Brain MRI - Seizure search pattern

Many times when patients have a history of seizures, they undergo a workup including a physical exam, detailed EEG analysis, and finally brain MRI to try to identify any potential structural causes of seizures. In this video, Dr. Michael Hoch walks us through his approach to a brain MRI to maximize your sensitivity for finding abnormalities.

The lecture is divided as follows:
00:00 - Introduction
01:53 - T1-MPRAGE Sagittal
03:43 - T1-MPRAGE Coronal
05:26 - T1-MPRAGE Axial
06:04 - FLAIR
07:39 - GRE
07:54 - Hippocampus
11:11 - Summary

Dr. Hoch suggests a 4-step approach using the mnemonic “3-2-1 go to the hippocampus”. In this way, he divides his search into more digestible parts.

“3” indicates the 3 planes that you have in a non-contrast T1 weighted MP-RAGE MRI. On this you should focus on the cortex, particularly at the 3 poles, the frontal, temporal, and occipital poles.

“2” indicates the 2 planes of FLAIR and 2 window settings you should use. You should review FLAIR images in both the coronal and axial planes. You should also use a window that is normal and a window that is narrow, or aggressive, to highlight lesions, particularly in the cortex, which are hard to see.

“1” indicates the single plane of blood sensitive imaging, either GRE or SWI, which can often see areas of prior hemorrhage or cavernous malformations.

“Go” to the hippocampus last to look for signs of mesial temporal sclerosis, which is manifested as a small hippocampus with loss of internal architecture and abnormal T2/FLAIR hyperintensity. This can be either from primary epilepsy or secondary to another lesion.

[asasa]

Excellent concise to the point . Well done thank you very much

[DFMagee]

I'm impressed - saw a few more nuances to be considered.

[immane]

Excellent as usual . Thank you very much .

[MegaBrolle]

Hey Michael, I am new to your channel. Based on your experience, what is a proper way to learn anatomy to master radiology. My guess Is: 3D anatomy, then cross sectional anatomy, then dissection? How is it taught in radiology school?

[quixotic]

Inspired by the comment on secondary hippocampal sclerosis being more common in the pediatric population: should the approach presented here be considered age specific (e.g. for adults)? Would certain age groups (infant, toddler, teen, elderly) reasonably merit variation in the search pattern?

[immane]

Excellent presentation . What do you think about 3D sequences ?is FLAIR 3D enough ? what about 3D T2 FSE ? is MPRAGE done in 2D or 3D ? Is T1 BRAVO from GE equivalent ?
Thank you very much for your response

[amirm]

Great
Do you have more lectures like this
How about c spine and T spine

[ashishmulavekar]

Very nice..excellent.. can it work on 1.5 T MRI?

[eltiarribero]

6:14😜we don't film anymore. I was under the impression that on Pacs Radiologists WL back and forth accordingly. 🤣Excellent video tho.

[nurjahan]

I got the results of my MRI and shows a 1cm CSF signal intensity lesion in the right temporal lobe...What means that?