A total of 317 individuals who had undergone 3T brain MRI of epilepsy protocol were eligible for the study. Keep patient at Isocenter For patients with small heads and long necks or large heads: Keep FOV box positioned higher than normal but not beyond ±50mm from glabella, May need to reduce/enlarge the FOV for the individual (not beyond 24 - 25.6). 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. October 1, 2008-- A study from Oregon Health & Science University (OHSU) in Portland has concluded that 3-tesla MRI is superior to 1.5-tesla MRI in detecting and accurately characterizing structural brain abnormalities in a group of patients undergoing whole-brain epilepsy evaluation. In patients who had bilateral hippocampal abnormalities detected by the quantifications methods, there was marked asymmetry. Correlation of perfusion- and diffusion-weighted MRI with NIHSS score in acute (<6.5-hour) ischemic stroke. More important, by using a dedicated epilepsy MR imaging protocol, the same group of “experts” described focal MR imaging abnormalities in 91% of the same group of patients (they did not include hippocampal volumetry or T2 relaxometry).20 Also, in this context, MRIs are always evaluated in the light of clinical, neuropsychological, and EEG data. Bergo—RELATED: Grant: FAPESP, Comments: Postdoctoral scholarship funding from a government agency. Special attention was given to rule out subtle signs of focal cortical dysplasia, such as sulcal morphology abnormalities, focal increase of cortical thickness, FLAIR focal signal hyperintensities, or small transmantle signs. 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. In this article, we used automated volumetry and a simple manual signal quantification in which it is necessary only to define a small region of interest in 3 sections of the T2 scan of each patient, without the need to define precisely the borders of the hippocampus. Therefore, we performed a 3T-MRI in 15 patients with a T/R head coil and a dedicated protocol fulfilling the conditions indicated by … RESULTS: Visual analysis classified 125 patients (62%) as having signs of hippocampal sclerosis and 78 (38%) as having normal MRI findings. Our aim was to compare visual analysis, volumetry, and signal quantification of the hippocampus for detecting hippocampal sclerosis in 3T MRI. The small additional gain of the quantification analyses was secondary to better discrimination of the bilateral hippocampal abnormalities. FOV 24 – 25.6, NOTE: Some NeuroQuant parameters vary depending on scanner manufacturer & field strength. In our series, only 1 patient with visual signs of HS had normal volumetry and signal quantification. Post‐processing of the 7T T1‐weighted magnetization‐prepared two rapid acquisition gradient echoes sequence was performed using the morphometric analysis program (MAP) with comparison to a … 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. 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. The laterality of the hippocampal abnormality detected by both absolute values and the asymmetry index in volumetry and T2 relaxometry analysis was concordant in all cases. Optimal MRI Sequence for Identifying Occlusion Location in Acute Stroke: Which Value of Time-Resolved Contrast-Enhanced MRA? 3T MRI superior to 1.5T MRI in epilepsy evaluation By Wayne Forrest, AuntMinnie.com contributing writer. Link, Google Scholar; 2 Tong DC, Yenari MS, Albers GW, O'Brien M, Marks MP, Moseley ME. Of 317, 240 (75.7%) were included for analysis and 77 (24.3%) were excluded (Fig-ure 1). 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 increase of patients with detectable MR imaging abnormalities compatible with the site of the seizure-onset origin is significantly important for drug-resistant focal epilepsies. Bruno Kubota—RELATED: Grant: FAPESP, Comments: scientific scholarship. The final group was then composed of 203 patients (129 female, 74 male; median age, 46 years; range, 17–74 years). NEURO MRI PROTOCOLS Updated 6/11/2020 BRAIN SPINE Routine Brain (-) (+/-) Oropharyngeal Mass (+/-) (3T only) Internal Auditory Canal ... ESP (-) 3T SIEMENS *coverage to include entire brain except coronal T2 thin oblique Sagittal T1 Axial DTI Coronal BRAVO Coronal T2 THIN OBL Axial T2 FLAIR Coronal T2 FLAIR 1. In patients with a histopathology of HS, visual analysis and volumetry detected abnormal hippocampi in all cases and relaxometry detected hyperintense signal in 15/18 (83%) patients. If patient has an implant unsafe for 3T, OK to scan on MR2 1.5T Ingenia. Volumetry detected bilateral hippocampal atrophy in 9 patients (8 with visual signs of HS and 1 with visually normal MR imaging findings). Bookmerilab helps you in saving up to Rs. In this article, we reproduced this optimal visual evaluation of MRI in patients with MTLE: Two epileptologists with expertise in MR imaging evaluation of patients with focal epilepsies reviewed the images of all patients (acquired with an extensive epilepsy protocol) in the context of clinical and EEG data. Use all motion reduction techniques except changing scan parameters, Surgical resections, shunts, metal (some are not compatible), Put saline bags on either side of patient's head, Can be ± 50mm from Nasion - should be as close as possible in all 3 planes, Re - landmark, if C-spine was done first as part of a double study, Echo test failure – call your network admin, Delete incorrect series from queue monitor, Extend slice coverage 1-2 mm beyond the skin margin, not necessarily to cover the ears. MRI Brain With Epilepsy Protocol is a painless procedure that requires minimum planning. According to ictal and interictal scalp EEG, 184 patients had unilateral temporal epileptic focus (117 left MTLE and 67 right MTLE) and 19 had bitemporal epileptic focus. Publicationdate 2012-09-01. MR imaging visual analysis detected 125 (62%) patients with signs of HS (62 left, 54 right, 6 bilateral with left-sided predominance, 3 bilateral with right-sided predominance). MATERIALS AND METHODS: Two hundred three patients with mesial temporal lobe epilepsy defined by clinical and electroencephalogram criteria had 3T MRI visually analyzed by imaging epilepsy experts. The patient with a normal hippocampus on histology had no signs of HS detected by either visual or quantitative methods. Brain imaging with MRI identifies structural cerebral pathology that may give rise to seizures. The distribution of the hippocampal asymmetry index for volumetry and T2 relaxometry in patients and controls is shown in Fig 3. This section of the website will explain planning for various types of MRI scans, MRI protocols, positioning for MRI, and common indications for MRI scans. A2, FreeSurfer volumetry images in which the hippocampi are shown in yellow. Recently automatic analyses have been shown to be promising; however, there are few studies comparing their efficacy with the visual analyses of high-quality MR imaging by experts in the field.12,13. 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. As a second step, we performed automatic quantification of hippocampal volumes with FreeSurfer and T2 relaxometry with an in-house software. T1 weighted - Always4. No Special Requirements, If the patient is not cooperative then fasting is required for 5-6 hours The greatest yield is from MRI at 3T using epilepsy protocols, and reported by expert neuroradiologists who possess the full clinical data. Laurens De Cocker, Felice D'Arco and Philippe Demaerel and Robin Smithuis. Hippocampal signal values higher than 2 SDs from the mean of the control group composed of the same individuals in the volumetry analysis (absolute value and/or asymmetry index, defined by the ratio of higher and lower hippocampal signals of each individual) were considered hyperintense signal. 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 … Mode – 3D3. Braces are usually okay, if there is not a great deal of motion, keep head tightly padded. Corrected volume of the left hippocampus: 3.50 cm3 (z score = −2.20 SDs). Landmark at nasion/glabella (±50mm), you must re-landmark in the brain if another body part is scanned first. Epilepsy protocols were used for the 3T and 7T acquisitions. We do not capture any email address. Although the qualitative analysis detected signs of hippocampal sclerosis in 62% of patients, one cannot say in how many it failed to detect HS because the remaining 38% of patients may or may not have had HS in their histology, even though they all had MTLE. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. 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). However, this specificity is biased because all patients who underwent surgery in our group had similar findings in both visual and quantification analysis, and the visual analysis was used in the selection of the patients for the surgical procedure. mesial temporal sclerosis and malformation of cortical development). Brain imaging with MRI identifies structural cerebral pathology that may give rise to seizures. However, a good correlation of volume and signal abnormalities detected by quantification analysis and histopathology of HS has been previously demonstrated.27 Also, in our group of patients, the laterality of abnormal hippocampal volume and signal was highly concordant with the laterality of the epileptic focus defined by EEG recordings. In 1.5T MRI, a good correlation of volume and signal abnormalities detected by quantification analysis and histopathology of HS has been demonstrated.29 More recently, histologic studies have proposed that different patterns of neuronal loss in the hippocampus might be associated with different seizure outcome after surgical removal of the temporal lobe.30 Also, it has been shown that quantitative measures in 3T MRI can demonstrate ultrastructural details of HS pathology not detectable with lower field scanners.17,31 These in vivo quantitative measurements of this detailed HS pathology on 3T MR imaging scanners might contribute, in the future, to the better selection of patients with drug-resistant MTLE who will benefit from surgical procedures. Magnetic resonance imaging (MRI) is a pivotal component in the investigation of patients with any form of epilepsy because of its unmatched ability in visualizing structural brain pathology. 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