Epilepsy protocol (MRI)

Last revised by Dr Raymond Chieng on 02 May 2022

MRI protocol for epilepsy is a group of MRI sequences put together to improve sensitivity and specificity in identifying possible structural abnormalities that underlie seizure disorders (e.g. mesial temporal sclerosis and malformation of cortical development). MRI is the imaging modality of choice for epilepsy investigation, especially 3 tesla MRI. 

Note: This article is intended to outline some general principles of protocol design. The specifics will vary depending on MRI hardware and software, radiologist's and referrer's preference, institutional protocols, patient factors (e.g. allergy) and time constraints. 

Sequences

Non-focal epilepsy protocol 

A good protocol for this purpose involves at least 4,5:

  • T1
    • sequence: axial and coronal; in modern scanners it can be replaced by a 3D isotropic acquisition
    • purpose:
      • visualizing brain anatomy and morphology
      • measuring cortical thickness and appreciate grey-white matter differentiation
      • visualize unusual location of grey matter as in grey matter heterotopia 
  • FLAIR
    • sequence: axial and angled coronal; in modern scanners it can be replaced by a 3D isotropic acquisition.
    • purpose: look for cortical or subcortical hyperintensities 
  • SWI or T2*
    • purpose: identifying hemoglobin breakdown products as in post traumatic bleed and cavernomas
  • DWI/ADC
  • Double Inversion recovery Sequence (DIR)
    • sequence: 3D isotropic acquisition 
  • T1-weighted C+
    • purpose: accessing tumor-like lesions, vascular malformations, or infectious disease process
Temporal lobe epilepsy protocol 

A good protocol for this purpose involves at least:

  • T1
    • sequence: axial and coronal; in modern scanners it can be replaced by a 3D isotropic acquisition 
  • FLAIR
    • sequence: axial and angled coronal; in modern scanners it can be replaced by a 3D isotropic acquisition 
  • T2
    • sequence: angled coronal
  • DWI/ADC
  • SWI or T2*
  • fiber-tracking technique
    • the fiber-tracking technique allow to investigate the effect of temporal lobe epilepsy on reorganization of the linguistic functions 2,3

ADVERTISEMENT: Supporters see fewer/no ads

Cases and figures

  • Case 1: normal brain (non-focal epilepsy protocol)
    Drag here to reorder.
  • Case 2: normal brain (non-focal epilepsy protocol)
    Drag here to reorder.
  • Case 3: normal temporal lobe epilepsy protocol
    Drag here to reorder.
  • Updating… Please wait.

     Unable to process the form. Check for errors and try again.

     Thank you for updating your details.