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3T phased array MRI improves the presurgical evaluation in focal epilepsies

A prospective study

From A.A. Martinos Center for Biomedical Imaging (Drs. Knake, Triantafyllou, Wald, Wiggins, Stufflebeam, Shiraishi, Dale, Halgren, and Grant, and G.P. Kirk and M.T. Foley), Massachusetts General Hospital, Harvard Medical School, Charlestown; Department of Neurology (Dr. Knake), Philipps-University, Marburg, Germany; The National Center for Epilepsy (Dr. Larsson), Sandvika, Norway; and Department of Radiology (Dr. Grant), Massachusetts General Hospital, Boston.

Address correspondence and reprint requests to Dr. P. Ellen Grant, Director, Pediatric Neuroradiology, Department of Radiology, Neuroradiology Section, Gray 2, B285, 55 Fruit Street, Boston, MA 02114-2696; e-mail: ellen{at}nmr.mgh.harvard.edu

Background: Although detection of concordant lesions on MRI significantly improves postsurgical outcomes in focal epilepsy (FE), many conventional MR studies remain negative. The authors evaluated the role of phased array surface coil studies performed at 3 Tesla (3T PA MRI).

Methods: Forty patients with medically intractable focal epilepsies were prospectively imaged with 3T PA-MRI including high matrix TSE T2, fluid attenuated inversion recovery, and magnetization prepared rapid gradient echo. All patients were considered candidates for epilepsy surgery. 3T PA-MRIs were reviewed by a neuroradiologist experienced in epilepsy imaging with access to clinical information. Findings were compared to reports of prior standard 1.5T MRI epilepsy studies performed at tertiary care centers.

Results: Experienced, unblinded review of 3T PA-MRI studies yielded additional diagnostic information in 48% (19/40) compared to routine clinical reads at 1.5T. In 37.5% (15/40), this additional information motivated a change in clinical management. In the subgroup of patients with prior 1.5T MRIs interpreted as normal, 3T PA-MRI resulted in the detection of a new lesion in 65% (15/23). In the subgroup of 15 patients with known lesions, 3T PA-MRI better defined the lesion in 33% (5/15).

Conclusion: Phased array surface coil studies performed at 3 Tesla read by an experienced unblinded neuroradiologist can improve the presurgical evaluation of patients with focal epilepsy when compared to routine clinical 1.5T studies read at tertiary care centers.

Commentary, see page 975

See also page 1094

Supported in part by the National Center for Research Resources (P41RR14075), the Mental Illness and Neuroscience Discovery (MIND) Institute, the Föderverein Neurologie, University of Marburg, Germany, the GlaxoSmithKline Grant for Clinical Epileptology, and the Professor Dr. Adolf Schmidtmann-Stiftung, Germany.

Disclosure: L.L. Wald, PhD, works as a scientific advisor for Siemens. The authors report no conflicts of interest.

Received October 26, 2004. Accepted in final form June 20, 2005.

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