting for the expert radiologists (H‐MRI = 57 positive; noH‐MRI = 33, p < .001) and the scanner field strength (H‐MRI 43 = positive, noH‐MRI = 23, p < .001), while clinical information were more present in H‐MRI (p < .002). Significance The adoption of a standardized and optimized MRI acquisition protocol together with adequate clinical information contribute to identify a higher number of potentially epileptogenic lesions (especially FCD) thus impacting concretely on the clinical management of patients with focal epilepsy.

Intraoperative ECoG in bottom‐of‐the‐sulcus syndrome using a novel flexible strip electrode

“…A 3 T brain MRI (according to HARNESS protocol) 10,11 showed a focal hyperintensity of the right inferior frontal lobe with a subtle transmantle sign. These findings were suggestive of a FCD, later also confirmed by morphometric post-processing analysis (Figure 1).…”

The role of the amygdala in ictal central apnea: insights from brain MRI morphometry

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