Lesson 1Importance of lesion location and cortical involvement for seizure focus localisationExplores how lesion location and cortical involvement influence seizure semiology and localisation, highlighting eloquent cortex, limbic structures, and network connectivity, and how radiologists can align imaging findings with clinical EEG data.
Frontal lobe lesions and seizure patternsTemporal lobe lesions and mesial structuresParietal and occipital cortical seizure correlatesInsular and opercular lesion presentationsLesion laterality and language or motor riskIntegrating MRI with EEG and clinical semiologyLesson 2Assessing enhancement patterns: minimal, patchy, ring, nodular—implications for tumour grade and nonneoplastic mimicsReviews cortical lesion enhancement patterns on post-contrast MRI, linking minimal, patchy, ring, and nodular enhancement to tumour grade, blood–brain barrier disruption, treatment effect, and key nonneoplastic mimics such as demyelination and infection.
Minimal or absent enhancement in low-grade lesionsPatchy and heterogeneous enhancement in neoplasmsRing enhancement: abscess, metastasis, demyelinationNodular and solid enhancement in higher grade tumoursTemporal evolution of enhancement after therapyPitfalls from vascular structures and leptomeningesLesson 3Role of restricted diffusion, perfusion imaging, and MR spectroscopy in grading and differential narrowingDetails how diffusion, perfusion, and MR spectroscopy refine lesion characterisation and grading, covering restricted diffusion patterns, rCBV thresholds, metabolic spectra, and how to integrate these advanced techniques into practical differential diagnosis.
Interpreting restricted diffusion in cortical lesionsPerfusion metrics and rCBV in tumour gradingSpectroscopy patterns in neoplasm and gliosisSpectroscopy in infection, abscess, and demyelinationCombining DWI, perfusion, and MRS for diagnosisTechnical pitfalls and artefacts in advanced imagingLesson 4When to suggest biopsy, surgical referral, EEG correlation, or interval MRI follow-upExplains how to translate MRI findings into management advice, outlining imaging and clinical features that warrant biopsy, surgical referral, EEG correlation, or short- versus long-interval follow-up, while considering patient age, symptoms, and comorbidities.
Imaging red flags that favour urgent biopsyFeatures suggesting neurosurgical referral for resectionWhen to recommend EEG correlation for seizure focusCriteria for short-interval MRI surveillanceWhen longer interval follow-up is appropriateCommunicating uncertainty and shared decision makingLesson 5Cortical–subcortical lesion differentials in adults with seizures: DNET, ganglioglioma, cortical dysplasia, low-grade glioma, abscess, metastasisOutlines cortical–subcortical lesion differentials in adults with seizures, focusing on DNET, ganglioglioma, focal cortical dysplasia, low-grade glioma, abscess, and metastasis, with key MRI signs that help narrow the diagnosis and guide further workup.
MRI features of DNET and bubbly cortical lesionsGanglioglioma: cyst, mural nodule, and calcificationFocal cortical dysplasia and transmantle signDistinguishing low-grade glioma from dysplasiaAbscess versus necrotic tumour in seizure patientsMetastasis patterns involving cortex and junctionLesson 6Reporting recommendations for solitary cortical lesions: findings to include, recommended further imaging, and urgencyProvides structured reporting guidance for solitary cortical lesions, specifying essential descriptors, suggested differentials, recommended additional imaging, and how to convey urgency, uncertainty, and follow-up needs to referring clinicians.
Key lesion descriptors to include in reportsStating leading and alternative differentialsRecommending additional MRI or CT sequencesWhen to suggest advanced imaging or PETCommunicating urgency and need for referralStandardised phrases to reduce ambiguityLesson 7MRI sequences and their diagnostic roles: T1, T2, FLAIR, DWI/ADC, T2*, susceptibility, and post-contrast T1Reviews core MRI sequences used in cortical lesion assessment, including T1, T2, FLAIR, DWI/ADC, susceptibility, and post-contrast T1, emphasising how each contributes unique information to lesion detection, characterisation, and seizure evaluation.
Role of T1-weighted imaging in lesion anatomyT2 and FLAIR for oedema and cortical signalDWI and ADC for cytotoxic versus vasogenic oedemaSusceptibility imaging for blood and calcificationPost-contrast T1 for enhancement assessmentOptimising protocols for epilepsy MRI studiesLesson 8Imaging features distinguishing low-grade versus high-grade gliomas: signal patterns, contrast enhancement, diffusion, and mass effectCompares MRI features of low- versus high-grade gliomas, including signal characteristics, enhancement, diffusion, perfusion, and mass effect, and explains how these findings correlate with histology, prognosis, and potential treatment planning.
Typical MRI appearance of low-grade gliomasHigh-grade glioma enhancement and necrosisDiffusion and perfusion differences by tumour gradePatterns of mass effect and midline shiftNonenhancing high-grade glioma pitfallsImaging clues to malignant transformation
