OBJECTIVES: Approximately one-third of candidates for epilepsy surgery have no visible abnormalities on conventional magnetic resonance imaging. This is extremely discouraging, as these patients have a less favorable prognosis. We aimed to evaluate the utility of quantitative magnetic resonance imaging in patients with drug-resistant neocortical focal epilepsy and negative imaging. METHODS: A prospective study including 46 patients evaluated through individualized postprocessing of five quantitative measures: cortical thickness, white and gray matter junction signal, relaxation rate, magnetization transfer ratio, and mean diffusivity. Scalp video-electroencephalography was used to suggest the epileptogenic zone. A volumetric fluid-attenuated inversion recovery sequence was performed to aid visual inspection. A critical assessment of follow-up was also conducted throughout the study. RESULTS: In the subgroup classified as having an epileptogenic zone, individualized postprocessing detected abnormalities within the region of electroclinical origin in 9.7% to 31.0% of patients. Abnormalities outside the epileptogenic zone were more frequent, up to 51.7%. In five patients initially included with negative imaging, an epileptogenic structural abnormality was identified when a new visual magnetic resonance imaging inspection was guided by information gleaned from postprocessing. In three patients, epileptogenic lesions were detected after visual evaluation with volumetric fluid-attenuated sequence guided by video electroencephalography. CONCLUSION: Although quantitative magnetic resonance imaging analyses may suggest hidden structural lesions, caution is warranted because of the apparent low specificity of these findings for the epileptogenic zone. Conversely, these methods can be used to prevent visible lesions from being ignored, even in referral centers. In parallel, we need to highlight the positive contribution of the volumetric fluid-attenuated sequence.

Abstract Introduction Multiple Sclerosis (MS) is a neurodegenerative disease characterized by inflammatory demyelination in the central nervous system. Quantitative Magnetic Resonance Imaging (qMRI) enables a detailed characterization of brain tissue, but generates a large number of numerical results. In this study, we elucidated the main qMRI techniques and the brain regions that allow the identification of MS patients from neuroimaging data and pattern recognition techniques. Methods The data came from the combination of computational tools of image processing and neuroimaging acquired in a 3 Tesla scanner using different techniques: Diffusion, T2 Relaxometry, Magnetization Transfer Ratio (MTR) and Structural Morphometry. Data from 126 brain regions of 203 healthy individuals and 124 MS patients were separated into two groups and processed in a data-mining program using the k-nearest-neighbor (KNN) algorithm. Results The most relevant anatomical structures in the classification procedure were: corpus callosum, precuneus, left cerebellum and fusiform. Among the quantitative techniques the most relevant was the MTR, being indicated for longitudinal studies of this disease. KNN with 5 neighbors and pre-selected attributes had a better performance with an area under the ROC curve (97.3%) and accuracy (95.7%). A restricted classification considering only brain regions previously reported in the literature as affected by MS brought slightly lower scores, area: 97.1% and accuracy: 93.2%. Conclusion The use of standard recognition techniques from quantitative neuroimaging techniques has confirmed that the white matter of the brain is the most affected tissue by MS following a global pattern with greater involvement of the left hemisphere.