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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 25:919-926, June-July 2004
© 2004 American Society of Neuroradiology

BRAIN

MR Imaging in the Presurgical Workup of Patients with Drug-Resistant Epilepsy

Horst Urbach^a, Jörg Hattingen^a, Joachim von Oertzen^b, Cordelia Luyken^c, Hans Clusmann^c, Thomas Kral^c, Martin Kurthen^b, Johannes Schramm^c, Ingmar Blümcke^d and Hans H. Schild^a

^a Department of Radiology, University of Bonn Medical Center, Germany
^b Department of Epileptology, University of Bonn Medical Center, Germany
^c Department of Neurosurgery, University of Bonn Medical Center, Germany
^d Department of Neuropathology, University of Bonn Medical Center, Germany

Address reprint requests to Horst Urbach, MD, Department of Radiology/Neuroradiology, University of Bonn Medical Center, Sigmund Freud Str 25, D - 53105 Bonn, Germany

BACKGROUND AND PURPOSE: Whether an epileptic lesion is detected with MR imaging depends on the quality of the images and the expertise of the reader. We analyzed the role of 1.5-T MR imaging in the presurgical evaluation of patients with drug-resistant epilepsy at one center.

METHODS: In a 2-year prospective study, 385 patients with drug-resistant epilepsy underwent standardized MR imaging at 1.5 T. We analyzed whether lesions were detected, whether they were precisely characterized by MR imaging, and whether lesion characterization allowed us to estimate seizure outcomes.

RESULTS: Lesions were found on MR images in 318 patients (83%). Following presurgical evaluation, 209 (66%) underwent surgery, and 109 (34%) did not. Freedom from seizures was achieved in 130 (70%) of 186 patients. Nine (14%) of 66 patients without an MR imaging lesion underwent surgery; histopathologic findings were unrevealing in seven patients, and five (56%) achieved freedom from seizures. Hippocampal sclerosis was the most common lesion (52%) and correctly characterized in 101 (97%) of 104 patients. Glioneuronal tumors (20%) were sometimes imprecisely characterized: Four nonenhancing gangliogliomas were mistaken for focal cortical dysplasias. Outcomes were not different between lesion groups. However, there were trends toward a favorable outcome for focal cortical dysplasias with balloon cells and an unfavorable outcome for gyral scars.

CONCLUSION: MR imaging detection of lesions influences further presurgical workup, though lesion characterization does not allow us to predict seizure outcome. If MR imaging fails to depict a lesion and patients undergo surgery because of electrophysiologic findings, histopathologic findings are often unrevealing.

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