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PAPER |
1 Department of Epileptology, University of Bonn, Bonn, Germany
2 Department of Radiology and Neuroradiology, University of Bonn
Correspondence to:
Correspondence to:
Dr J von Oertzen, Department of Epileptology, University of Bonn, Sigmund-Freud-Str 25, 53105 Bonn, Germany;
joachim-von.oertzen{at}ukb.uni-bonn.de
Methods: Comparison of results of standard MRI reported by "non-expert" radiologists, standard MRI evaluated by epilepsy "expert" radiologists, and epilepsy specific MRI read by "expert" radiologists in 123 consecutive patients undergoing epilepsy surgery evaluation between 1996 and 1999. Validation of radiological findings by correlation with postoperative histological examination.
Results: Sensitivity of "non-expert" reports of standard MRI reports for focal lesions was 39%, of "expert" reports of standard MRI 50%, and of epilepsy dedicated MRI 91%. Dedicated MRI showed focal lesions in 85% of patients with "non-lesional" standard MRI. The technical quality of standard MRI improved during the study period, but "non-expert" reporting did not. In particular, hippocampal sclerosis was missed in 86% of cases. Neuropathological diagnoses (n=90) were predicted correctly in 22% of "non-expert" standard MRI reports but by 89% of dedicated MRI reports.
Conclusions: Standard MRI failed to detect 57% of focal epileptogenic lesions. Patients without MRI lesion are less likely to be considered candidates for epilepsy surgery. Patients with refractory epilepsy should be referred to an MRI unit with epileptological experience at an early point.
Keywords: epilepsy; neurosurgery; magnetic resonance imaging
Abbreviations: MRI, magnetic resonance imaging; HS, hippocampal sclerosis
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