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. 2012 Sep;85(1017):1236-42.
doi: 10.1259/bjr/30177037. Epub 2012 May 9.

3.0 T MRI of 2000 consecutive patients with localisation-related epilepsy

I J Craven  1 , P D Griffiths, D Bhattacharyya, R A Grunewald, T Hodgson, D J A Connolly, S C Coley, R Batty, C A J Romanowski, N Hoggard
Affiliations

3.0 T MRI of 2000 consecutive patients with localisation-related epilepsy

I J Craven et al. Br J Radiol. 2012 Sep.

Abstract

Objectives: Clinical guidelines suggest that all patients diagnosed with localised seizures should be investigated with MRI to identify any epileptogenic structural lesions, as these patients may benefit from surgical resection. There is growing impetus to use higher field strength scanners to image such patients, as some evidence suggests that they improve detection rates. We set out to review the detection rate of radiological abnormalities found by imaging patients with localised seizures using a high-resolution 3.0 T epilepsy protocol.

Methods: Data were reviewed from 2000 consecutive adult patients with localisation-related epilepsy referred between January 2005 and February 2011, and imaged at 3.0 T using a standard epilepsy protocol.

Results: An abnormality likely to be related to seizure activity was identified in 403/2000 (20.2%) patients, with mesial temporal sclerosis diagnosed in 211 patients. 313/2000 (15.6%) had lesions potentially amenable to surgery. Abnormalities thought unrelated to seizure activity were found in 324/2000 (16.1%), with 8.9% having evidence of ischaemic disease.

Conclusions: Since the introduction of the then National Institute for Clinical Excellence guidelines in 2004, the detection rate of significant pathology using a dedicated 3.0 T epilepsy protocol has not fallen, despite the increased numbers of patients being imaged. This is the largest study of epilepsy imaging at 3.0 T to date and highlights the detection rates of significant pathology in a clinical setting using a high-strength magnet. The prevalence of ischaemic disease in this population is significantly higher than first thought, and may not be incidental, as is often reported.

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Figures

Figure 1
Figure 1
The proportion of examinations performed each year since the National Institute for Health and Clinical Excellence guidelines were introduced (*only includes the first 18 examinations in 2011) and the ages of the patients referred (in years).
Figure 2
Figure 2
The proportion of related and unrelated abnormal findings correlated to the age of the patient. The percentages are of the total number of patients in that age range.
Figure 3
Figure 3
The proportion of potentially resectable abnormalities by age. MTS, mesial temporal sclerosis.
Figure 4
Figure 4
The prevalence of changes secondary to cerebral ischaemia found in this study compared with our experience of healthy volunteers.
See this image and copyright information in PMC

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