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. 2022 Apr;64(4):753-764.
doi: 10.1007/s00234-021-02884-8. Epub 2022 Jan 5.

Value of ultra-high field MRI in patients with suspected focal epilepsy and negative 3 T MRI (EpiUltraStudy): protocol for a prospective, longitudinal therapeutic study

R H G J van Lanen  1   2 , C J Wiggins  3 , A J Colon  4 , W H Backes  5   6 , J F A Jansen  5   4   6   7 , D Uher  5   6 , G S Drenthen  5   6 , A Roebroeck  8 , D Ivanov  8 , B A Poser  8 , M C Hoeberigs  5   4   6 , S M J van Kuijk  9 , G Hoogland  10   5   4 , K Rijkers  10   5   4 , G L Wagner  4 , J Beckervordersandforth  11 , D Delev  12 , H Clusmann  12 , S Wolking  13 , S Klinkenberg  5   4   14 , R P W Rouhl  5   4   14 , P A M Hofman  4   6 , O E M G Schijns  10   5   4
Affiliations

Value of ultra-high field MRI in patients with suspected focal epilepsy and negative 3 T MRI (EpiUltraStudy): protocol for a prospective, longitudinal therapeutic study

R H G J van Lanen et al. Neuroradiology. 2022 Apr.

Abstract

Purpose: Resective epilepsy surgery is a well-established, evidence-based treatment option in patients with drug-resistant focal epilepsy. A major predictive factor of good surgical outcome is visualization and delineation of a potential epileptogenic lesion by MRI. However, frequently, these lesions are subtle and may escape detection by conventional MRI (≤ 3 T).

Methods: We present the EpiUltraStudy protocol to address the hypothesis that application of ultra-high field (UHF) MRI increases the rate of detection of structural lesions and functional brain aberrances in patients with drug-resistant focal epilepsy who are candidates for resective epilepsy surgery. Additionally, therapeutic gain will be addressed, testing whether increased lesion detection and tailored resections result in higher rates of seizure freedom 1 year after epilepsy surgery. Sixty patients enroll the study according to the following inclusion criteria: aged ≥ 12 years, diagnosed with drug-resistant focal epilepsy with a suspected epileptogenic focus, negative conventional 3 T MRI during pre-surgical work-up.

Results: All patients will be evaluated by 7 T MRI; ten patients will undergo an additional 9.4 T MRI exam. Images will be evaluated independently by two neuroradiologists and a neurologist or neurosurgeon. Clinical and UHF MRI will be discussed in the multidisciplinary epilepsy surgery conference. Demographic and epilepsy characteristics, along with postoperative seizure outcome and histopathological evaluation, will be recorded.

Conclusion: This protocol was reviewed and approved by the local Institutional Review Board and complies with the Declaration of Helsinki and principles of Good Clinical Practice. Results will be submitted to international peer-reviewed journals and presented at international conferences.

Trial registration number: www.trialregister.nl : NTR7536.

Keywords: 7 T; 9.4 T; Epilepsy; Epilepsy surgery; UHF MRI.

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Figures

Fig. 1
Fig. 1
Study participants’ timeline
Fig. 2
Fig. 2
7 T 3D T1-MP2RAGE axial image of a test subject’s cerebrum with an isotropic voxel size of 0.7 mm. The di-electric pads can be seen on both sides
Fig. 3
Fig. 3
7 T 2D dual-echo GRE (T2*) axial image of a test subject’s cerebrum with a voxel size of 0.3 × 0.3 × 2.0 mm
See this image and copyright information in PMC

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