Epilepsy protocol (MRI)

MRI protocol for epilepsy is a group of MRI sequences put together to improve sensitivity and specificity in identifying possible structural abnormalities that underlie seizure disorders (e.g. mesial temporal sclerosis and malformation of cortical development). MRI is the imaging procedure of choice for epilepsy investigation, especially 3 tesla MRI.

Note: This article is intended to outline some general principles of protocol design. The specifics will vary depending on MRI hardware and software, radiologist's and referrer's preference, institutional protocols, patient factors (e.g. allergy) and time constraints.

Sequences

Non-focal epilepsy protocol 

A good protocol for this purpose involves at least:

• T1
  • sequence: axial and coronal; in modern scanners it can be replaced by a 3D isotropic acquisition 
• FLAIR
  • sequence: axial and angled coronal; in modern scanners it can be replaced by a 3D isotropic acquisition 
• inversion recovery sequences 
  • DIR
    • sequence: 3D isotropic acquisition 
• DWI/ADC
• SWI or T2*

Temporal lobe epilepsy protocol 

A good protocol for this purpose involves at least:

• T1
  • sequence: axial and coronal; in modern scanners it can be replaced by a 3D isotropic acquisition 
• FLAIR
  • sequence: axial and angled coronal; in modern scanners it can be replaced by a 3D isotropic acquisition 
• T2
  • sequence: angled coronal
• DWI/ADC
• SWI or T2*
• fiber-tracking technique
  • the fiber-tracking technique allow to investigate the effect of temporal lobe epilepsy on reorganization of the linguistic functions