The small additional gain of the quantification analyses was secondary to better discrimination of the bilateral hippocampal abnormalities. On the right side of the graphic are shown the hippocampal volumes of patients (white circles = hippocampi ipsilateral to the epileptic focus; mean volume, 3.78 ± 0.51 cm3; black triangles = hippocampi contralateral to the epileptic focus; mean volume, 4.28 3± 0.56 cm). Resection of these lesions can lead to seizure freedom in many patients. An epilepsy protocol MRI is different from a standard brain MRI because the pictures are focused to look in the structures of the brain that are most likely to cause seizures. In many patients with epilepsy antiepileptic drug treatment is unable to control the seizures. The patient with discordant volumetry and MR imaging visual analysis had a subtle hippocampal atrophy and clear hyperintense T2 signal on the left hippocampus by visual analysis, which was concordant with the T2 relaxometry. Acquisition protocols are proposed for the main MRI devices. Automatic volumetric analysis was performed with FreeSurfer software (Version 5.1.0; http://surfer.nmr.mgh.harvard.edu) by using T1WI volume. This article has not yet been cited by articles in journals that are participating in Crossref Cited-by Linking. The Neuroimaging Task Force from the International League Against Epilepsy (ILAE) Diagnostic Methods Commission has published a new set of recommendations regarding which patients are candidates for structural magnetic resonance imaging (MRI), the minimum prerequisites for an MRI protocol, how MRI should be evaluated, and how lesion detection can be optimized. The clinical use of 7-Tesla MRI enhances Mayo Clinic's ability to manage epilepsy, certain brain and peripheral nerve tumors, and other neurological disorders. Fernando Cendes—RELATED: Grants: FAPESP and Conselho Nacional de Desenvolvimento Científico e Tecnológico, Brazil,* Comments: FAPESP grants 2005/56578-four and 2009/54552–9. The ROIs were manually drawn to include the larger area of the hippocampus in that section but also to carefully avoid contamination of the hippocampal signal with CSF signal (Fig 1). T2WI volume: isotropic voxels of 1.5 mm, acquired in the sagittal plane (no gap, TR = 1800 ms, TE = 340 ms, matrix = 140 × 140, FOV = 230 × 230, TSE factor = 120; flip angle = 90°; geometry-corrected). Bruno Kubota contributed the relaxometry analysis; Felipe Bergo, volumetry analysis; Brunno M. Campos, patient recruitment and volumetry analysis; Fernando Cendes, study concept and design, review of patient selection, MRI visual analysis, interpretation of the data, manuscript writing, and reviewing. On the right side is the boxplot graphic of z scores of the volumetry asymmetry index (gray) and T2 relaxometry asymmetry index (black) of patients with MTLE. The objective is to quantitatively assess surgical outcomes in epilepsy patients who underwent scanning at 7T MRI whose lesions were undetectable at c… CLINCIAL Currently, most studies of hippocampal volumetry apply manual hippocampal delimitation, and whether manual28 or automatic analysis has higher sensitivity and specificity is still debatable.12,13 Despite this controversy, in the clinical context, the quantification of hippocampal abnormalities must be as fast and practical as possible. A Study on Hippocampal Atrophy in Mesial Temporal Lobe Epilepsy, Default Mode Network patterns and its interactions with memory performance in patients with Temporal Lobe Epilepsy and controls, The Effect of Electroencephalography Leads on Image Quality in Cerebral Perfusion SPECT and 18F-FDG PET/CT, Mesial Temporal Sclerosis: Accuracy of NeuroQuant versus Neuroradiologist, The spectrum of hippocampal sclerosis: a quantitative magnetic resonance imaging study, MRI of amygdala and hippocampus in temporal lobe epilepsy, Quantitative hippocampal MRI and intractable temporal lobe epilepsy, The neurobiology of temporal lobe epilepsy: too much information, not enough knowledge, Hippocampal sclerosis can be reliably detected by magnetic resonance imaging, Hippocampal sclerosis in temporal lobe epilepsy demonstrated by magnetic resonance imaging, MRI volumetric measurements of amygdala and hippocampus in temporal lobe epilepsy, Detection of hippocampal pathology in intractable partial epilepsy. Left hippocampus T2 signal: 111.40 (z score = 3.52 SDs). B, A 28-year-old male patient with MTLE and left seizure focus. The asymmetry index had a higher sensitivity to detect the hippocampal volume reduction (76% [98 patients] had significant hippocampal volume reduction detected by the absolute volume and 98% [126 patients] were detected by asymmetry index) and a lower sensitivity to detect T2 hyperintense signal (92% [109 patients] with significant hippocampal T2 hyperintense signal detected by the absolute volume and 70% [82 patients] detected by asymmetry index). Although FreeSurfer software is not approved for clinical use by the US Food and Drug Administration, as far as we know, there is at least 1 software approved for automated volumetric analyses of brain MRI.27 However, this has only been evaluated for the detection of hippocampal abnormalities on 1.5T scanners.13. For the remaining 78 (38%) patients, MRI had normal findings by visual analyses. All patients underwent one or more MRI 1.5 Tesla (1.5T) or 3 Tesla (3T) studies with a standard epilepsy protocol with Siemens scanners (Erlangen, Germany). OHSU responds to a coronavirus surge while caring for all our patients. For the 10% of individuals who experience a seizure their lifetime,the majority (two-thirds) will represent a new-onset, nonrecurringseizure.10Peak prevalence is bimodal (< 1 yr and > 55yrs of age). MR imaging signs of HS detected by quantification analysis. Indicates open access to non-subscribers at www.ajnr.org. Mesial temporal lobe epilepsy (MTLE) is the most common form of epilepsy in adults.1 Although hippocampal sclerosis (HS) is the main pathologic substrate in patients with MTLE, there are several other causes and some patients may have normal MR imaging findings and no specific histopathologic changes detected postoperatively.1,2 HS can be reliably detected on MRI,2 and quantitative analysis of hippocampal formation improves the sensitivity for detecting this pathology.3,4 With advances in the MR imaging field in the past decades, the current contributions of these postprocessing MR imaging tools for the detection of hippocampal pathology, especially in tertiary epilepsy centers, are not clear. Nineteen patients (10%) underwent surgical treatment (anterior temporal lobectomy or selective amygdalohippocampectomy) due to refractory seizures. X-ray CT scanning has a role in assessing patients with seizures in the context of an acute neurological illness. Detailed imaging parameters can be found elsewhere (Wang, et al. On the left side of the graphic is the hippocampal T2 signal of controls (white circles = right hippocampi; mean signal, 96.77 ± 4.05; black triangles = left hippocampi; mean signal, 96.98 ± 4.10). What is MRI epilepsy protocol. 2012). Mayo Clinic was the first center in North America to use clinical 7-Tesla MRI, after the Food and Drug Administration (FDA) approved the system in … Charge as: Brain WO An MRI provides an accurate picture of the structures of the brain using magnetic technology. In patients who had bilateral hippocampal abnormalities detected by the quantifications methods, there was marked asymmetry. A group of 79 healthy controls (with similar age and sex distribution) was used for comparison (60% female; median age, 42 years; range, 21–70 years). Bergo—RELATED: Grant: FAPESP, Comments: Postdoctoral scholarship funding from a government agency. To make the ROI placement more consistent among patients, we defined the section of the hippocampus head as the first in which it was possible to see the temporal horn of the lateral ventricle and therefore to appropriately separate the hippocampal formation from the amygdala. For this analysis, a region of interest was manually defined in 3 different MR imaging sections, including the hippocampus of each individual (1 in the head, 1 in the body, and 1 in the tail of the hippocampus) by an investigator blinded to the results of the MR imaging visual evaluation (B.K.). This ensures adequate coverage/signal on the AX and COR MPRs. In MRI performed with a 3T scanner and visually inspected by imaging experts, quantification of hippocampal volume and T2 signal can increase the detection of signs of HS in approximately 28% of patients with MTLE. Relaxometry analysis detected hyperintense T2 signal in 103 (82%) patients with visually detected hippocampal sclerosis and in 15 (19%) with visually normal MR imaging findings. On the left side is the boxplot graphic of z scores of the volumetry asymmetry index (gray) and T2 relaxometry asymmetry index (black) of controls. Re: Epilepsy Protocol MRI Submitted by jmccand on Fri, 2006-10-06 08:15 I have heard of a new MRI procedure that they are doing for epilepsy, where they also have an EEG going at the same time as the contrast MRI. A, A 67-year-old male patient, with MTLE and left EEG seizure focus. Automatic volumetry analysis detected hippocampal atrophy in 119 (95%) patients with visual signs of HS and in 10 (13%) patients with visually normal MR imaging findings. Check the positioning block in the other two planes. The difference between a radiologist’s “call” of a “normal” versus “abnormal” may also be dependent on the protocols that a given center is using with a 3T MRI. From the 125 patients with MTLE with HS signs detected by visual analysis, 117 had unilateral epileptic focus (defined by ictal and interictal EEG); in 88% (103/117), the side of signs with HS was concordant with the epileptic focus, and it was contralateral in 7.5% (9/117). A1, T1WI in which both hippocampi were considered normal by visual analysis. In the remaining 4 patients, 2 had bilateral asymmetric hippocampal abnormalities on visual analyses and the relaxometry lateralized to the side with less hippocampal atrophy by both visual and automatic volumetry, and the other 2 patients had unilateral hippocampal atrophy (concordant by visual and automatic volumetry) and the relaxometry lateralized to the side contralateral to the atrophy and hyperintense T2 signal defined by visual analysis. and the images were classified as having normal findings or signs of HS. In this context, we believe that the use of hippocampal quantification measures in 3T MRI, as we showed in this article, can help in the recognition of these individuals with hippocampal sclerosis not detected by visual analysis who could benefit from surgical procedures for control of drug-resistant seizures. A total of 317 individuals who had undergone 3T brain MRI of epilepsy protocol were eligible for the study. 3T MRI Quantification of Hippocampal Volume and Signal in Mesial Temporal Lobe Epilepsy Improves Detection of Hippocampal Sclerosis, Voxel-Based Morphometry--from Hype to Hope. The final group was then composed of 203 patients (129 female, 74 male; median age, 46 years; range, 17–74 years). MR imaging sequences were corrected for gradient nonlinearity during the reconstruction step in the scanner. Coil: Head. This study was funded by São Paulo Research Foundation, grants 2005/56578-4 and 2009/54552-9. This pattern of subtle and localized hippocampal abnormality (restricted to the hippocampal body) is not commonly seen. Relaxometry detected bilateral hippocampal hyperintense signal in 22 patients (20 with visual signs of HS and 2 with visually normal MR imaging findings). MRI epilepsy protocol refers to the sequence of images taken of the brain when evaluating a potential seizure disorder. In this group, 176 (87%) patients had drug-resistant seizures, while 27 (13%) had been free of seizures for at least 2 years. MRI Protocols for physicians and technologists- MR Epilepsy/Seizure WWO Neuro Protocol Skip to main content Skip to main navigation OHSU brings you safe, excellent care — … Andrea Bernasconi, MD. Oregon Health & Science University is dedicated to improving the health and quality of life for all Oregonians through excellence, innovation and leadership in health care, education and research. CLINCIAL Increased sensitivity with quantitative magnetic resonance T2 relaxometry, T2 relaxometry can lateralize mesial temporal lobe epilepsy in patients with normal MRI, Neuroimaging methods to evaluate the etiology and consequences of epilepsy, Automatic detection and quantification of hippocampal atrophy on MRI in temporal lobe epilepsy: a proof-of-principle study, Temporal lobe epilepsy: quantitative MR volumetry in detection of hippocampal atrophy, 3T phased array MRI improves the presurgical evaluation in focal epilepsies: a prospective study, Comparison of hippocampal volumetry at 1.5 T and at 3 T, Volume determination of amygdala and hippocampus at 1.5 and 3.0 T MRI in temporal lobe epilepsy, Histologically confirmed hippocampal structural features revealed by 3T MR imaging: potential to increase diagnostic specificity of mesial temporal sclerosis, Proposal for revised classification of epilepsies and epileptic syndromes: Commission on Classification and Terminology of the International League Against Epilepsy, Nuclear magnetic resonance imaging, a new approach to the investigation of refractory temporal lobe epilepsy, Standard magnetic resonance imaging is inadequate for patients with refractory focal epilepsy, Preoperative MRI predicts outcome of temporal lobectomy: an actuarial analysis, Hippocampal sclerosis without detectable hippocampal atrophy, Normal magnetic resonance imaging and medial temporal lobe epilepsy: the clinical syndrome of paradoxical temporal lobe epilepsy, Epilepsy surgery outcomes in temporal lobe epilepsy with a normal MRI, Late seizures in patients initially seizure free after epilepsy surgery, Seizure outcome after anterior temporal lobectomy and its predictors in patients with apparent temporal lobe epilepsy and normal MRI, Fully-automated volumetric MRI with normative ranges: translation to clinical practice. 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