Epilepsy protocol (MRI)

Last revised by Andrew Murphy on 23 Mar 2023

Citation, DOI, disclosures and article data

Citation:

Di Muzio B, Murphy A, Chieng R, et al. Epilepsy protocol (MRI). Reference article, Radiopaedia.org (Accessed on 01 Dec 2023) https://doi.org/10.53347/rID-38460

DOI:

https://doi.org/10.53347/rID-38460

Permalink:

https://radiopaedia.org/articles/38460

rID:

38460

Article created:

20 Jul 2015, Bruno Di Muzio ◉ ◈

Disclosures:

At the time the article was created Bruno Di Muzio had no recorded disclosures.

View Bruno Di Muzio's current disclosures

Last revised:

23 Mar 2023, Andrew Murphy ◉

Disclosures:

At the time the article was last revised Andrew Murphy had no financial relationships to ineligible companies to disclose.

View Andrew Murphy's current disclosures

Revisions:

18 times, by 11 contributors - see full revision history and disclosures

Systems:

Central Nervous System

Tags:

mri protocol, cns protocol

Synonyms:

MRI epilepsy protocol

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