MR imaging is the imaging modality of choice in epilepsy for detecting structural brain abnormalities, particularly those being considered for surgery. A dedicated epilepsy protocol typically includes high-resolution 3 dimensional (3D) T1-weighted imaging (eg, magnetization prepared rapid acquisition gradient echo) and 3D T2 fluid-attenuation inversion recovery (FLAIR) of the whole brain for anatomic detail and characterization of suspected malformations of cortical development including subtle focal cortical dysplasias. Coronal T2-weighted and/or T2/FLAIR sequences perpendicular to the hippocampus are critical for assessing the architecture of the hippocampus and evaluating for mesial temporal sclerosis and other temporal lobe pathologies.
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