Bargalló Núria, Vitali Paolo, Álvarez-Linera Juan, Rosazza Cristina, González-Ortiz Sofía, Urbach Horst
Department de Radiologia, Centre de Diagnostic per la Imatge, Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain.
Insitut d'investigacins Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.
Eur Radiol. 2025 Jun;35(6):3385-3395. doi: 10.1007/s00330-024-11266-6. Epub 2024 Dec 19.
Epilepsy, a neurological disorder characterised by recurrent seizures, poses significant challenges in diagnosis, treatment, and management. Understanding the underlying causes and identifying precise anatomical locations of epileptogenic foci are critical for effective management strategies, particularly in drug-resistant patients. Neuroimaging techniques, particularly magnetic resonance (MR), play a pivotal role in the evaluation of epilepsy patients, offering insights into structural abnormalities, epileptogenic lesions, and functional alterations within the brain. Diverse clinical scenarios that warrant neuroimaging in epilepsy patients, ranging from first-onset seizures to drug-resistant epilepsy, will be presented, elucidating the considerations and recommendations for imaging modalities. The dedicated MR protocol for epilepsy patients will be discussed, justifying the rationale behind sequence selection and optimisation strategies and providing clues about how to read these magnetic resonance imaging (MRI) exams. Finally, MR findings associated with common epileptogenic lesions, such as hippocampal sclerosis, focal cortical dysplasia, and long-term epilepsy-associated tumours, will be described. This article reviews essential concepts, including definitions, classification, imaging indications, protocols, and neuroradiological findings, aiming to understand how neuroimaging contributes to diagnosing and managing epilepsy comprehensively. KEY POINTS: MR should be performed in adults and children with a recent diagnosis of epilepsy of unknown aetiology, a first seizure, and a negative CT. Performing a dedicated MR protocol in focal epilepsy is essential for increasing the detection of potentially epileptogenic lesions. For presurgical evaluations, MR abnormalities should correlate with the electric pattern, semiology data, or other neuroimaging examination to be considered the epileptogenic lesion.
癫痫是一种以反复发作性癫痫发作为特征的神经系统疾病，在诊断、治疗和管理方面带来了重大挑战。了解潜在病因并确定致痫灶的精确解剖位置对于有效的管理策略至关重要，尤其是对于耐药患者。神经影像学技术，特别是磁共振成像（MR），在癫痫患者的评估中起着关键作用，能够深入了解大脑的结构异常、致痫性病变和功能改变。本文将介绍癫痫患者需要进行神经影像学检查的各种临床情况，从首次发作到耐药性癫痫，阐明成像方式的考虑因素和建议。还将讨论针对癫痫患者的专用MR检查方案，说明序列选择和优化策略背后的原理，并提供解读这些磁共振成像（MRI）检查结果的线索。最后，将描述与常见致痫性病变相关的MR表现，如海马硬化、局灶性皮质发育不良和长期癫痫相关肿瘤。本文回顾了一些基本概念，包括定义、分类、成像指征、检查方案和神经放射学表现，旨在了解神经影像学如何全面地有助于癫痫的诊断和管理。要点：对于近期诊断为病因不明的癫痫、首次发作且CT检查阴性的成人和儿童，应进行MR检查。在局灶性癫痫中执行专用的MR检查方案对于增加潜在致痫性病变的检测至关重要。对于术前评估，MR异常应与脑电图模式、症状学数据或其他神经影像学检查结果相关联，才能被视为致痫性病变。
