Epilepsy

In pharmaco-resistant epilepsy, surgical intervention offers a 50%–60% chance of postoperative seizure freedom but requires precise delineation of epileptogenic lesions. As at least one-third of focal epileptogenic lesions are not detected on 1.5T and 3T systems, 7T has been investigated as a promising candidate for the identification of MRI-negative cases with undiscovered epileptogenic zones. As confirmed by the current body of studies, mainly higher resolution and increased T2⁎ contrast of 7T can be used to identify new lesions in previously MR-negative cases. Still, the existing studies lack the integrated view and comparability for a clear definition of 7T benefits. A new consensus protocol has been proposed to address these issues. Furthermore, advanced MRI modalities could add information about metabolism (MRSI, CEST, X-nuclei) and functional connectivity (fMRI) but remain in the initial stages of research. Nevertheless, 7T has the potential to improve treatment outcomes in the most difficult cases of epilepsy.