9.4T MRI shows similar FCD detection to 3T in small epilepsy cohort, reveals one quantitative feature
Photo by Google DeepMind / Unsplash
Key Takeaway
Note: 9.4T MRI findings in this small study were consistent with 3T; a quantifiable T2* feature in one lesion requires larger validation.
This cohort study compared 9.4T MRI (0.8 mm isotropic MP2RAGE, high-resolution T2*-weighted GRE) to standard 3T MRI (MP2RAGE, FLAIR) in 21 patients with drug-resistant focal epilepsy (DRFE) and 20 healthy controls during presurgical workup. The primary aim was detecting subtle epileptogenic lesions like focal cortical dysplasias (FCDs).
In the 16 patients with negative 3T MRI, no new epileptogenic lesions were visually identified with 9.4T. In 2 patients with histopathologically confirmed FCD IIb lesions, the lesions were visible with distinct features at both field strengths. One of these lesions showed a focal cortical T2* reduction at 9.4T that could be quantified via automated cortical profiling, consistent with the black line sign.
Safety and tolerability data were not reported. Key limitations include the very small cohort size (n=21) and the acknowledged need for further optimization of ultra-high-field protocols and analysis methods in larger studies. The restrained practice relevance is that higher-resolution T2*-weighted sequences at 9.4T can reveal a quantitative feature (the black line sign via cortical profiling) not seen at 3T, which might potentially help refine surgical or ablation targeting for some FCDs, but this is based on a single lesion observation.
View Original Abstract ↓
Background: The detection of subtle epileptogenic lesions such as focal cortical dysplasias (FCDs) is a clinical challenge in the management of drug-resistant focal epilepsy (DRFE). Ultra-high field (UHF) MRI offers increased signal-to-noise ratios and spatial resolution compared to 3Tesla (T) MRI and may improve diagnostic yield. Here, we present a 9.4T MRI cohort study of patients with DRFE. Methods: We recruited n=21 DRFE patients (with 3T-MRI findings: 2 positive, 3 equivocal, 16 negative) undergoing presurgical workup, and n=20 healthy controls for 9.4T MRI (0.8 mm isotropic MP2RAGE, slabs of 0.375 x 0.375 x 0.8 mm T2*-weighted GRE) and 3T MRI (MP2RAGE, FLAIR) acquisitions. Visual review for possible epileptogenic lesions was performed by clinical experts. For histopathologically confirmed FCD lesions, we extracted surface-based quantitative features (cortical thickness, qT1, FLAIR, T2*, and QSM values) across cortical depths and distances from the lesion centre and performed high-resolution cortical profiling of 9.4T T2* values. Results: No new epileptogenic lesions were visually identified at 9.4T in 3T MRI negative patients. In the two patients with histopathologically confirmed lesions, the FCD IIb lesions were visible with distinct qualitative and quantitative features at both field strengths. One of these FCD IIb showed a focal cortical T2* reduction at 9.4T that could here be quantified via automated cortical profiling, consistent with the previously described "black line sign". Conclusion: 9.4T MRI findings in epileptogenic lesions underlying DRFE are consistent with those on 3T MRI. While additional lesions were not identified in patients with negative 3T MRI, higher resolution T2*-weighted sequences can reveal a feature not seen at 3T: Cortical profiling of FCDs highlights the black line sign and can possibly help refine surgical or ablation targeting for some FCDs. Further optimization of UHF protocols and analysis methods on larger cohorts may reveal clinically applicable diagnostic benefits.
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