Department of Epileptology, University of Bonn Medical Center, Bonn, Germany.
Curr Opin Neurol. 2018 Apr;31(2):223-231. doi: 10.1097/WCO.0000000000000539.
MRI has a crucial position in the diagnostic routine of epilepsy patients. It relevantly contributes to etiological diagnostics and is indispensable in presurgical evaluation. As modern MRI research has been a boon to clinical neuroscience in general, it also holds the promise of enhancing diagnostics of epilepsy patients; i.e. increasing the diagnostic yield while decreasing the number of MRI-negative patients. Its rapid progress, however, has caused uncertainty about which of its latest developments already are of clinical interest and which still are of academic interest. It is the purpose of this review to clarify what, to the authors' mind, good practice of MRI in epilepsy patient care is today and what it might be tomorrow.
Progress of diagnostic MRI in epilepsy patients is driven by development of scanner hardware, scanner sequence and data postprocessing. Ultra high-field MRI and elaborate sequences provide datasets of novel quality which can be fed into postprocessing programs extracting pathognomonic features of structural or functional anatomy. The integration of these features by means of computerized classifiers yield previously unsurpassed diagnostic validity. Enthusiasm about Diffusion Tensor Imaging and functional MRI in the evaluation before epilepsy surgery is quelled.
The application of an epilepsy tailored MRI protocol at 3 Tesla followed by meticulous expert evaluation early after the onset of epilepsy is most crucial. It is hoped that future research will result in MRI workups more standardized than today and widely used postprocessing routines analyzing co-registered three-dimensional volumes from different modalities.
MRI 在癫痫患者的诊断常规中具有至关重要的地位。它对病因诊断有重要贡献，在术前评估中不可或缺。由于现代 MRI 研究对一般临床神经科学是一个福音，它也有望提高癫痫患者的诊断；即增加诊断产量，同时减少 MRI 阴性患者的数量。然而，它的快速发展导致了不确定性，即哪些最新进展已经具有临床意义，哪些仍然具有学术意义。本综述的目的是阐明作者认为今天在癫痫患者护理中 MRI 的良好实践是什么，以及明天可能是什么。
癫痫患者的诊断 MRI 进展是由扫描仪硬件、扫描仪序列和数据后处理的发展驱动的。超高场 MRI 和精细序列提供了具有新颖质量的数据集，可以输入到提取结构或功能解剖特征的后处理程序中。这些特征通过计算机分类器的集成提供了以前无法达到的诊断有效性。在癫痫手术前评估中，弥散张量成像和功能 MRI 的应用热情消退了。
在癫痫发作后早期应用针对癫痫的 3T MRI 方案，并进行细致的专家评估是最重要的。希望未来的研究将导致 MRI 检查比今天更标准化，并广泛使用分析来自不同模态的配准三维容积的常规后处理程序。
