Tim Wehner1, Philippe Weckesser1, Steven Schulz1, Annika Kowoll2, Sebastian Fischer2, Jessica Bosch1, Leonie Weinhold3, Rolf Fimmers3, Matthias Schmid3, Jörg Wellmer4. 1. Ruhr - Epileptology, Department of Neurology, University Hospital Knappschafts-krankenhaus, Ruhr - University Bochum, In der Schornau 23 - 25, 44892, Bochum, Germany. 2. Department of Neuroradiology, University Hospital Knappschaftskrankenhaus, Ruhr - University Bochum, In der Schornau 23 - 25, 44892, Bochum, Germany. 3. Department of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Venusberg Campus 1, Gebäude 11, 53127, Bonn, Germany. 4. Ruhr - Epileptology, Department of Neurology, University Hospital Knappschafts-krankenhaus, Ruhr - University Bochum, In der Schornau 23 - 25, 44892, Bochum, Germany. joerg.wellmer@kk-bochum.de.
Abstract
BACKGROUND: To prospectively analyze factors associated with detecting epileptogenic lesions on MRI within the work-sharing process of neurologists, epileptologists, radiologists and neuroradiologists. METHODS: We assembled four sets of six MRI scans, each set representing five typical epileptogenic lesions (hippocampal sclerosis or limbic encephalitis; focal cortical dysplasias; periventricular nodular or other heterotopias; long-term epilepsy associated tumors; gliotic scar, hemosiderin or cavernoma), and non - lesional epilepsy. At professional conferences, we invited neurologists, epileptologists, radiologists, and neuroradiologists to read two out of four MRI sets, one of which was presented with a clinical focus hypothesis. Participants were randomly assigned to MRI sets. Effects of examiners' specialty, duration of training and professional experience on detection rate of epileptogenic lesions were investigated. RESULTS: Fourty-eight neurologists, 22 epileptologists, 20 radiologists and 21 neuroradiologists read 1323 MRI scans. Overall, 613 of 1101 (55.7%) epileptogenic lesions were detected. Long-term epilepsy associated tumors (182/221, 82.4%) were found more frequently than gliotic scar, hemosiderin or cavernoma (157/220, 71.4%), hippocampal sclerosis or limbic encephalitis (141/220, 64.1%), nodular heterotopia (68/220, 30.9%) and focal cortical dysplasias (65/220, 29.5%, p < 0.001). Provision of a focus hypothesis improved the detection of hippocampal sclerosis or limbic encephalitis (86/110, 78.2% vs 55/110, 50%, p < 0.001) and focal cortical dysplasias (40/110, 36.4% vs 25/110, 22.7%, p = 0.037). Neuroradiologists and epileptologists were more likely than radiologists and neurologists to be amongst the most successful readers. In multivariable analysis, type of epileptogenic lesion, specialty of MRI reader, and provision of focus hypothesis predicted correct identification of epileptogenic lesions. CONCLUSIONS:Epileptogenic lesions are often not recognized on MRI even by expert readers. Their detection can be improved by providing a focus hypothesis. These results stress the need for training in the MRI characteristics of epilepsy - specific pathology, and, most importantly, interdisciplinary communication between neurologists/epileptologists and (neuro)radiologists to improve detection of epileptogenic lesions.
RCT Entities:
BACKGROUND: To prospectively analyze factors associated with detecting epileptogenic lesions on MRI within the work-sharing process of neurologists, epileptologists, radiologists and neuroradiologists. METHODS: We assembled four sets of six MRI scans, each set representing five typical epileptogenic lesions (hippocampal sclerosis or limbic encephalitis; focal cortical dysplasias; periventricular nodular or other heterotopias; long-term epilepsy associated tumors; gliotic scar, hemosiderin or cavernoma), and non - lesional epilepsy. At professional conferences, we invited neurologists, epileptologists, radiologists, and neuroradiologists to read two out of four MRI sets, one of which was presented with a clinical focus hypothesis. Participants were randomly assigned to MRI sets. Effects of examiners' specialty, duration of training and professional experience on detection rate of epileptogenic lesions were investigated. RESULTS: Fourty-eight neurologists, 22 epileptologists, 20 radiologists and 21 neuroradiologists read 1323 MRI scans. Overall, 613 of 1101 (55.7%) epileptogenic lesions were detected. Long-term epilepsy associated tumors (182/221, 82.4%) were found more frequently than gliotic scar, hemosiderin or cavernoma (157/220, 71.4%), hippocampal sclerosis or limbic encephalitis (141/220, 64.1%), nodular heterotopia (68/220, 30.9%) and focal cortical dysplasias (65/220, 29.5%, p < 0.001). Provision of a focus hypothesis improved the detection of hippocampal sclerosis or limbic encephalitis (86/110, 78.2% vs 55/110, 50%, p < 0.001) and focal cortical dysplasias (40/110, 36.4% vs 25/110, 22.7%, p = 0.037). Neuroradiologists and epileptologists were more likely than radiologists and neurologists to be amongst the most successful readers. In multivariable analysis, type of epileptogenic lesion, specialty of MRI reader, and provision of focus hypothesis predicted correct identification of epileptogenic lesions. CONCLUSIONS:Epileptogenic lesions are often not recognized on MRI even by expert readers. Their detection can be improved by providing a focus hypothesis. These results stress the need for training in the MRI characteristics of epilepsy - specific pathology, and, most importantly, interdisciplinary communication between neurologists/epileptologists and (neuro)radiologists to improve detection of epileptogenic lesions.
Authors: Andrea Bernasconi; Fernando Cendes; William H Theodore; Ravnoor S Gill; Matthias J Koepp; Robert Edward Hogan; Graeme D Jackson; Paolo Federico; Angelo Labate; Anna Elisabetta Vaudano; Ingmar Blümcke; Philippe Ryvlin; Neda Bernasconi Journal: Epilepsia Date: 2019-05-28 Impact factor: 5.864
Authors: Jörg Wellmer; Carlos M Quesada; Lars Rothe; Christian E Elger; Christian G Bien; Horst Urbach Journal: Epilepsia Date: 2013-10-07 Impact factor: 5.864
Authors: Daniel L Kenney; Kristen M Kelly-Williams; Karl N Krecke; Robert J Witte; Robert E Watson; Amy L Kotsenas; Elaine C Wirrell; Katherine C Nickels; Lily C Wong-Kisiel; Elson So Journal: Epilepsy Res Date: 2016-07-01 Impact factor: 3.045
Authors: Robert S Fisher; Carlos Acevedo; Alexis Arzimanoglou; Alicia Bogacz; J Helen Cross; Christian E Elger; Jerome Engel; Lars Forsgren; Jacqueline A French; Mike Glynn; Dale C Hesdorffer; B I Lee; Gary W Mathern; Solomon L Moshé; Emilio Perucca; Ingrid E Scheffer; Torbjörn Tomson; Masako Watanabe; Samuel Wiebe Journal: Epilepsia Date: 2014-04-14 Impact factor: 5.864