Evidence map›Paper›PMID 34365971›Full record

ArticleNeurological research and practice2021

Factors influencing the detection of treatable epileptogenic lesions on MRI. A randomized prospective study.

Tim Wehner, Philippe Weckesser, Steven Schulz, Annika Kowoll, Sebastian Fischer, Jessica Bosch, Leonie Weinhold, Rolf Fimmers, Matthias Schmid, Jörg Wellmer

Abstract read
In one paragraph

Article in Neurological research and practice, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Tim Wehner *Ruhr - Epileptology, Department of Neurology, University Hospital Knappschafts-krankenhaus, Ruhr - University Bochum, In der Schornau 23 - 25, 44892, Bochum, Germany.ORCID http://orcid.org/0000-0003-3319-2339
Philippe Weckesser *Ruhr - Epileptology, Department of Neurology, University Hospital Knappschafts-krankenhaus, Ruhr - University Bochum, In der Schornau 23 - 25, 44892, Bochum, Germany.
Steven SchulzRuhr - Epileptology, Department of Neurology, University Hospital Knappschafts-krankenhaus, Ruhr - University Bochum, In der Schornau 23 - 25, 44892, Bochum, Germany.
Annika KowollDepartment of Neuroradiology, University Hospital Knappschaftskrankenhaus, Ruhr - University Bochum, In der Schornau 23 - 25, 44892, Bochum, Germany.
Sebastian FischerDepartment of Neuroradiology, University Hospital Knappschaftskrankenhaus, Ruhr - University Bochum, In der Schornau 23 - 25, 44892, Bochum, Germany.
Jessica BoschRuhr - Epileptology, Department of Neurology, University Hospital Knappschafts-krankenhaus, Ruhr - University Bochum, In der Schornau 23 - 25, 44892, Bochum, Germany.
Leonie WeinholdDepartment of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Venusberg Campus 1, Gebäude 11, 53127, Bonn, Germany.
Rolf FimmersDepartment of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Venusberg Campus 1, Gebäude 11, 53127, Bonn, Germany.
Matthias SchmidDepartment of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Venusberg Campus 1, Gebäude 11, 53127, Bonn, Germany.
Jörg WellmerRuhr - Epileptology, Department of Neurology, University Hospital Knappschafts-krankenhaus, Ruhr - University Bochum, In der Schornau 23 - 25, 44892, Bochum, Germany. joerg.wellmer@kk-bochum.de.ORCID http://orcid.org/0000-0003-2919-0496

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundTo prospectively analyze factors associated with detecting epileptogenic lesions on MRI within the work-sharing process of neurologists, epileptologists, radiologists and neuroradiologists.

methodsWe 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.

resultsFourty-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.

conclusionsEpileptogenic 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.

Indexed as

Focal cortical dysplasiaGliotic scarHippocampal sclerosisLimbic encephalitisLow grade epilepsy associated tumorNodular heterotopia

Identifiers

PMID34365971
PMCPMC8351149

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