RT Journal Article
SR Electronic
T1 MR Imaging in the Presurgical Workup of Patients with Drug-Resistant Epilepsy
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 919
OP 926
VO 25
IS 6
A1 Horst Urbach
A1 Jörg Hattingen
A1 Joachim von Oertzen
A1 Cordelia Luyken
A1 Hans Clusmann
A1 Thomas Kral
A1 Martin Kurthen
A1 Johannes Schramm
A1 Ingmar Blümcke
A1 Hans H. Schild
YR 2004
UL http://www.ajnr.org/content/25/6/919.abstract
AB 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.