MRI in the evaluation of localization‐related epilepsy

Abstract

This article covers the MRI evaluation of patients with epilepsy, with a focus on neuroimaging in those with localization-related epilepsy who may be potential epilepsy surgery candidates. The article includes structural MRI to identify a lesion, functional MRI to identify the eloquent cortex and diffusion tensor imaging to identify the eloquent white matter tracts. We consider the equipment, protocol or procedures, and reporting of MRI in patients with epilepsy. Recommendations for both adult and pediatric patients are described for protocols and procedures. The authors hope that this article will provide a standardized approach for clinical imaging of patients with suspected localization-related epilepsy who may be evaluated for epilepsy surgery. J. Magn. Reson. Imaging 2016.

Definitions and classification of malformations of cortical development: practical guidelines

“…MRI is certainly recommended as the most important imaging method in the evaluation of MCD, thanks to its optimal delineation of grey and white matter structures in the absence of ionizing radiation. Radiologists should strive to maximize the quality of their MRI protocols when suspecting MCD, using the best/highest resolution/highest contrast scanner available in their institutions ( Martinez-Rios et al , 2016 ). We support the use of 3 T over 1.5 T scanners whenever available, provided that imaging protocols are optimized.…”

“…We support the use of 3 T over 1.5 T scanners whenever available, provided that imaging protocols are optimized. Radiologists should also obtain detailed information from the referring clinicians regarding the size of the head, possible syndromic clinical features, epilepsy semiology, and EEG findings (particularly, location of origin of spikes) before reporting the examination ( Martinez-Rios et al , 2016 ).…”

“…Furthermore, it is of great importance to become familiar with the changes in imaging appearance of MCD associated with the age of the patient ( Eltze et al , 2005 ) and the type of magnetic resonance sequences that are best suited to detect these anomalies ( Martinez-Rios et al , 2016 ). Remarkably, ongoing myelination and maturation modifies the appearance of the normal grey and white matter and causes interval changes in the delineation of grey-white matter interfaces that, in turn, cause MCDs to become more or less easily identifiable at any given age.…”

Refractory Epilepsy: The Role of Positron Emission Tomography

“…It is acknowledged that higher-field MRI, particularly 3T, is preferred for epilepsy imaging and may identify subtle abnormalities such as focal cortical dysplasia. 7 It provides higher-resolution imaging and can increase lesion identification and thus improve outcomes following epilepsy surgery. 8 The number of abnormal MRI findings also varies among different care settings due to differences in epilepsy imaging protocols.…”

Teaching Neuro Images : Homotopic motor distribution on fMRI in closed-lip schizencephaly

“…Functional MRI (fMRI) shows homotopic distribution of tongue/finger/foot motor function at the edge of and along the depth of the schizencephalic cleft, supported by intracranial mapping (figures 1 and 2). fMRI is a reliable tool to identify the eloquent cortex in the planning for epilepsy surgery 1. 2 AUTHOR CONTRIBUTIONS Dr. Bartolini designed and drafted the article.…”