title: Refractory epilepsy: comparison of MR imaging, CT, and histopathologic findings in 117 patients.
abstract: OBJECTIVE
  We compared computed tomography (CT) and magnetic resonance (MR) imaging for the detection of abnormalities underlying epilepsy.
  
  
  METHODS
  CT and MR imaging findings in 117 patients (56 female, 61 male patients; age at surgery, 12-56 years) who underwent surgery for medically refractory epilepsy were compared with histopathologic findings by using the McNemar and chi 2 statistics.
  
  
  RESULTS
  Sensitivities for detecting abnormalities were 95% (104 of 109) for MR imaging and 32% (35 of 109) for CT; specificities were 87% (13 of 15) for MR imaging and 93% (14 of 15) for CT (P < .001 for MR versus histopathologic findings). In the subgroup of 113 patients with solitary findings, MR imaging depicted an abnormality at the surgical site in 86% (n = 97) of 113 patients compared to 28% (n = 32) for CT (P < .001). In this same subgroup, histopathologic findings were predicted by using MR imaging in 88% (n = 99) of 113 patients versus 35% (n = 40) with CT (P < .001). Multiple findings were observed in 3% of CT (three of 117) and 17% of MR (20 of 117) images.
  
  
  CONCLUSIONS
  CT has no role in the diagnostic evaluation of medically refractory epilepsy. Even in patients with medically controlled epilepsy, use of less costly CT instead of MR imaging seems imprudent.
authors.affiliation: Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT 06510, USA.
authors.forename: R A
authors.initials: RA
authors.lastname: Bronen
authors.forename: R K
authors.initials: RK
authors.lastname: Fulbright
authors.forename: D D
authors.initials: DD
authors.lastname: Spencer
authors.forename: S S
authors.initials: SS
authors.lastname: Spencer
authors.forename: J H
authors.initials: JH
authors.lastname: Kim
authors.forename: R C
authors.initials: RC
authors.lastname: Lange
authors.forename: C
authors.initials: C
authors.lastname: Sutilla
mesh_terms: D000293:Adolescent; D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D016022:Case-Control Studies; D002648:Child; D004828:Epilepsies, Partial / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed