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MRI essentials in epileptology: a review from the ILAE Imaging Taskforce Volume 22, issue 4, August 2020

TEST YOURSELF

(1) Which statement(s) about FLAIR images are true?

A. FLAIR stands for Fluid Attenuated Inversion Recovery

B. FLAIR is a modified T1-weighted sequence

C. FLAIR is useful for detection of epileptogenic lesions

D. FLAIR cannot be acquired with 1.5T

E. FLAIR is suited for patients of all age groups

 

(2) Which statement(s) regarding indications for MRI are true?

A. A first seizure requires acquisition of MRI

B. An implanted pacemaker is a contraindication

C. MRI should be acquired for presurgical evaluation only

D. MRI is indicated for all types of epilepsy

E. Tattoos are contraindications

 

(3) Which sequence(s) are mandatory for MRI according to the HARNESS-protocol?

A. Susceptibility weighted imaging (T2*)

B. 3D-FLAIR

C. 3D-T1

D. Axial spin echo/T2

E. Coronal spin echo/T2

 

(4) Which statement(s) regarding inspection of MRI are true?

A. Special attention should be paid to the mesial temporal structures

B. Lesions should only be reported if seen with more than one sequence

C. Partial volume effects do not occur on 3D series

D. Inspection of the white matter is not important due to the neuronal generation of seizures

E. Any additional information (e.g. EEG, MEG, PET, SPECT, etc.) should be taken into account for inspection

 

(5) Which MRI feature(s) can be observed as signs of hippocampal sclerosis?

A. Malrotation of the hippocampus

B. Decreased T1- and increased T2-weighted signal

C. Hypertrophy of the ipsilateral fornix

D. Deep ipsilateral collateral sulcus

E. Atrophy of the temporal pole

 

(6) Which statement(s) regarding ganglioglioma and DNET are true?

A. Ganglioglioma and DNET are isointense to gray matter on T1

B. Ganglioglioma and DNET are isointense to gray matter on T2

C. Gadolinium enhancement is typically strong in ganglioglioma and DNET

D. Gadolinium enhancement is more common in ganglioglioma

E. Ganglioglioma have a typical multilobulated appearance on T2

 

(7) Which statement(s) regarding malformations of cortical development are NOT true?

A. Abnormal cortical thickness is a sign of FCD

B. Blurred gray-white junction is a sign of FCD

C. Nodules in periventricular nodular heterotopia may be single or multiple, unilateral or bilateral

D. A transmantle sign is specifically associated with FCD IIb

E. Polymicrogyria only occurs unilaterally

 

(8) Which statement(s) regarding vascular malformations are NOT true?

A. Cavernous angiomas show no (or only subtle) changes on T2, but show strong susceptibility artifacts on T2*

B. Cavernous angiomas typically show a multi-cystic appearance

C. Cortical involvement is associated with a higher risk of epilepsy

D. Mesial temporal cavernomas do not show an association with more severe epilepsy

E. Ischemic and hemorrhagic stroke may be associated with refractory seizures

 

(9) Which statement(s) regarding other structural alterations and lesions in epilepsy are NOT true?

A. Glial scars are hypointense on T2 and hyperintense on T1

B. Glial scars may be associated with FCD type III

C. MRI characteristics of Rasmussen’s encephalitis include early cortical swelling

D. Herpes simplex encephalitis is associated with hyperintensity on T2 and hypointensity on T1

E. Calcified neurocysticercosis cysts usually show no surrounding edema and a loss of T2 signal

 

(10) Which statement(s) regarding “MRI-negative” epilepsy are true?

A. The definition of MRI-negative is dependent on the party viewing the scans

B. Only about 10% of patients with drug-resistant epilepsy evaluated for surgery have no apparent lesion on MRI

C. Encephalitis is the most common pathologic substrate in epilepsies with negative MRI

D. A second focused review with additional information may reveal a lesion

E. MRI post-processing requires specialized sequences and cannot be done retrospectively

 

 

 

 

 

 

 

 

 

 

 

 

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Answers

(1) A, C

 

(2) B

 

(3) B, C

 

(4) A, E

 

(5) B, E

 

(6) A, E

 

(7) E

 

(8) A, D

 

(9) A

 

(10) A, D

 

 

 

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