Related Experiment Video
Updated: Mar 15, 2026
Author Spotlight: Advancing Pediatric Epilepsy Surgery in Children Through Novel Biomarkers and Enhanced Localization
Published on: September 20, 2024
Qualitative analysis of double inversion recovery MRI in drug-resistant epilepsy
Thomas Wychowski1, Ali Hussain2, Madalina E Tivarus2
1Department of Neurology, Strong Memorial Hospital, University of Rochester, 601 Elmwood Ave., Box 673, Rochester, NY 14642 USA.
Purpose:
To determine whether Double Inversion Recovery (DIR) on 3T MRI can enhance detection of epileptogenic lesions Methods: 29 adult patients with DRE were enrolled in a prospective pilot study. Brain MRIs were obtained using a specialized protocol that included: (1) Fast-Spin EchoT2, (2) T2 fluid attenuated inversion recovery (FLAIR), and (3) DIR sequences. Two neuroradiologists blinded to clinical information independently reviewed each sequence in the order listed above for T2-hyperintense lesions. Cortical lesions were determined to be concordant with the epileptic focus based upon available clinical and electrodiagnostic testing.
Results:
Of 29 studies, 21 had a lesion identified with 13/21 abnormalities being non-specific. Of 8 remaining studies, 3 revealed a lesion only with DIR sequencing. DIR-lesions were concordant with clinical data in 1 subject, non-discordant in 1 subject, and discordant in 1 subject.
Significance:
DIR has the potential to be more sensitive in detecting cortically based lesions relative to standard imaging. More data are needed to assess the sensitivity and specificity of DIR, particularly as it pertains to identification of epileptogenic lesions using electrodiagnostic testing and outcome after surgery.
Insights
Double Inversion Recovery (DIR) MRI shows promise for detecting subtle epileptogenic lesions in patients with drug-resistant epilepsy (DRE). Further research is needed to confirm its sensitivity and specificity compared to standard imaging techniques.
Area of Science:
- Neuroradiology
- Epileptology
- Medical Imaging
Background:
- Drug-resistant epilepsy (DRE) often requires precise identification of epileptogenic lesions for effective treatment.
- Standard MRI sequences may not always detect subtle cortical lesions associated with DRE.
Purpose of the Study:
- To evaluate the efficacy of 3 Tesla (3T) Double Inversion Recovery (DIR) MRI in enhancing the detection of epileptogenic lesions.
- To compare the sensitivity of DIR sequences against standard MRI techniques (T2-weighted and FLAIR) in identifying lesions in DRE patients.
Main Methods:
- A prospective pilot study involving 29 adult patients with DRE.
- Brain MRI acquisition using a specialized protocol including Fast-Spin Echo T2, T2 FLAIR, and DIR sequences.
- Independent review of MRI sequences by two blinded neuroradiologists to identify T2-hyperintense lesions and assess concordance with the epileptic focus.
Main Results:
- Of 29 patients, 21 had identified lesions, with 13 being non-specific.
- Three lesions were detected exclusively with DIR sequencing among the remaining eight studies.
- The clinical concordance of DIR-detected lesions varied, with one concordant, one non-discordant, and one discordant case.
Conclusions:
- Double Inversion Recovery (DIR) MRI demonstrates potential for increased sensitivity in detecting cortical lesions compared to standard MRI sequences.
- Additional research is necessary to establish the definitive sensitivity and specificity of DIR for identifying epileptogenic lesions.
- Further studies should correlate DIR findings with electrodiagnostic testing and surgical outcomes in DRE patients.
More Related Videos
10:23Equipment Setup and Artifact Removal for Simultaneous Electroencephalogram and Functional Magnetic Resonance Imaging for Clinical Review in Epilepsy
Published on: June 23, 2023
08:23A Multimodal Imaging- and Stimulation-based Method of Evaluating Connectivity-related Brain Excitability in Patients with Epilepsy
Published on: November 13, 2016