Lesson 1Structured reporting for seizure MRI: targeted descriptions, differential prioritisation, and suggested next imaging or EEG correlationThis section explains how to build structured seizure MRI reports, emphasising targeted lesion description, clear localisation, differential prioritisation, and explicit recommendations for further imaging, EEG correlation, and multidisciplinary discussion in practice.
Standardised report templates and headingsDescribing lesion location and extent clearlyPrioritising differential diagnoses by likelihoodStating limitations and motion or artefact issuesRecommending follow-up imaging or protocolsLinking imaging findings with EEG and clinical dataLesson 2Vascular and infectious/inflammatory causes of seizures visible on MRI and red flags requiring urgent neurovascular or infectious work-upThis section reviews vascular, infectious, and inflammatory seizure aetiologies on MRI, enabling learners to recognise key patterns, identify imaging red flags, and know when urgent neurovascular or infectious work-up and multidisciplinary consultation are required.
Arterial ischaemic stroke and seizure correlationCerebral venous thrombosis and haemorrhagic lesionsVasculitis patterns on vessel wall and parenchymaEncephalitis: limbic and diffuse involvementNeurocysticercosis and other parasitic infectionsImaging red flags requiring urgent escalationLesson 3Mesial temporal sclerosis imaging: hippocampal volume loss, increased T2/FLAIR signal, internal architecture loss, and asymmetry assessmentThis section focuses on mesial temporal sclerosis imaging criteria, covering hippocampal volume loss, increased T2/FLAIR signal, internal architecture disruption, asymmetry assessment, and common mimics that can confound confident diagnosis in epilepsy evaluation.
Hippocampal volumetry and qualitative atrophyT2 and FLAIR hyperintensity patternsLoss of internal hippocampal architectureAssessing asymmetry across coronal planesDifferentiating MTS from normal variantsMTS associations with dual pathologyLesson 4Systematic cortical and hippocampal inspection techniques: symmetry checks, cortical thickness, cortical/subcortical signal changesThis section teaches a stepwise visual routine for cortical and hippocampal review, with emphasis on symmetry, cortical thickness, grey–white junction, and subtle signal changes that may indicate focal cortical dysplasia or mesial temporal pathology.
Establishing a consistent inspection workflowAssessing hemispheric and lobar symmetryEvaluating cortical thickness and gyral patternsGrey–white junction and subcortical signal changesFocused hippocampal head, body, tail reviewCommon pitfalls and normal anatomic variantsLesson 5Optimised MRI protocols for first seizure evaluation and when to add high-resolution seizure protocolsThis section covers practical MRI protocol design for first seizure evaluation, addressing minimum core sequences, when to extend with high-resolution epilepsy protocols, and how to adapt parameters to patient age, clinical suspicion, and scanner constraints.
Essential sequences for initial seizure MRISlice orientation and coverage optimisationWhen to add high-resolution temporal lobe imaging3D T1 and 3D FLAIR for cortical lesion detectionProtocol adjustments in paediatric patientsBalancing scan time, motion risk, and image qualityLesson 6Imaging features of low-grade gliomas on MRI: T1/T2/FLAIR appearances, contrast behaviour, DWI/ADC characteristics, perfusion and spectroscopy correlatesThis section details MRI appearances of low-grade gliomas relevant to seizures, reviewing T1, T2, and FLAIR signal, contrast enhancement patterns, DWI/ADC behaviour, and how perfusion and MR spectroscopy help grade lesions and guide surgical planning.
Typical T1 and T2 signal characteristicsFLAIR hyperintensity and lesion marginsContrast enhancement patterns and absenceDWI and ADC in low cellularity tumoursPerfusion metrics and relative cerebral blood volumeMR spectroscopy metabolic signatures in gliomasLesson 7Sequence-by-sequence approach to interpretation: what to evaluate on localisers, T1, T2, FLAIR, DWI/ADC, SWI/GRE, and post-contrast T1This section teaches a structured, sequence-by-sequence reading strategy, enabling learners to know what to check on localisers, T1, T2, FLAIR, DWI/ADC, GRE/SWI, and post-contrast T1, minimising missed lesions and improving reproducible seizure MRI interpretation.
Using localisers for orientation and coverageSystematic review on T1-weighted imagesOedema and gliosis assessment on T2 and FLAIRAcute and subacute changes on DWI and ADCMicrobleeds and calcifications on GRE and SWIEnhancement patterns on post-contrast T1Lesson 8Core brain MRI sequences and their biophysical bases: T1, T2, FLAIR, DWI/ADC, GRE/SWI, and post-contrast T1This section explains core brain MRI sequences used in seizure imaging and their biophysical bases, linking tissue properties to T1, T2, FLAIR, DWI/ADC, GRE/SWI, and post-contrast T1 appearances, emphasising how each sequence contributes unique diagnostic value.
T1-weighted contrast and tissue relaxationT2-weighted imaging and fluid sensitivityFLAIR suppression and periventricular lesionsDWI and ADC: diffusion and cytotoxic oedemaGRE and SWI for blood and mineral detectionPost-contrast T1 and blood–brain barrier integrityLesson 9Recognising focal cortical dysplasia: MRI signs (cortical thickening, blurring of grey-white junction, transmantle sign) and recommended high-resolution sequencesThis section reviews MRI signs of focal cortical dysplasia and optimal sequences for detection, highlighting cortical thickening, grey–white blurring, transmantle sign, and the role of high-resolution 3D T1 and FLAIR in pre-surgical evaluation for epilepsy.
Cortical thickening and abnormal gyral patternsGrey–white junction blurring on 3D sequencesTransmantle sign and radial band appearanceBest planes for detecting subtle FCD lesionsHigh-resolution 3D T1 and 3D FLAIR protocolsDifferentiating FCD from polymicrogyria and scars
