Passaro Erasmo A
Continuum (Minneap Minn). 2023 Feb 1;29(1):104-155. doi: 10.1212/CON.0000000000001242.
This article discusses the fundamental importance of optimal epilepsy imaging using the International League Against Epilepsy-endorsed Harmonized Neuroimaging of Epilepsy Structural Sequences (HARNESS) protocol and the use of multimodality imaging in the evaluation of patients with drug-resistant epilepsy. It outlines a methodical approach to evaluating these images, particularly in the context of clinical information.
Epilepsy imaging is rapidly evolving, and a high-resolution epilepsy protocol MRI is essential in evaluating newly diagnosed, chronic, and drug-resistant epilepsy. The article reviews the spectrum of relevant MRI findings in epilepsy and their clinical significance. Integrating multimodality imaging is a powerful tool in the presurgical evaluation of epilepsy, particularly in "MRI-negative" cases. For example, correlation of clinical phenomenology, video-EEG with positron emission tomography (PET), ictal subtraction single-photon emission computerized tomography (SPECT), magnetoencephalography (MEG), functional MRI, and advanced neuroimaging such as MRI texture analysis and voxel-based morphometry enhances the identification of subtle cortical lesions such as focal cortical dysplasias to optimize epilepsy localization and selection of optimal surgical candidates.
The neurologist has a unique role in understanding the clinical history and seizure phenomenology, which are the cornerstones of neuroanatomic localization. When integrated with advanced neuroimaging, the clinical context has a profound impact on identifying subtle MRI lesions or finding the "epileptogenic" lesion when multiple lesions are present. Patients with an identified lesion on MRI have a 2.5-fold improved chance of achieving seizure freedom with epilepsy surgery compared with those without a lesion. This clinical-radiographic integration is essential to accurate classification, localization, determination of long-term prognosis for seizure control, and identification of candidates for epilepsy surgery to reduce seizure burden or attain seizure freedom.
本文讨论了使用国际抗癫痫联盟认可的癫痫结构序列统一神经影像学（HARNESS）方案进行最佳癫痫成像的根本重要性，以及多模态成像在耐药性癫痫患者评估中的应用。它概述了一种评估这些图像的系统方法，特别是在临床信息背景下。
癫痫成像正在迅速发展，高分辨率癫痫方案MRI对于评估新诊断的、慢性的和耐药性癫痫至关重要。本文回顾了癫痫相关MRI表现的范围及其临床意义。整合多模态成像在癫痫术前评估中是一种强大的工具，特别是在“MRI阴性”病例中。例如，将临床现象学、视频脑电图与正电子发射断层扫描（PET）、发作期减影单光子发射计算机断层扫描（SPECT）、脑磁图（MEG）、功能MRI以及诸如MRI纹理分析和基于体素的形态计量学等先进神经成像相结合，可增强对细微皮质病变（如局灶性皮质发育不良）的识别，以优化癫痫定位并选择最佳手术候选者。
神经科医生在理解临床病史和发作现象学方面具有独特作用，而临床病史和发作现象学是神经解剖定位的基石。当与先进的神经成像相结合时，临床背景对识别细微的MRI病变或在存在多个病变时找到“致痫性”病变具有深远影响。MRI上发现病变的患者通过癫痫手术实现无发作的机会比没有病变的患者提高2.5倍。这种临床与影像学的整合对于准确分类、定位、确定癫痫控制的长期预后以及识别癫痫手术候选者以减轻发作负担或实现无发作至关重要。
