Utility of 7 Tesla Magnetic Resonance Imaging in Patients With Epilepsy: A Systematic Review and Meta-Analysis

Abstract

Objective: 7 Tesla magnetic resonance imaging (MRI) enables high resolution imaging and potentially improves the detection of morphologic abnormalities in patients with epilepsy. However, its added value compared with conventional 1.5T and 3.0T MRI is unclear. We reviewed the evidence for the use of 7 Tesla MRI in patients with epilepsy and compared the detection rate of focal lesions with clinical MRI.Methods: Clinical retrospective case studies were identified using the indexed text terms “epilepsy” AND “magnetic resonance imaging” OR “MR imaging” AND “7T” OR “7 Tesla” OR “7T” in Medline (2002-September 1, 2020) and Embase (1999-September 1, 2020). The study setting, MRI protocols, qualitative, and quantitative assessment were systematically reviewed. The detection rate of morphologic abnormalities on MRI was reported in each study in which surgery was used as the reference standard. Meta-analyses were performed using a univariate random-effects model in diagnostic performance studies with patients that underwent both 7T MRI and conventional MRI.Results: Twenty-five articles were included (467 patients and 167 healthy controls) consisting of 10 case studies, 10 case-control studies, 4 case series, and 1 cohort study. All studies included focal epilepsy; 12 studies (12/25, 48%) specified the disease etiology and 4 studies reported focal but non-lesional (MRI-negative on 1.5/3.0T) epilepsy. 7T MRI showed superior detection and delineation of morphologic abnormalities in all studies. In nine comparative studies, 7T MRI had a superior detection rate of 65% compared with the 22% detection rate of 1.5T or 3.0T.Significance: 7T MRI is useful for delineating morphologic abnormalities with a higher detection rate compared with conventional clinical MRI. Most studies were conducted using a case series or case study; therefore, a cohort study design with clinical outcomes is necessary.Classification of Evidence: Class IV Criteria for Rating Diagnostic Accuracy Studies.

Advanced neuroimaging techniques in epilepsy

“…Susceptibility-weighted images were particularly good for identifying vascular abnormalities. A further systematic review gave comparable results [4]. In individuals with lesions seen at 3T, 7T imaging was associated with increased conspicuity and definition of boundaries but with increased artefacts, particularly in the temporal lobes [5], and there was benefit from postacquisition morphometric analysis in individuals with unremarkable scans at 3T [6].…”

Surgery for pediatric drug resistant epilepsy: a narrative review of its history, surgical implications, and treatment strategies

“…Magnetoencephalography may be an imaging modality for correlating localizations with seizure localization ( 60 ). The broadened utility of 7T MRI may identify small areas of neocortical dysplasia that would otherwise not be seen with less powerful magnets ( 61 ). BOLD functional MRI and diffusion tensor MRI with tractography allow for advanced mapping when eloquent cortex and/or white matter tracts may be involved in epileptogenic focus or prospective surgery ( 62 ).…”

Bildgebung in der prächirurgischen Epilepsiediagnostik

“…B. der Sehbahn oder der Pyramidenbahn) darstellen, um sie bei der Operation möglichst zu verschonen und das Risiko postoperativer Defizite gering zu halten [ 11 ]. Eine Neuentwicklung im Bereich der strukturellen MRT ist die Hochfeldtomographie mit 7‑T-magnetischer Flussdichte, die eine bis zu 65 % höhere Detektionsrate epileptogener Läsionen erlaubt, bisher aber nur begrenzt Eingang in den klinischen Alltag gefunden hat [ 25 ].…”