Value of ultra-high field MRI in patients with suspected focal epilepsy and negative 3 T MRI (EpiUltraStudy): protocol for a prospective, longitudinal therapeutic study

• Published in: Neuroradiology Vol. 64; no. 4; pp. 753 - 764
• Main Authors: van Lanen, R. H. G. J., Wiggins, C. J., Colon, A. J., Backes, W. H., Jansen, J. F. A., Uher, D., Drenthen, G. S., Roebroeck, A., Ivanov, D., Poser, B. A., Hoeberigs, M. C., van Kuijk, S. M. J., Hoogland, G., Rijkers, K., Wagner, G. L., Beckervordersandforth, J., Delev, D., Clusmann, H., Wolking, S., Klinkenberg, S., Rouhl, R. P. W., Hofman, P. A. M., Schijns, O. E. M. G.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.04.2022; Springer Nature B.V
• Subjects: Child; Convulsions & seizures; Drug resistance; Drug Resistant Epilepsy - diagnostic imaging; Drug Resistant Epilepsy - surgery; Epilepsies, Partial - diagnostic imaging; Epilepsies, Partial - surgery; Epilepsy; Functional Neuroradiology; Humans; Imaging; Lesions; Longitudinal Studies; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Medicine; Medicine & Public Health; Neurology; Neuroradiology; Neurosciences; Neurosurgery; Patients; Prospective Studies; Radiology; Seizures; Structure-function relationships; Surgery; Treatment Outcome; 7 T; 9.4 T; Epilepsy surgery; Epilepsy; UHF MRI
• ISSN: 0028-3940; 1432-1920
• DOI: 10.1007/s00234-021-02884-8

Purpose Resective epilepsy surgery is a well-established, evidence-based treatment option in patients with drug-resistant focal epilepsy. A major predictive factor of good surgical outcome is visualization and delineation of a potential epileptogenic lesion by MRI. However, frequently, these lesions are subtle and may escape detection by conventional MRI (≤ 3 T). Methods We present the EpiUltraStudy protocol to address the hypothesis that application of ultra-high field (UHF) MRI increases the rate of detection of structural lesions and functional brain aberrances in patients with drug-resistant focal epilepsy who are candidates for resective epilepsy surgery. Additionally, therapeutic gain will be addressed, testing whether increased lesion detection and tailored resections result in higher rates of seizure freedom 1 year after epilepsy surgery. Sixty patients enroll the study according to the following inclusion criteria: aged ≥ 12 years, diagnosed with drug-resistant focal epilepsy with a suspected epileptogenic focus, negative conventional 3 T MRI during pre-surgical work-up. Results All patients will be evaluated by 7 T MRI; ten patients will undergo an additional 9.4 T MRI exam. Images will be evaluated independently by two neuroradiologists and a neurologist or neurosurgeon. Clinical and UHF MRI will be discussed in the multidisciplinary epilepsy surgery conference. Demographic and epilepsy characteristics, along with postoperative seizure outcome and histopathological evaluation, will be recorded. Conclusion This protocol was reviewed and approved by the local Institutional Review Board and complies with the Declaration of Helsinki and principles of Good Clinical Practice. Results will be submitted to international peer-reviewed journals and presented at international conferences. Trial registration number www.trialregister.nl : NTR7536.