7T Epilepsy Task Force Consensus Recommendations on the Use of 7T MRI in Clinical Practice

Giske Opheim1, Anja van der Kolk2, Karin Markenroth Bloch2

  • 1From the Neurobiology Research Unit (G.O., L.H.P.), and Epilepsy Clinic (L.H.P.), Department of Neurology, Rigshospitalet Copenhagen University Hospital; Faculty of Health and Medical Sciences (G.O.), UCPH, Denmark; Departments of Neurology and Neurosurgery (T.J.V.), UMC Utrecht Brain Center, and Department of Radiology (A.v.d.K.), University Medical Center Utrecht, Utrecht University; Department of Radiology (A.v.d.K.), Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam; Lund University Bioimaging Center (K.M.B.), Lund University, Sweden; Department of Neurology (A.J.C.), Neurophysiology and Neurosurgery, ACE Kempenhaeghe/MUMC, Heeze/Maastricht, the Netherlands; Department of Radiology (J.M.S.) and Penn Epilepsy Center (K.D.), Hospital of the University of Pennsylvania, Philadelphia; Department of Neurology (T.R.H.) and Center for Magnetic Resonance Research (P.-F.V.d.M., R.E.M.), University of Minnesota, Minneapolis; Department of Radiology and Nuclear Medicine (J.F.A.J.), Maastricht University Medical Center; School for Mental Health and Neuroscience (J.F.A.J.), Maastricht University; Department of Electrical Engineering (J.F.A.J.), Eindhoven University of Technology, the Netherlands; Imaging Institute (S.E.J.) and Epilepsy Center (I.W.), Cleveland Clinic, OH; Department of Neurology and Radiology (J.W.P.), University of Pittsburg, PA; Department of Neurosurgery (K.R.), Medical University of Vienna, Austria; Departments of Neurology and Clinical Sciences (M.C.S.), Lund University Hospital, Sweden; Department of Biomedical Imaging and Image Guided Therapy (S.T.), High Field MR Center, Medical University of Vienna, Austria; Neuroradiology Division, Diagnostic Unit (M.I.V.), University Hospitals and Faculty of Medicine of Geneva, Switzerland; Epileptology Department - INS (F.B.) and CRMBM - CEMEREM (J.-P.R., M.G.), Timone Hospital APHM, Aix Marseille Univ, INSERM, CNRS, France; Neuroimaging of Epilepsy Laboratory (NOEL) (N.B., A.B.), Montreal Neurological Institute (B.B.), and McConnell Brain Imaging Centre (N.B., A.B.), McGill University, Montreal, Canada; Department of Radiology (I.B.-B.), Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Translational Research and New Technologies in Medicine and Surgery (M.C.), University of Pisa, Italy; Department of Neurology (S.R.D.), University of Pennsylvania, Philadelphia; NeuroSpin (L.H.-P., A.V.), Paris-Saclay University, CEA, CNRS, BAOBAB, Gif-sur-Yvette, France; UMR 1141 (L.H.-P), University of Paris, France; EEG Section (S.I.), NINDS, NIH, Bethesda, MD; Department of Medical Imaging (M.T.J.), Children's Hospital at London Health Sciences Centre; Department of Medical Biophysics (M.T.J., A.R.K.), Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Canada; Imaging Research Laboratories (A.R.K.), Robarts Research Institute, London, ON, Canada; Functional Neurosurgery Department (S.L.), Beijing Children's Hospital of Capital Medical University, Beijing, China; Department of Radiology (S.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; NYU Grossman School of Medicine (H.P.), New York; Harvard MIT Division of Health Sciences and Technology (J.R.P., S.S.), Massachusetts Institute of Technology, Cambridge; Athinoula A. Martinos Center for Biomedical Imaging (J.R.P., S.S.), Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Charlestown, MA; Scannexus Ultrahigh Field MRI Research Center (E.S., C.J.W.), Maastricht; Department of Radiology and Nuclear Medicine (T.J.V.), Meander Medical Center, Amersfoort, the Netherlands; Wellcome Centre for Integrative Neuroimaging (N.V.), FMRIB Division, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; EEG and Epilepsy Unit (S.V.), Neurology, Department of Clinical Neurosciences, University Hospitals and Faculty of Medicine of Geneva, Switzerland; State Key Lab of Brain and Cognitive Science (R.X.), Beijing MRI Center for Brain Research, Institute of Biophysics, Chinese Academy of Sciences, China; Neuroscience Department (R.G.), Children's Hospital A. Meyer-University of Florence; and IMAGO 7 Foundation (R.G.), Florence, Italy giskeopheim@nru.dk.

Neurology
|December 28, 2020
PubMed

Insights

High-field 7 Tesla MRI (7T MRI) offers improved detection of brain lesions in epilepsy compared to conventional MRI. This guidance provides recommendations for its clinical use in epilepsy management.

Area of Science:

  • Neurology
  • Radiology
  • Medical Imaging

Background:

  • Identifying structural brain lesions on MRI is crucial for epilepsy management, particularly for seizure freedom after surgery in drug-resistant focal epilepsy.
  • Conventional MRI (1.5T and 3T) detects lesions in only 60%-85% of cases, highlighting the need for advanced imaging techniques.
  • 7 Tesla MRI (7T MRI) has shown added value in detecting epileptogenic lesions, but its clinical translation remains challenging.

Purpose of the Study:

  • To provide practical recommendations for the targeted clinical use of 7T MRI in epilepsy management.
  • To guide neurologists and radiologists on clinical indications, patient selection, acquisition protocols, and image interpretation for 7T MRI in epilepsy.

Main Methods:

  • The 7T Epilepsy Task Force, comprising experts from 21 international 7T MRI centers with extensive experience in epilepsy imaging, synthesized their knowledge.
  • The article focuses on structural imaging while also discussing promising nonstructural MRI techniques benefiting from 7T.
  • Recommendations cover referral criteria, suitable 7T MRI protocols, and image interpretation guidelines.

Main Results:

  • 7T MRI demonstrates superior lesion detection capabilities compared to conventional MRI strengths in epilepsy patients.
  • The task force shares practical experience on optimizing 7T MRI for epilepsy, addressing technical challenges and setup.
  • Guidelines are provided for integrating 7T MRI into routine clinical epilepsy care.

Conclusions:

  • 7T MRI is a valuable tool for enhancing the diagnosis of structural brain abnormalities in epilepsy.
  • This guidance facilitates the broader adoption of 7T MRI in clinical practice for improved epilepsy management.
  • Future directions include leveraging advanced nonstructural MRI techniques at 7T for epilepsy research and diagnosis.

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