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A Multimodal Imaging- and Stimulation-based Method of Evaluating Connectivity-related Brain Excitability in Patients with Epilepsy
Published on: November 13, 2016
Factors influencing the detection of treatable epileptogenic lesions on MRI. A randomized prospective study
Tim Wehner1, Philippe Weckesser1, Steven Schulz1
1Ruhr - Epileptology, Department of Neurology, University Hospital Knappschafts-krankenhaus, Ruhr - University Bochum, In der Schornau 23 - 25, 44892, Bochum, Germany.
Background:
To prospectively analyze factors associated with detecting epileptogenic lesions on MRI within the work-sharing process of neurologists, epileptologists, radiologists and neuroradiologists.
Methods:
We assembled four sets of six MRI scans, each set representing five typical epileptogenic lesions (hippocampal sclerosis or limbic encephalitis; focal cortical dysplasias; periventricular nodular or other heterotopias; long-term epilepsy associated tumors; gliotic scar, hemosiderin or cavernoma), and non - lesional epilepsy. At professional conferences, we invited neurologists, epileptologists, radiologists, and neuroradiologists to read two out of four MRI sets, one of which was presented with a clinical focus hypothesis. Participants were randomly assigned to MRI sets. Effects of examiners' specialty, duration of training and professional experience on detection rate of epileptogenic lesions were investigated.
Results:
Fourty-eight neurologists, 22 epileptologists, 20 radiologists and 21 neuroradiologists read 1323 MRI scans. Overall, 613 of 1101 (55.7%) epileptogenic lesions were detected. Long-term epilepsy associated tumors (182/221, 82.4%) were found more frequently than gliotic scar, hemosiderin or cavernoma (157/220, 71.4%), hippocampal sclerosis or limbic encephalitis (141/220, 64.1%), nodular heterotopia (68/220, 30.9%) and focal cortical dysplasias (65/220, 29.5%, p < 0.001). Provision of a focus hypothesis improved the detection of hippocampal sclerosis or limbic encephalitis (86/110, 78.2% vs 55/110, 50%, p < 0.001) and focal cortical dysplasias (40/110, 36.4% vs 25/110, 22.7%, p = 0.037). Neuroradiologists and epileptologists were more likely than radiologists and neurologists to be amongst the most successful readers. In multivariable analysis, type of epileptogenic lesion, specialty of MRI reader, and provision of focus hypothesis predicted correct identification of epileptogenic lesions.
Conclusions:
Epileptogenic lesions are often not recognized on MRI even by expert readers. Their detection can be improved by providing a focus hypothesis. These results stress the need for training in the MRI characteristics of epilepsy - specific pathology, and, most importantly, interdisciplinary communication between neurologists/epileptologists and (neuro)radiologists to improve detection of epileptogenic lesions.
Insights
Epileptogenic lesions on MRI are frequently missed by experts. Providing a clinical focus hypothesis significantly improves detection rates for certain lesion types, highlighting the need for better interdisciplinary communication.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Detecting epileptogenic lesions on MRI is crucial for epilepsy diagnosis and management.
- Current detection rates of these lesions by various medical specialists remain a concern.
Purpose of the Study:
- To identify factors influencing the detection of epileptogenic lesions on MRI scans.
- To evaluate the impact of a clinical focus hypothesis on lesion detection rates.
- To assess the performance differences among neurologists, epileptologists, radiologists, and neuroradiologists.
Main Methods:
- Four sets of MRI scans, including five types of epileptogenic lesions and non-lesional epilepsy, were analyzed.
- Neurologists, epileptologists, radiologists, and neuroradiologists reviewed MRI sets, some with a clinical focus hypothesis.
- The study investigated the effects of reader specialty, training duration, and experience on lesion detection.
Main Results:
- Overall detection rate for epileptogenic lesions was 55.7%.
- Long-term epilepsy-associated tumors had the highest detection rate (82.4%), while focal cortical dysplasias had the lowest (29.5%).
- A focus hypothesis improved detection of hippocampal sclerosis/limbic encephalitis and focal cortical dysplasias. Neuroradiologists and epileptologists showed higher detection success.
Conclusions:
- Epileptogenic lesions are often under-recognized on MRI, even by experienced specialists.
- Providing a focus hypothesis enhances lesion detection, particularly for specific types.
- Improved training in epilepsy-specific MRI pathology and enhanced interdisciplinary communication are essential for better detection rates.
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