This has been true, in part, because even when enlarged, these spaces frequently remain below the threshold of in vivo detectability using MRI. PVSs have been reported in previous investigations of epilepsy however, the relationship between a patient’s epilepsy and the presence of enlarged PVSs remains uncertain 20– 23. Historically, PVSs have been visible on MRI only when grossly enlarged by diseases or disorders 19. Alteration in PVSs structure and appearance on high resolution MRI exams and may provide biomarkers for the altered macrophage activity associated with seizure onset 18. Recent experiments indicate the involvement of PVSs in the recruitment of macrophages across the blood brain barrier 16, 17. The brain lacks conventional lymphatic vessels and a growing body of research suggests that PVSs play an important role in a waste clearance, or glymphatic (glial + lymphatic), system 11– 15. Perivascular spaces (PVSs), also known as Virchow-Robin spaces 9, are small cerebrospinal fluid-filled areas between blood vessels and the pia mater, and can be visualized using high resolution T 2-weighted MRI sequences 10. Subtle MRI features, now visible at ultra-high fields, may prove to be non-invasive biomarkers towards localizing and confirming the suspected SOZ, even when the features are not directly related to the epileptogenic focus.
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There is increasing evidence that epilepsy is a complex network disease affecting brain functioning interictally and altering brain structure beyond the primary suspected seizure onset zone (SOZ) 4– 8. The increased strength of the main magnetic field in 7T MRI generates a greater signal to noise ratio (SNR), which may be parlayed into enhanced conspicuity of abnormal structural features in epilepsy including those beyond the epileptogenic focus.
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Positive identification of a lesion of epileptogenic potential on an MRI exam is an important component of determining the most promising treatment options for refractory epilepsy. Ultra-high field magnetic resonance imaging (MRI) scanners, such as those operating at 7 Tesla (7T), enable the visualization of the brain with very high resolution and contrast 1– 3.