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Summary   Objective  The aim of this study is to determine whether the use of 7 tesla (T)  MRI  in clinical practice leads to higher detection rates of focal cortical dysplasias in possible candidates for epilepsy surgery.    Methods  In our center patients are referred for 7 T  MRI  if lesional focal epilepsy is suspected, but no abnormalities are detected at one or more previous, sufficient‐quality lower‐field  MRI  scans, acquired with a dedicated epilepsy protocol, or when concealed pathology is suspected in combination with  MR ‐visible mesiotemporal sclerosis—dual pathology. We assessed 40 epilepsy patients who underwent 7 T  MRI  for presurgical evaluation and whose scans (both 7 T and lower field) were discussed during multidisciplinary epilepsy surgery meetings that included a dedicated epilepsy neuroradiologist. We compared the conclusions of the multidisciplinary visual assessments of 7 T and lower‐field  MRI  scans.    Results  In our series of 40 patients, multidisciplinary evaluation of 7  T MRI  identified additional lesions not seen on lower‐field  MRI  in 9 patients (23%). These findings were guiding in surgical planning. So far, 6 patients underwent surgery, with histological confirmation of focal cortical dysplasia or mild malformation of cortical development.    Significance  Seven T  MRI  improves detection of subtle focal cortical dysplasia and mild malformations of cortical development in patients with intractable epilepsy and may therefore contribute to identification of surgical candidates and complete resection of the epileptogenic lesion, and thus to postoperative seizure freedom.

Seven tesla MRI improves detection of focal cortical dysplasia in patients with refractory focal epilepsy