Rationale and objectives: Magnetic resonance imaging has become a standard screening tool in the evaluation of patients with complex partial seizures. This study prospectively addresses the efficacy, if any, of routinely adding gadolinium-enhanced images to routine T2-weighted images in patients with a normal neurologic examination.
Methods: One hundred consecutive patients with electroencephalogram and clinical evidence of complex partial seizures and no other neurologic abnormalities were examined prospectively with axial and coronal T2-weighted spin-echo images, followed by axial and coronal gadolinium-enhanced T1-weighted scans.
Results: The scans in 73 patients were interpreted as normal, 14 had nonspecific white matter lesions, 5 had asymmetry of the temporal horns, and 2 had asymmetric signal intensity in the temporal lobes, and the scans in 6 showed abnormal gadolinium enhancement. Of the lesions in the six patients whose scans showed abnormal enhancement, four were seen well on the T2-weighted images. Of the remaining two, one was a small cerebellar venous angioma, and the other, a probable tiny convexity meningioma. One temporal lobe glioma seen on the T2 scans did not enhance with gadolinium.
Conclusions: Routine administration of gadolinium does not appear to be of benefit in imaging patients with complex partial seizures who are otherwise neurologically normal.