Why does an epilepsy protocol differ from a routine brain?

It targets the hippocampus with thin, high-resolution coronal sequences angled perpendicular to the temporal lobe, plus a volumetric T1. A routine axial stack lacks the resolution and angulation to show mesial temporal sclerosis reliably.

How are the coronal slices angled for epilepsy imaging?

Perpendicular to the long axis of the hippocampus — in practice, parallel to the brainstem on the sagittal — so each slice cuts the hippocampus in true cross-section.

Why is head symmetry so important here?

The diagnosis often rests on comparing the two hippocampi. A rolled or tilted head makes one side look brighter or larger than the other, mimicking or masking pathology.

Resources/Protocols

Seizure / epilepsy

A routine brain will miss the subtle target of epilepsy imaging. This protocol is built around the hippocampus — high-resolution, angled specifically to the temporal lobe — to find mesial temporal sclerosis and small cortical lesions.

Protocols/Brain

When this study is used

New-onset or refractory seizures.
Pre-surgical evaluation for epilepsy.
Suspected mesial temporal sclerosis or focal cortical dysplasia.

Patient & coil positioning

Head-first supine in a head coil; straight, no roll — asymmetry ruins the side-to-side hippocampal comparison this exam depends on.
Chin slightly tucked, centred on the glabella.
Immobilise firmly; the thin high-resolution sequences are very motion-sensitive.

Localizer

Three-plane localizer, plus a routine brain survey (DWI, FLAIR, T2, T1) as the backbone. The dedicated coronal-oblique sequences are then angled to the hippocampi on the sagittal.

Sequence planning

Each sequence below lists how the slice group is positioned — the reference line it follows, its coverage, and why it earns its place in the protocol. Plan against the localizer, not by eye.

Coronal oblique T2 (thin)

Coronal oblique

Planning — Angle perpendicular to the long axis of the hippocampus (parallel to the brainstem) on the sagittal. Thin 2–3 mm slices, no gap, through the whole temporal lobe.

Why — Hippocampal signal and internal architecture — the core of mesial temporal sclerosis detection.

Coronal oblique FLAIR (thin)

Coronal oblique

Planning — Same angulation and coverage as the coronal T2.

Why — Bright hippocampal signal and cortical/subcortical lesions against nulled CSF.

Volumetric 3D T1 (MPRAGE)

3D / reformatted

Planning — Whole-brain isotropic acquisition; reformat along the hippocampal axis.

Why — Hippocampal volume asymmetry and subtle cortical dysplasia; morphometry.

Axial DWI + FLAIR

Axial

Planning — Routine AC–PC angulation.

Why — Excludes acute causes and completes the survey.

Representative parameters

Ranges, not commandments — field strength, coil and vendor move the numbers. What must not move is understanding why each sits where it does.

Sequence	Slice / gap	Matrix	Notes
Coronal T2 (thin)	2–3 mm / 0%	384+	Perpendicular to hippocampi
Coronal FLAIR (thin)	2–3 mm / 0%	320+	TI nulls CSF
3D T1 MPRAGE	1 mm isotropic	256+	Volumetry, reformats
DWI (EPI)	4–5 mm	128–192	Rule out acute cause

Artifacts & how to fix them

Artifact	Typical cause	Mitigation
Asymmetric hippocampi	Rolled or tilted head	Reposition straight before scanning, not by angling alone
Partial volume on hippocampus	Slices too thick or off-axis	Thin slices, angled perpendicular to the hippocampal axis
Motion blur	Long thin-slice sequences	Firm immobilisation; parallel imaging to shorten
CSF flow on FLAIR	Temporal-horn pulsation	Flow compensation; verify against T2

What am I looking at?

You are not reporting the study, but recognising pathology helps you keep it in the field of view and know when to add a sequence or contrast. How the common findings read on the console:

Finding	Sequence to check	How it reads
Mesial temporal sclerosis	Coronal T2/FLAIR	Small, bright hippocampus with lost internal architecture
Focal cortical dysplasia	3D FLAIR / T1	Blurred grey–white junction, thickened cortex, 'transmantle' sign
Hippocampal volume loss	3D T1 reformats	Asymmetric size on side-by-side coronal reformats

Review checklist

Head straight — hippocampi genuinely comparable left to right.
Coronal obliques angled perpendicular to the hippocampal axis.
Thin slices with no gap through both temporal lobes.
Volumetric T1 acquired for reformatting and morphometry.

Mistakes that cost repeats

Running only a routine brain and missing subtle mesial temporal sclerosis.
A rolled head making one hippocampus look abnormally bright.
Slices too thick to resolve hippocampal architecture.
Skipping the volumetric T1 that quantifies asymmetry.

Common questions

Why does an epilepsy protocol differ from a routine brain?: It targets the hippocampus with thin, high-resolution coronal sequences angled perpendicular to the temporal lobe, plus a volumetric T1. A routine axial stack lacks the resolution and angulation to show mesial temporal sclerosis reliably.
How are the coronal slices angled for epilepsy imaging?: Perpendicular to the long axis of the hippocampus — in practice, parallel to the brainstem on the sagittal — so each slice cuts the hippocampus in true cross-section.
Why is head symmetry so important here?: The diagnosis often rests on comparing the two hippocampi. A rolled or tilted head makes one side look brighter or larger than the other, mimicking or masking pathology.

Try it in ScanFlo: Angle a coronal stack perpendicular to the hippocampal axis, then repeat it with a straight coronal, and compare how the hippocampus is cut. Only the angled view shows it in true cross-section — the difference decides whether sclerosis is visible.

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