Multimodal Presurgical Evaluation of Medically Refractory Focal Epilepsy in Adults: An Update for Radiologists

Research output: Contribution to journalReview articlepeer-review

Abstract

Surgery is a potentially curative treatment option for patients with medically refractory focal epilepsy. Advanced neuroimaging modalities often improve surgical outcomes by contributing key information during the highly individualized surgical planning process and intraoperative localization. Hence, neuroradiologists play an integral role in the multidisciplinary management team. In this review, we initially present the conceptual background and practical framework of the presurgical evaluation process, including a description of the surgical treatment approaches used for medically refractory focal epilepsy in adults. This background is followed by an overview of the advanced modalities commonly used during the presurgical workup at level IV epilepsy centers, including diffusion imaging techniques, blood oxygenation level–dependent functional MRI (fMRI), PET, SPECT, and subtraction ictal SPECT, and by introductions to 7-T MRI and electrophysiologic techniques including electroencephalography and magnetoencephalography. We also provide illustrative case examples of multimodal neuroimaging including PET/ MRI, PET/MRI–diffusion-tensor imaging (DTI), subtraction ictal SPECT, and image-guided stereotactic planning with fMRI-DTI.

Original languageEnglish (US)
Pages (from-to)488-500
Number of pages13
JournalAmerican Journal of Roentgenology
Volume219
Issue number3
DOIs
StatePublished - Sep 2022

Keywords

  • DTI
  • MRI
  • PET/MRI
  • epilepsy
  • fMRI
  • presurgical evaluation of epilepsy
  • subtraction ictal SPECT

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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