MRI Interpretation Errors in Adult Patients with Medically Refractory Epilepsy.

Area of Science:

• Neurology
• Radiology
• Medical Imaging

Background:

• Medically refractory epilepsy (MRE) diagnosis relies heavily on neuroimaging.
• Accurate interpretation of MRI scans is crucial for effective epilepsy management.
• Previous studies have not fully detailed common MRI interpretation errors in MRE patients.

Purpose of the Study:

• To identify and analyze the most frequent MRI interpretation errors in patients with medically refractory epilepsy (MRE).
• To increase awareness among radiologists regarding potential 'blind spots' in MRE imaging.
• To emphasize the critical role of integrating clinical and electroencephalographic (EEG) data for precise diagnoses.

Main Methods:

• Retrospective observational study of 886 MRE patients undergoing 3 Tesla MRI with an epilepsy protocol.
• Inclusion criteria: patients discussed at a weekly interdisciplinary epilepsy conference (January 2008 - July 2023).
• Review of initial and final MRI interpretations to identify discrepancies.

Main Results:

• 148 discrepant MRI reports were identified among 886 MRE patients.
• Commonly missed pathologies included focal cortical dysplasia, encephalocele, and enlarged amygdala (EA).
• Mesial temporal sclerosis (MTS) was the most frequent pathology overall.

Conclusions:

• Accurate MRI interpretation in MRE necessitates robust interdisciplinary collaboration.
• Radiologists benefit from awareness of common interpretation pitfalls to maximize diagnostic yield.
• Combining MRI findings with clinical and EEG data is essential for optimal patient care.