Abstract
Primary goal of magnetic resonance imaging in epilepsy patients is to detect epileptogenic lesions with small lesions best detectable on a 3D FLAIR SPACE sequence with 1 mm3 voxels. Morphometric analysis of 3D T1-weighted data sets helps to find subtle lesions and may reveal the true extent of a lesion. In further presurgical work-up, language lateralization and spatial relationship of epileptogenic lesions to eloquent cortex and white matter tracts must be evaluated. With clear left lateralization language, fMRI is sufficient; in atypical lateralizations, Wada test and electrical stimulation mapping may be added. Primary motor cortex and corticospinal tract on one and visual cortex and optic radiation on the other side are displayed with fMRI and diffusion tensor tractography. For the corticospinal tract a „global“ tracking algorithm, for the optic radiation including Meyer’ loop, which may be damaged in anterior temporal lobe resections, a probabilistic algorithm is best suited.
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References
Rosenow F, Lüders H. Presurgical evaluation of epilepsy. Brain. 2001;124:683–1700.
Fisher RS, Acevedo C, Arzimanoglou A, Bogacz A, Cross JH, Elger CE, Engel J, Jr., Forsgren L, French JA, Glynn M, Hesdorffer DC, Lee BI, Mathern GW, Moshé SL, Perucca E, Scheffer IE, Tomson T, Watanabe M, Wiebe S. A practical clinical definition of epilepsy. Epilepsia. 2014;55:475–82.
Blümcke I, Thom M, Aronica E, Armstrong DD, Bartolomei F, Bernasconi A, Bernasconi N, Bien CG, Cendes F, Coras R, Cross JH, Jacques TS, Kahane P, Mathern GW, Miyata H, Moshé SL, Oz B, Özkara Ç, Perucca E, Sisodiya S, Wiebe S, Spreafico R. International consensus classification of hippocampal sclerosis in temporal lobe epilepsy: a task force report from the ILAE commission on diagnostic methods. Epilepsia. 2013;54:1315–29.
Bien CG, Szinai M, Wagner J, Clusmann H, Becker AJ, Urbach H. Characteristics and surgical outcome of patients with refractory MRI-negative epilepsies. Arch Neurol. 2009;66:1491–9.
Urbach H, Huppertz HJ, Schwarzwald R, Becker AJ, Wagner J, Delsous Bahri M, Tschampa HJ. Is the type and extent of hippocampal sclerosis measurable on high-resolution MRI? Neuroradiology. 2014;56:731–5.
Bien CG, Raabe AL, Schramm J, Becker A, Urbach H, Elger CE. Trends in presurgical evaluation and surgical treatment of epilepsy at one centre from 1988–2009. J Neurol Neurosurg Psychiatry. 2013;84:54–61.
Wellmer J, Quesada CM, Rothe L, Elger CE, Bien CG, Urbach H. Proposal for a magnetic resonance imaging protocol for the detection of epileptogenic lesions at early outpatient stages. Epilepsia. 2013;44:1977–87.
Huppertz HJ. Morphometric MRI analysis. In: Urbach H, Editor. MRI in epilepsy. New York: Springer Heidelberg; 2013. pp. 73–84.
Wagner J, Weber B, Urbach H, Elger CE, Huppertz HJ. Morphometric MRI analysis improves detection of focal cortical dysplasia type II. Brain. 2011;134(Pt 10):2844–54.
Huppertz HJ, Wellmer J, Staack AM, Altenmüller DM, Urbach H, Kröll J. Voxel-based 3D MRI analysis helps to detect subtle forms of subcortical band heterotopia. Epilepsia. 2008;49(5):772–85.
Oldfield RC. The assessment and analysis of handedness. Neuropsychologia. 1971;9:97–113.
Springer JA, Binder JR, Hammeke TA, Swanson SJ, Frost JA, Bellgowan PS, Brewer CC, Perry HM, Morris GL, Mueller WM. Language dominance in neurologically normal and epilepsy subjects. Brain. 1999;122:2033–45.
Bauer P, Reitsma JB, Houweling BM, Ferrier CH, Ramsey NF. Can fMRI safely replace the Wada test for preoperative assessment of language lateralisation? A meta-analysis and systematic review. J Neurol Neurosurg Psychiatry. 2014;85(5):581–8.
Destrieux C, Fischl B, Dale A, Halgren E. Automatic parcellation of human cortical gyri and sulci using standard anatomical nomenclature. Neuroimage. 2010;53:1–15.
Maldjian JA, Laurienti PJ, Kraft RA, Burdette JH. An automated method for neuroanatomic and cytoarchitectonic atlas-based interrogation of fMRI data sets. Neuroimage. 2003;19:1233–9.
Mori S, Crain BJ, Chacko VP, van Zilj PC. Three-dimensional tracking of axonal projections in the brain by magnetic resonance imaging. Ann Neurol. 1999;45:265–9.
Reisert M, Mader I, Anastasopoulos C, Weigel M, Schnell S, Kiselev V. Global fiber reconstruction becomes practical. Neuroimage. 2011;54:955–62.
Anastasopoulos C, Reisert M, Kiselev VG, Nguyen-Thanh T, Schulze-Bonhaage A, Zentner J, Mader I. Local and global fiber tractography in patients with epilepsy. AJNR Am J Neuroradiol. 2014;35:291–6.
Winston GP, Daga P, Stretton J, Modat M, Symms MR, McEvoy AW, Ourselin S, Duncan JS. Optic radiation tractography and vision in anterior temporal lobe resection. Ann Neurol. 2012;71:334.
Parker GJ, Haroon HA, Wheeler-Kingshott CA. A framework for a streamline-based probabilistic index of connectivity (PICo) using a structural interpretation of MRI diffusion measurements. J Magn Reson Imaging. 2003;18:242–54.
Kreher BW, Schnell S, Mader I, Il’yasov KA, Hennig J, Kiselev VG, Saur D. Connecting and merging fibres: pathway extraction by combining probability maps. Neuroimage. 2008;43:81–9.
Ryvlin P, Cross JHM, Rheims S. Epilepsy surgery in children and adults. Lancet Neurol. 2014;13:1114.
Kovalev D, Spreer J, Honegger J, Zentner J, Schulze-Bonhage A, Huppertz HJ. Rapid and fully automated visualization of subdural electrodes in the presurgical evaluation of epilepsy patients. AJNR Am J Neuroradiol. 2005;26:1078–83.
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Urbach, H., Mast, H., Egger, K. et al. Presurgical MR Imaging in Epilepsy. Clin Neuroradiol 25 (Suppl 2), 151–155 (2015). https://doi.org/10.1007/s00062-015-0387-x
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DOI: https://doi.org/10.1007/s00062-015-0387-x