E1701. Seize the Moment: Neuroimaging Findings of Epilepsy
  1. Mia Ma; Henry Ford Hospital
  2. Stefan Brancel; Henry Ford Hospital
  3. Alex Lee; Wayne State University School of Medicine
  4. Michael Stone; Henry Ford Hospital
  5. Daneil Noujaim; Henry Ford Hospital
Epilepsy occurs with a prevalence of 4 - 10 per 1,000 and neuroimaging plays a critical role in evaluation of new onset and chronic intractable cases. Pathology ranges from obvious tumors to subtle focal cortical defects. These findings guide surgical treatments making appropriate identification of imaging findings critical for appropriate management.

Educational Goals / Teaching Points
We discuss pathologies associated with epilepsy including focal cortical dysplasia, polymicrogyria, schizencephaly, periventricular nodular heterotopia, hemimegaloencephaly, cortical hamartomas, Sturge-Weber syndrome, seizure associated tumors, cavernous malformations, mesial temporal sclerosis, and sequela of infections such as herpes simplex virus encephalitis. The frequency, clinical characteristics, and MRI findings of these pathologies are discussed. The role of nuclear medicine studies and their imaging findings are highlighted. Finally, a brief review of normal and abnormal post-surgical findings is given.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
We perform a brief overview of critical neuroanatomy focused around the temporal lobe, periventricular white matter, and subcortical white matter. MRI findings of the above pathologies are described and shown with a focus on reporting details relevant to treatment. The differences between interictal positron emission tomography (PET) and ictal single photon emission computed tomography (SPECT) imaging, and basic interpretation of these imaging studies are outlined.

Detailed knowledge of epileptiform pathologies is key for radiologists to appropriately identify sometimes subtle underlying pathologies. Accurate identification and description of these imaging findings allows for appropriate patient selection for surgery, which can be curative in 80 % of temporal resection cases. When MRI does not find a culprit, pathology PET and SPECT can sometimes provide anatomic localization.