MRI ‐negative epilepsy: A systematic review and meta‐analysis

作者：Ravnoor Gill, Francesco Deleo, Boris C. Bernhardt, Samuel Wiebe, Neda Bernasconi, Andrea Bernasconi · 发表于：Epilepsia · 年份：2025 · DOI：10.1111/epi.18616 · 被引用次数：12 · 研究领域：Epilepsy research and treatment、Glioma Diagnosis and Treatment、Advanced MRI Techniques and Applications

Abstract Objective Drug‐resistant focal epilepsy is commonly dichotomized based on magnetic resonance imaging (MRI) lesion visibility into positive (MRI‐pos) and negative (MRI‐neg). Yet, the criteria used to ascribe such categorization are variable. We used a systematic review and meta‐analysis to synthesize evidence for the designation of MRI‐neg status. Methods In accordance with Preferred Reporting Items for Systematic reviews and Meta‐Analyses (PRISMA) guidelines, the systematic review (1990–2025) across Embase, Cochrane, and Medline databases identified cohorts with MRI‐neg epilepsy. Unsupervised clustering stratified studies based on co‐occurrence of imaging modalities. Within identified classes, we assessed the consistency of reporting MRI parameters, rater expertise, post‐processing, and stereo–electroencephalography (SEEG). Meta‐analyses evaluated the effects of post‐processing on diagnostic yield and MRI‐neg status on post‐surgical outcome. Results We screened 2622 records and assessed the eligibility of 448 full‐text articles, 246 of which met the inclusion criteria for systematic review: 108 (44%) provided data only on MRI‐neg and 138 (56%) on mixed adult cohorts, for a total of 10.463 MRI‐neg and 7436 MRI‐pos patients. Compared to MRI‐pos, MRI‐neg patients underwent SEEG more frequently (75% vs 54%, p < 0.05), underwent surgery less frequently (73% vs 84%; odds ratio [OR] = 1.14, p < 0.001), and had less favorable outcomes (61% vs 72%, p < 0.05). Clustering ident...