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Research ArticleUltra-High-Field MRI/Imaging of Epilepsy/Demyelinating Diseases/Inflammation/Infection

MRI Interpretation Errors in Adult Patients with Medically Refractory Epilepsy

Aoife M. Haughey, Nadav Gasner and Timo Krings
American Journal of Neuroradiology July 2025, 46 (7) 1501-1509; DOI: https://doi.org/10.3174/ajnr.A8681
Aoife M. Haughey
aFrom the Division of Neuroradiology, Joint Department of Medical Imaging, University Health Network and Toronto Western Hospital, Department of Medical Imaging (A.M.H., N.G., T.K.), University of Toronto, Toronto, Ontario, Canada
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Nadav Gasner
aFrom the Division of Neuroradiology, Joint Department of Medical Imaging, University Health Network and Toronto Western Hospital, Department of Medical Imaging (A.M.H., N.G., T.K.), University of Toronto, Toronto, Ontario, Canada
bDivision of Neurology (N.G.), Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
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Timo Krings
aFrom the Division of Neuroradiology, Joint Department of Medical Imaging, University Health Network and Toronto Western Hospital, Department of Medical Imaging (A.M.H., N.G., T.K.), University of Toronto, Toronto, Ontario, Canada
cDivision of Neurointerventional Radiology (T.K.), Lahey Hospital and Neurovascular Center Beth Israel Lahey Health, University of Massachusetts Chan Medical School, Boston, Massachusetts
dEdward Singleton Department of Radiology (T.K.), Texas Children’s Hospital and Baylor College of Medicine, Houston, Texas
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Abstract

BACKGROUND AND PURPOSE: The aim is to determine the most common MRI interpretation errors in patients with medically refractory epilepsy (MRE) according to our experience in a tertiary academic center with a large volume epilepsy program, to raise awareness of the “blind spots” in imaging patients with MRE, and to highlight the importance of combining clinical and electroencephalographic information to obtain the most accurate diagnosis.

MATERIALS AND METHODS: This is a retrospective observational study. All patients with MRE who underwent MRI brain (on 3T, with dedicated epilepsy protocol), and who were discussed at the weekly interdisciplinary epilepsy conference in our center between January 2008 and July 2023 were included. The initial MRI interpretation and final MRI interpretation results were reviewed.

RESULTS: A total of 886 patients with MRE were included. Three hundred patients were MRI-negative (33.86%), diagnoses were missed in 95 patients (10.7%), a second diagnosis was missed in patients with dual pathologies in 42 patients (4.74%), findings were misinterpreted in 4 patients (0.45%), an overcall was made in 2 patients (0.2%), and in 5 patients the correct diagnosis was discussed but erroneously deemed absent on initial interpretation (0.56%), resulting in a total of 148 discrepant MRI reports. Mesial temporal sclerosis comprised the most common pathology encountered overall, followed by encephalomalacia related to prior insult, enlarged amygdala (EA), malformations of cortical development, cavernoma, and ulegyria. The relative proportion of missed focal cortical dysplasia, encephalocele, and EA accounted for the most common misses/misdiagnoses.

CONCLUSIONS: Evaluation of patients with MRE requires excellent interdisciplinary care. Input from all members of the interdisciplinary team is essential for accurate interpretation of MRI in patients with MRE for the neuroradiologist. We hope to inform radiologists of commonly overlooked pathologies in MRI brain interpretation for patients with epilepsy. In doing so, we want to maximize the yield of initial MRI interpretation in these patients.

ABBREVIATIONS:

EA
enlarged amygdala
EEG
electroencephalogram
EMR
electronic medical record
FCD
focal cortical dysplasia
MCD
malformations of cortical development
MEG
magnetoencephalography
MRE
medically refractory epilepsy
MTS
mesial temporal sclerosis
PVNH
periventricular nodular heterotopia
SCNH
subcortical nodular heterotopia
TLE
temporal lobe epilepsy
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American Journal of Neuroradiology: 46 (7)
American Journal of Neuroradiology
Vol. 46, Issue 7
1 Jul 2025
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Cite this article
Aoife M. Haughey, Nadav Gasner, Timo Krings
MRI Interpretation Errors in Adult Patients with Medically Refractory Epilepsy
American Journal of Neuroradiology Jul 2025, 46 (7) 1501-1509; DOI: 10.3174/ajnr.A8681

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Interpretation Errors in Adults with MRE
Aoife M. Haughey, Nadav Gasner, Timo Krings
American Journal of Neuroradiology Jul 2025, 46 (7) 1501-1509; DOI: 10.3174/ajnr.A8681
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