Research in Brief: Hiding in Plain Sight – Commonly Missed MRI Findings in Patients with Drug-Resistant Epilepsy

Researchers Call for Closer Review of Brain MRIs in Complex Cases

Burlington, MA — A new study led by investigators at Lahey Hospital & Medical Center (LHMC) quantifies the most common mistakes or oversights made by specialists interpreting MRI brain scans in patients with a drug-resistant form of epilepsy, known as medically refractory epilepsy. The study, published in the American Journal of Neuroradiology, found that nearly 17 percent of patients had MRI reports with some form of discrepancy — either a missed diagnosis, a misinterpretation, or a finding that was overlooked entirely.

“Our study’s aim was to raise awareness of potential ‘blind spots’ in interpreting MRIs of patients with medically refractory epilepsy,” said Timo Krings, MD, PhD, chair of the Division of Neurointerventional Radiology and director of the Neurovascular Center at LHMC.

In this retrospective observational study, Krings and colleagues reviewed nearly 900 cases of patients with medically refractory epilepsy — a form of epilepsy that doesn’t respond to medication — who had brain MRIs and whose cases were discussed at weekly interdisciplinary epilepsy conferences at an academic medical center with a large epilepsy program between 2008 and 2023. (The patients were not seen at Lahey or other Beth Israel Lahey Health hospitals.)

The researchers found notable gaps in how some brain scans were originally interpreted, versus their ultimate diagnoses. In 11 percent of cases (95 patients), a key diagnosis was missed, and in another five percent, a second brain abnormality was present but overlooked. Many of the missed findings were hard-to-detect differences in brain structure that may play a critical role in triggering seizures. Overall, 148 brain scan reports, or just under 17 percent, contained important differences between the first and final interpretations, pointing to the need for careful, team-based review to improve the accuracy of epilepsy diagnoses.

Krings, who is also professor of radiology at UMass Chan-Lahey, emphasizes that interpreting brain MRIs in patients with complex epilepsy isn’t just about looking at images; it requires collaborative discussion among radiologists, neurologists, and epilepsy specialists, and taking clinical findings, seizure history, and EEG results into consideration.

By identifying which diagnoses are most frequently missed, the team hopes to improve initial MRI interpretation accuracy, thereby reducing delays in appropriate treatment, including surgery, for patients who need it.

“We hope this work helps neuroradiologists know what to look for — and look again — when reviewing scans of patients with medically refractory epilepsy,” Krings said.

Co-authors included Aoife M. Haughey and Nadav Gasner of the Division of Neuroradiology, Joint Department of Medical Imaging, University Health Network and Toronto Western Hospital, Department of Medical Imaging, University of Toronto.

About Lahey Hospital & Medical Center

Lahey Hospital & Medical Center (LHMC) is a world-renowned tertiary academic medical center known for its innovative technology, pioneering medical treatments and leading-edge research. As a physician-led hospital, LHMC offers a legacy of care and education committed to putting the patient at the center through a multidisciplinary, collaborative and team-based approach. LHMC’s research efforts and clinical trials cross numerous medical disciplines, providing patients with access to the latest options in treatment and care.

LHMC is a part of Beth Israel Lahey Health, a health care system that brings together academic medical centers and teaching hospitals, community and specialty hospitals, more than 4,700 physicians and 39,000 employees in a shared mission to expand access to great care and advance the science and practice of medicine through groundbreaking research and education.