3T phased array MRI improves the

presurgical evaluation in focal epilepsies

A prospective study
S. Knake, MD; C. Triantafyllou, PhD; L.L. Wald, PhD; G. Wiggins, PhD; G.P. Kirk, MS; P.G. Larsson, MD;
S.M. Stufflebeam, MD; M.T. Foley; H. Shiraishi, MD, PhD; A.M. Dale, PhD; E. Halgren, PhD;
and P.E. Grant, MD

Abstract—Background: Although detection of concordant lesions on MRI significantly improves postsurgical outcomes in
focal epilepsy (FE), many conventional MR studies remain negative. The authors evaluated the role of phased array
surface coil studies performed at 3 Tesla (3T PA MRI). Methods: Forty patients with medically intractable focal epilepsies
were prospectively imaged with 3T PA-MRI including high matrix TSE T2, fluid attenuated inversion recovery, and
magnetization prepared rapid gradient echo. All patients were considered candidates for epilepsy surgery. 3T PA-MRIs
were reviewed by a neuroradiologist experienced in epilepsy imaging with access to clinical information. Findings were
compared to reports of prior standard 1.5T MRI epilepsy studies performed at tertiary care centers. Results: Experienced,
unblinded review of 3T PA-MRI studies yielded additional diagnostic information in 48% (19/40) compared to routine
clinical reads at 1.5T. In 37.5% (15/40), this additional information motivated a change in clinical management. In the
subgroup of patients with prior 1.5T MRIs interpreted as normal, 3T PA-MRI resulted in the detection of a new lesion in
65% (15/23). In the subgroup of 15 patients with known lesions, 3T PA-MRI better defined the lesion in 33% (5/15).
Conclusion: Phased array surface coil studies performed at 3 Tesla read by an experienced unblinded neuroradiologist can
improve the presurgical evaluation of patients with focal epilepsy when compared to routine clinical 1.5T studies read at
tertiary care centers.
NEUROLOGY 2005;65:1026–1031

Approximately 60% of all patients with epilepsy have
focal epilepsy (FE) syndromes, a total of 0.4% of the
population in industrialized countries. Approxi-
mately 15% of these patients are not adequately con-
trolled with anticonvulsant drugs and may benefit
from epilepsy surgery.1,2 MRI is an essential part of
the diagnostic evaluation of poorly controlled pa-
tients since the detection of a lesion within the
epileptogenic region dramatically increases the proba-
bility of a seizure-free postsurgical outcome.3-5 In tem-
poral lobe epilepsy, the probability of a seizure free
outcome is 82% with concordant lesions vs 56% for
patients with an unremarkable MRI.6 In frontal lobe
epilepsy, the probability of an excellent outcome is 72%
with a concordant lesion vs 41% when no abnormality
is detected.7 The best postsurgical outcome is ex-
pected when the MRI-visible lesion is consistent
with the EEG focus and can be completely resected.8
Therefore increasing the sensitivity of MRI is impor-
tant to the diagnostic evaluation of epilepsies.
In the hands of reviewers experienced in reading
MRI studies of epilepsy patients given the probable
lobar location of seizure onset, high resolution
phased array images at 1.5T increased the lesion
detection rate by up to 64% and allowed better deter-
mination of lesion type when compared to routine
high resolution head coil images read by the same
reviewers.9 One limitation of this study was the
hardware limitation of a four-element array, which
resulted in only limited spatial coverage. The next
logical steps in improving MR quality are to increase
phased array coverage by increasing the number of
elements in the array and to further increase SNR
by imaging at 3T.

Commentary, see page 975

See also page 1094

From A.A. Martinos Center for Biomedical Imaging (Drs. Knake, Triantafyllou, Wald, Wiggins, Stufflebeam, Shiraishi, Dale, Halgren, and Grant, and G.P.
Kirk and M.T. Foley), Massachusetts General Hospital, Harvard Medical School, Charlestown; Department of Neurology (Dr. Knake), Philipps-University,
Marburg, Germany; The National Center for Epilepsy (Dr. Larsson), Sandvika, Norway; and Department of Radiology (Dr. Grant), Massachusetts General
Hospital, Boston.
Supported in part by the National Center for Research Resources (P41RR14075), the Mental Illness and Neuroscience Discovery (MIND) Institute, the
Föderverein Neurologie, University of Marburg, Germany, the GlaxoSmithKline Grant for Clinical Epileptology, and the Professor Dr. Adolf Schmidtmann-
Stiftung, Germany.
Disclosure: L.L. Wald, PhD, works as a scientific advisor for Siemens. The authors report no conflicts of interest.
Received October 26, 2004. Accepted in final form June 20, 2005.
Address correspondence and reprint requests to Dr. P. Ellen Grant, Director, Pediatric Neuroradiology, Department of Radiology, Neuroradiology Section,
Gray 2, B285, 55 Fruit Street, Boston, MA 02114-2696; e-mail: ellen@nmr.mgh.harvard.edu

1026 Copyright © 2005 by AAN Enterprises, Inc.

 Our hypothesis was therefore that further evalua-
tion at an Epilepsy Imaging Center which provided
3T phased array MRI (3T PA-MRI) reviewed by an
unblinded neuroradiologist with epilepsy experience
would result in increased lesion detection and dis-
crimination compared to local interpretation of rou-
tine clinical epilepsy MR studies performed at tertiary
care centers. The impact of the 3T PA-MRI results on
clinical management was recorded and when available
the results were compared with the postsurgical out-
come and the histopathologic diagnosis.
Methods. Forty consecutive patients with medically intractable
FE considered to be surgical candidates were referred from ter-
tiary care institutions to our Epilepsy Imaging Center for 3T PA
MRI as part of their extended presurgical evaluation. All patients
were considered as potential candidates for an invasive phase 2
evaluation as the presurgical evaluation had given some non-
conclusive findings. Patients referred from the collaborating epi-
lepsy centers between July 2004 and September 2004 were
eligible for this study if they had already undergone an extensive
phase 1 evaluation which included several scalp EEGs, long term
video-EEG monitoring, and at least one high-resolution head-coil
MRI scan at 1.5T performed at tertiary epilepsy centers. All 1.5T
MRIs had been read previously at the referring center by an
experienced radiologist with expertise in epilepsy and had been
reviewed previously at the referring center in interdisciplinary
case conferences by a team of epilepsy specialists in possession of
all clinical and diagnostic information. In most cases PET,
SPECT, and neuropsychological evaluation were also part of
the phase 1 evaluation but these were not a requirement. Re-
sults of these previous presurgical evaluations were available
prior to the MRI study to allow thin section imaging through
the lobe of interest.
Written informed consent was obtained from all patients prior
to trial entry and the study protocol was approved by the local
ethics committee. The total scan time for the 3T PA MRI was
about 40 minutes. All MRI scans were performed on the same 3T
whole body scanner (Siemens TRIO, Siemens Medical Solutions,
Erlangen, Germany). The phased array (PA) coil used in all stud-
ies was an eight-channel array coil built specifically for evaluating
cortical lesions. This is a flexible array consisting of eight overlap-
ping receive-only coils curved to wrap symmetrically around the
whole head. The array was adjusted to the individual head shape
and then closed with tape in front of the forehead to achieve near
complete brain coverage. The PA coil was operated in receive-only
mode with the body-coil providing homogeneous excitation. One of
the authors was present during scanning to ensure that the coil
placement included the region of interest as best as possible.
The imaging protocol included a T1-weighted coronal and an
axial volumetric magnetization prepared rapid gradient echo
(MPRAGE) sequence (number of partitions 128, thickness 1.33
mm, field of view [FOV] 256 ⫻ 256, matrix 256 ⫻ 256, echo
time/repetition time/inversion time [TE/TR/TI]: 3.31/2,530/950
msec), a coronal and an axial T2-weighted sequence (slices 25, gap
0%, slice thickness 3 mm, FOV 230 ⫻ 173, matrix 192 ⫻ 256, TE
97 msec, TR 6,000 msec), and a coronal fluid attenuated inversion
recovery (FLAIR) sequence (slices 40, thickness 3 mm, gap 0%,
FOV 230 173, matrix 144 ⫻ 256, TE 86 msec, TR 7,000 msec).
Intensity correction of the reconstructed 3T PA MR images is
required due to spatially varying gray-level inhomogenities
that are a result of the non-uniform sensitivity profile of the PA
coil. In the current approach, an online edge-filled low pass
filter is used to generate images of uniform signal intensity for
clinical interpretation.10,11
All images were reviewed by a neuroradiologist experienced in
epilepsy imaging and a neurologist with special expertise in epi-
leptology for the presence, extent, and type of cortical abnormal-
ity. They were provided information regarding lobe of interest,
suspected location of the EEG focus, and the semiology. In addi-
tion, written reports of all previous investigations were available
at the time of 3T PA MRI interpretation. Results of the 3T PA-
MRI study were presented at the referring center’s presurgical
epilepsy conferences by one of the authors. The referring physi-
cians, typically a team of epileptologists and neurosurgeons, deter-
mined if the new information added new insights and if this new
information resulted in a change in clinical management (CIM).
Image interpretation results were recorded and the locations of
detected cortical lesions were compared with the location of the
irritative zone/ictal onset zone defined by EEG and with the symp-
tomatogenic zone defined by semiology. If surgery was performed,
imaging findings were compared with postsurgical outcome and
histopathologic findings.
Results. We studied 40 consecutive patients with medi-
cally intractable focal epilepsies, 23 female (57%) and 17
male patients (43%) aged 9 to 57 years (average age: 29
years) with an average age at seizure onset of 10.6 years
(range: 3 months to 36 years) (tables 1 and 2). Three pa-
tients had mild neurologic abnormalities with slight spas-
ticity of the left side in one patient (Patient 1), a symmetric
moderate hyperreflexia in another (Patient 16), and a sub-
tle left sided weakness in the third (Patient 27). One pa-
tient was slightly demented (Patient 15) and three had
mild cognitive delay (Patients 1, 27, 30). Patients were
grouped into four categories depending on the results of
the previous MRI and the results of the 3T PA-MRI.
Group 1: Normal 1.5T head coil study, abnormal 3T PA
MRI study (15 patients, table 1). New findings were de-
tected on the 3T PA MR images in 15 patients (Patients 1
to 15). Ten had temporal lobe epilepsy, four frontal lobe
epilepsy, and one occipital lobe epilepsy. Lesions detected
were focal cortical dysplasia,8 one of which was a trans-
mantle dysplasia1 (figure 1), periventricular nodular hete-
rotopia,1 hypothalamic hamartoma,2 cavernous venous
anomaly in association with bilateral hippocampal sclero-
sis,1 and unilateral hippocampal sclerosis.3 In 8/15 pa-
tients, these 3T PA MRI results had an impact on the
clinical management with omission of invasive monitor-
ing,4 definition of a clear target for invasive monitoring,
and a reduction in the region requiring invasive monitor-
ing1 and patients no longer considered good surgical candi-
dates.5 Six of the 15 patients have been operated on so far.
The result of the 3T PA MRI did influence the surgical
procedure in four of the six patients. In all four patients, a
targeted lesionectomy was performed. Histopathology con-
firmed the MRI diagnosis in all five cases that went to
surgery.
To date, four patients with complete resection of a sin-
gle focal lesion detected on 3T PA MRI have had signifi-
cant improvement in seizure activity with all four
remaining seizure free with 10 to 16 months of follow-up.
In one patient who was considered a poor surgical candi-
date after 3T PA imaging due to detection of bilateral
hippocampal sclerosis and a left CVA, there was no signif-
icant improvement in seizure frequency after a right
hippocampal-amygdala resection.
Group 2: Normal 1.5T head coil study, normal 3T PA
MRI study (8 patients). All patients in this group had
unremarkable 1.5T head coil studies and no new abnor-
malities detected on the 3T PA MRI. Four patients had
temporal lobe epilepsy, four frontal lobe epilepsy. In all
patients, 3T PA MRI did not add any additional informa-
tion and did not alter patient management. None of the
patients have progressed to surgery at this time.
Group 3: Abnormal 1.5T head coil study and abnormal
3T PA MRI study (15 patients, table 2). All 15 patients
with an abnormal head coil study at 1.5T had an abnormal
3T PA MRI study. However, the 3T PA MRI study contrib-
October (1 of 2) 2005 NEUROLOGY 65 1027
Table 1 Electrophysiologic, clinical, imaging, and pathologic findings in Group 1: 15 patients with normal 1.5T head coil study and
abnormal phased array surface coil studies performed at 3 Tesla (3T PA MRI) study

Patient
no./age, y Epilepsy 3T PA MRI CIM Surgery PSO Histology

1/22 R FLE R CD superior FG, cortical folding No surgery, VNS

abnormality
2/9 L FLE L CD frontal precentral dysplasia, omega
hand area
3/21 R FLE R CD frontal, near midline Direct surgery, skip iEEG Y SF (13 mo) CD
4/23 R TLE R CD amygdala Direct surgery, skip iEEG Y SF (10 mo) CD
5/17 R FLE R CD frontal (face area) Grid placement Y NSC CD
6/37 R OLE R CD occipital region
7/27 R TLE R CD inferior temporal gyrus Direct surgery, skip iEEG Y SF (16 mo) CD
8/32 R TLE Transmantle dysplasia R anterior frontal Direct surgery planned
9/29 R TLE HH No surgery
10/25 L TLE HH No surgery
11/21 L TLE PNH No surgery
12/54 L and R TLE L HS
13/35 R TLE R HS
14/42 LTLE L HS suspicious of additional R HS Y SF (15 mo) HS
15/52 L and R TLE CVA L temporal, hippocampi small Grid placement. Y UC Gliosis
bilaterally

CIM ⫽ change in clinical management based on new MRI findings; PSO ⫽ postsurgical outcome; FLE ⫽ frontal lobe epilepsy; CD ⫽
cortical dysplasia; VNS ⫽ vagal nerve stimulator; iEEG ⫽ invasive intracranial EEG; SF ⫽ seizure free; TLE ⫽ temporal lobe epilepsy;
OLE ⫽ occipital lobe epilepsy; HH ⫽ hypothalamic hamartoma; PNH ⫽ periventricular nodular heterotopia; HS ⫽ hippocampal sclero-
sis; CVA ⫽ cavernous venous angioma; UC ⫽ unchanged.

uted relevant clinical information in 5/15 with a FCD diag-
nosed in addition to the previously noted developmental
venous anomaly,1 a previously noted region of white mat-
ter T2 hyperintensity determined to be a FCD1 (figure 2),
and a larger extent to the previously noted lesions thought
to be candidates for the epileptogenic lesion.3 Two patients
with a larger extent identified on 3T PA MRI have under-
gone surgery: one with hemimegalencephaly (Patient 30)
and one with mesial temporal sclerosis (MTS) (Patient 31).
A topectomy was performed in the hemimegalencephaly
patient with a significant reduction in seizure frequency
since surgery 19 months ago (Engel class IIB). The histol-
ogy was nonspecific. In Patient 31, 3T PA MRI had shown
extensive left MTS extending beyond the suspected proba-
ble left hippocampal sclerosis. In this patient, a selective
left amygdalohippocampectomy was performed. MTS was
confirmed by the histopathology and the patient has been
seizure free for 12 months. In those two patients 3T PA
MRI is likely to improve the postsurgical outcome as the
resection boundaries were tailored to the better defined
lesion. Future studies need to confirm if 3T PA MRI can
improve the lesion definition and postsurgical outcome in
patients showing a lesion at 1.5T MRI.
Group 4: Normal 1.5T head coil study, indeterminate 3T
PA MRI study (2 patients). In two patients with previ-
ously normal head coil MRIs, the 3T surface-coil study
raised the suspicion of a focal cortical lesion. One patient
had right temporal lobe epilepsy. In this patient, a possible
focal cortical dysplasia was detected in the right inferior
frontal gyrus. The other patient had left frontal lobe epi-
lepsy. A probable left frontal transmantle dysplasia was
1028 NEUROLOGY 65 October (1 of 2) 2005
identified on 3T PA MRI. Neither has proceeded to inva-
sive monitoring or surgical resection at this time and
therefore the significance of these 3T PA MRI findings is
unclear.
Discussion. 3T PA MRI interpreted by an experi-
enced unblinded neuroradiologist had an important
clinical impact. Experienced unblinded review of 3T
PA MRI studies resulted in detection of new lesions
in 65% of previously MRI-negative patients and
added additional information in 50% with temporal
lobe epilepsy and 40% with frontal lobe epilepsy. The
3T PA MRI results allowed previously planned inva-
sive EEG evaluations to be avoided in 10% of pa-
tients. Overall, the clinical management was
changed in 38% of patients with FE.
Interestingly, 72% (11/15) of patients with normal
1.5T studies but lesions detected on 3T PA MRI had
malformations of cortical development, 73% (8/11) of
which were focal cortical dysplasias. These results
are similar to a previous study comparing phased
array (PA) to standard head coil imaging where 87%
(7/8) of newly detected lesions were malformations of
cortical development. These lesions can be difficult to
detect on MRI, especially if they are small or result
in subtle signal abnormalities.12 The improved signal
to noise of the 3T PA MRI studies resulted in better
definition of the gray white junction and a more uni-
form signal intensity in normal cortex, enabling su-
Table 2 Electrophysiologic, clinical, imaging, and pathologic findings in Group 3: 15 patients with abnormal 1.5T head coil study and
abnormal phased array surface coil studies performed at 3 Tesla (3T PA MRI)

Patient
no./age, y SCS Epilepsy 1.5 T MRI 3T PA MRI CIM Surgery PSO Histology

24/34 No R OLE CVA L OL CVA L OL

25/55 No L TLE CVA R PL CVA R PL
26/47 Yes R TLE DVA R TL CD R TL and DVA R TL Y—surgery scheduled
27/12 No L TLE SWS SWS
28/15 No MF TS TS
29/31 No L TLE Gliosis L TL (post ATL) Gliosis L TL (post ATL)
30/23 Yes R TLE Hemimegalencephaly R Hemimegalencephaly R Y—direct surgery Y SSR (19 mo)
max FL
31/32 Yes L TLE HS L HS L Y—direct surgery Y HS SF (15 mo)
32/29 No L TLE HS L HS L Y HS SF (13 mo)
33/32 No L TLE HS L HS L Y HS SF (11 mo)
34/32 No L TLE HS L HS L Y HS SF (19 mo)
35/10 Yes L PLE Hyperintensity L FL CD L central Y—extended testing
36/52 No L FLE Oligodendroglioma L FL Oligodendroglioma L FL
37/34 No R TLE PNH PNH with multiple nodules Y—no surgery
38/42 No L TLE Demyelinization CC Demyelinization CC

SCS ⫽ success surface coil study; CIM ⫽ change in clinical management based on new MRI findings; PSO ⫽ postsurgical outcome;
OLE ⫽ occipital lobe epilepsy; CVA ⫽ cavernous venous angioma; OL ⫽ occipital lobe; TLE ⫽ temporal lobe epilepsy; PL ⫽ parietal
lobe; DVA ⫽ developmental venous anomaly; TL ⫽ temporal lobe; CD ⫽ cortical dysplasia; SWS ⫽ Sturge Weber Syndrome; MF ⫽
multifocal epilepsy; TS ⫽ tuberous sclerosis; post ATL ⫽ after anterior temporal lobectomy; SSR ⫽ significant reduction in seizure fre-
quency; HS ⫽ hippocampal sclerosis; PLE ⫽ parietal lobe epilepsy; SF ⫽ seizure free; FLE ⫽ frontal lobe epilepsy; PNH ⫽ periven-
tricular nodular heterotopia; CC ⫽ corpus callosum.

perior detection of focal disruptions of these features
which are hallmarks of focal cortical dysplasias. Pa-
tients with focal cortical dysplasias can benefit by
detection of the lesion as surgical success is associ-
ated with complete removal of the structural
abnormality13-16 and lesion detection may obviate the
need for invasive monitoring. In this study all four
patients with complete resection of the newly de-
tected focal cortical dysplasia avoided invasive moni-
toring and have remained seizure free to date, albeit
with limited follow-up (see table 1). In all patients,
the results had an impact on the surgical procedure
and a tailored lesionectomy was performed. The
longest postoperative follow-up is currently 16
months.
Due to the findings of 3T PA-MRI, the clinical
management was changed in 38% of patients. Typi-
cally the findings affected the decision to perform

Figure 1. Transmantle dysplasia right

frontal–axial T2 FSE (D) and axial
magnetization prepared rapid gradient
echo (B), a thin section volumetric T1-
weighted sequence (right) obtained with
a 3T PA MRI showing a subtle right
frontal cone-shaped region of increased
T2 signal that begins at the ventricular
margin and extends to the depth of a
sulcus (see arrowheads in D). The le-
sion corresponds to a more subtle region
of decreased T1 signal (arrowheads, B).
On close scrutiny of the overlying cor-
tex, increased T2 signal (arrows, D)
and increased T1 signal (arrows, B)
with blurring of the gray-white junction
is identified. Previous high resolution
1.5T MRI obtained with a regular head coil did not show the lesion (A, T1-weighted image, C, T2-weighted image). Due
to different imaging protocols, the two images are angled slightly differently and have different slice thickness (1.5T im-
ages courtesy Dr. P. Due Tønnessen, Dept. of Radiology, Rikshospitalet Olso, Norway).
October (1 of 2) 2005 NEUROLOGY 65 1029

epilepsy surgery: in most patients, the detection of a
new structural lesion encouraged surgery without
further invasive monitoring. In all patients who
avoided invasive monitoring before surgery, the
newly detected lesion was congruent with the local-
ization of the ictal onset zone defined by video-EEG-
monitoring. None of the lesions was located in or
near eloquent cortex. In all patients, an extended
electrocorticography was performed during the resec-
tion. In a small number of patients, the newly iden-
tified lesion (for example a nodular periventricular
heterotopia) was associated with poor surgical out-
comes and therefore the patients were no longer con-
sidered good surgical candidates.
Increasing the sensitivity of MRI studies is crucial
in the presurgical evaluation of medically refractory
focal epilepsies where the patient’s MRI studies have
been interpreted as normal. Increased sensitivity can
be obtained when MR images are reviewed by a neu-
roradiologist experienced in reading MRI studies of
patients with epilepsy with access to clinical infor-
mation.17 Further increases in sensitivity can be
achieved by increasing the quality of the MRI stud-
ies. The first improvement in MRI quality at 1.5T
was the development of imaging sequences capable
of providing higher spatial resolution images in a
reasonable amount of time compared to standard
spin echo sequences.18 The next improvement in MRI
quality at 1.5T was the use of phased array coils
instead of a quadrature head coil. This resulted in
signal to noise improvements of three- to fourfold at
the cortex.19 The latest improvement in MRI quality
we describe here results from increasing the static
field strength from 1.5T to 3T as well as the use of
phased array coils. These advances result in im-
proved signal to noise which can be used to decrease
scan time, increase spatial resolution, and improve
contrast to noise ratio (CNR). In our study, the gains
in SNR were used to increase resolution and to im-
prove CNR.20 Although SNR should increase linearly
with field strength, the decrease in T1 contrast be-
tween gray and white matter, the increase in suscep-
tibility effects, and the difficulties with image
1030 NEUROLOGY 65 October (1 of 2) 2005
Figure 2. Focal cortical dysplasia with
only cortical involvement identified on
MRI. Axial T2 FSE scanned with a
regular head coil at 1.5T (A) and with
the 3T PA MRI (B). A blurred gray
white junction and focal cortical in-
creased T2 signal (arrow) are identified
on both images. 3T PA MRI helped to
better define the lesion. Lesion location
corresponded to seizure semiology (1.5T
images: Courtesy Dr. A. Golja, Dept. Of
Radiology, Children’s Hospital, Boston,
MA).
homogeneity at 3T decrease the impact of the theo-
retical increase in SNR over 1.5T images. The exact
increase in SNR has not been measured formally in
these patients but we estimate a twofold increase in
SNR when moving from 1.5 to 3T and an additional
fourfold increase in SNR at the cortex due to the
phased array receivers.21 Therefore, we estimate a
six- to eightfold increase in SNR for 3T PA MRI
compared to 1.5T head coil MRI.
When the reader has knowledge of the seizure
semiology there is a risk that lesions outside the lobe
of interest may be missed and lesions in the lobe of
interest may be overcalled. Although our preliminary
postsurgical follow-up is good when the detected le-
sion was completely resected suggesting that no
other epileptogenic lesions are present and patho-
logic confirmation was obtained in all 11 cases that
went to surgery, further follow-up and larger num-
bers of patients are necessary to determine the false
negative rate.
The impact of epilepsy imaging experience is diffi-
cult to quantify, especially when comparing a reader
more invested in the imaging outcome to a number of
readers in clinical practice who are under pressure to
read a large number of studies in a short period of
time. A previous study comparing expert and non-
expert review of routine head coil 1.5T MRI studies
showed that the sensitivity of the experts was 50%
compared to 39% for non-experts. The expert sensi-
tivity increased to 91% when high resolution head
coil 1.5T MRI epilepsy studies were reviewed.17 In
this prior study, the experts were also provided in-
formation on seizure semiology. In our study, not all
patients went to surgery and therefore statistical
sensitivity and specificity could not be calculated.
However, outside reports of high resolution head coil
1.5T MRI epilepsy studies noted a focal candidate
lesion in 30% (12/40) of patients whereas focal le-
sions were detected in 73% (29/40) of patients on
unblinded review of 3T PA MRI studies.
One limitation of this study is the inability to sep-
arate the effects of 3T imaging, PA imaging, an un-
blinded reader, and a reader experienced in epilepsy
imaging. However, this study does reflect the poten-
tial diagnostic yield a referring physician can expect
if a patient with FE is referred for 3T PA-MRI eval-
uation at a specialized Epilepsy Imaging Center af-
ter routine clinical epilepsy MRI evaluations at
tertiary care centers.
Acknowledgment
The authors thank Thomas Benner, Andre van der Kouwe, and
John Pitts for their help with sequence optimization. They also
thank Dr. A. Golja, MD, Department of Radiology, Childrens Hos-
pital Boston, and Dr. P. Due Tønnessen, Dept. of Radiology, Riks-
hospitalet Oslo, Norway, for providing the 1.5T MRIs and Drs.
Bruce Rosen, Greg Sorensen, and Keiko Hara for their support of
the epilepsy program. The authors thank their clinical collabora-
tors for patient referrals: Drs. Ann Bergin, Peter Black, Blaise
Bourgeois, Edward Bromfield, Keith Chiappa, Rees Cosgrove, An-
drew Cole, Barbara Dworetzky, Daniel Hoch, Gregory Holmes,
Joseph Madsen, James Riviello, Donald Schomer, and Elizabeth
Thiele.
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