Impact of an optimized epilepsy surgery imaging protocol for focal epilepsy: A monocentric prospective study |
| |
| Authors: | Anna Elisabetta Vaudano Alice Ballerini Francesca Zucchini Elisa Micalizzi Simona Scolastico Francesca Talami Giada Giovannini Matteo Pugnaghi Niccolò Orlandi Niccolò Biagioli Maria Cristina Cioclu Stefano Vallone Maurilio Genovese Alessandra Todeschini Francesca Cavalleri Marcella Malagoli Stefano Meletti |
| |
| Affiliation: | 1. Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy;2. Neuroradiology Unit, OCB Hospital, AOU Modena, Modena, Italy;3. Neurophysiology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy;4. Neurology Unit, OCB Hospital, AOU Modena, Modena, Italy;5. Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy Neurology Unit, OCB Hospital, AOU Modena, Modena, Italy |
| |
| Abstract: | Objective To evaluate in a real clinical scenario the impact of the ILAE-recommended “Harmonized neuroimaging of epilepsy structural sequences”- HARNESS protocol in patients affected by focal epilepsy. Methods We prospectively enrolled focal epilepsy patients who underwent a structural brain MRI between 2020 and 2021 at Modena University Hospital. For all patients, MRIs were: (a) acquired according to the HARNESS-MRI protocol (H-MRI); (b) reviewed by the same neuroradiology team. MRI outcomes measures were: the number of positive (diagnostic) and negative MRI; the type of radiological diagnosis classified in: (1) Hippocampal Sclerosis; (2) Malformations of cortical development (MCD); (3) Vascular malformations; (4) Glial scars; (5) Low-grade epilepsy-associated tumors; (6) Dual pathology. For each patient we verified for previous MRI (without HARNESS protocol, noH-MRI) and the presence of clinical information in the MRI request form. Then the measured outcomes were reviewed and compared as appropriate. Results A total of 131 patients with H-MRI were included in the study. 100 patients out from this cohort had at least one previous noH-MRI scan. Of those, 92/100 were acquired at the same Hospital than H-MRI and 71/92 on a 3T scanner. The HARNESS protocol revealed 81 (62%) positive and 50 (38%) negative MRI, and MCD was the most common diagnosis (60%). Among the entire pool of 100 noH-MRI, 36 resulted positive with a significant difference (p < .001) compared to H-MRI. Similar findings were observed when accounting for the expert radiologists (H-MRI = 57 positive; noH-MRI = 33, p < .001) and the scanner field strength (H-MRI 43 = positive, noH-MRI = 23, p < .001), while clinical information were more present in H-MRI (p < .002). Significance The adoption of a standardized and optimized MRI acquisition protocol together with adequate clinical information contribute to identify a higher number of potentially epileptogenic lesions (especially FCD) thus impacting concretely on the clinical management of patients with focal epilepsy. |
| |
| Keywords: | drug-resistant epilepsy focal cortical dysplasia focal epilepsy HARNESS-MRI magnetic resonance imaging structural imaging |
|
|
