Neuroimaging investigations are fundamental in the diagnosis of patients with epilepsy. The International League Against Epilepsy (ILAE) harmonized neuroimaging of epilepsy structural sequences (HARNESS-MRI) protocol was intended as a generalizable structural MRI protocol. The European Reference Network for Rare and Complex Epilepsies, EpiCARE, includes 50 centers, across 26 countries, with expertise in epilepsy. We investigated adherence to the HARNESS-MRI protocol across EpiCARE. A survey on the clinical use of imaging and postprocessing methods in epilepsy patients was distributed among the centers. A descriptive analysis was performed, and results were compared to existing guidelines, as well as a previous survey in 2016. 79% of centers were adhering to the HARNESS-MRI protocol in all epilepsy patients. All centers were acquiring 3D T1-weighted sequences, 90% were acquiring 3D FLAIR and 87% were acquiring high in-plane 2D coronal T2 MRI sequences in all epilepsy patients. In comparison, in 2016, only 50% of centers were following MRI recommendations at the time. Across European expert epilepsy centers, there has been increased harmonization of MRI sequences since the introduction of the HARNESS-MRI protocol. This standardization supports optimal radiological review at individual centers as well as enabling harmonization of multicenter datasets for research. PLAIN LANGUAGE SUMMARY: Neuroimaging investigations are a fundamental component of epilepsy diagnosis. The International League Against Epilepsy (ILAE) has created guidelines about what MRI images to obtain in all epilepsy patients. In this study, we assessed the adherence of expert European epilepsy centers to these guidelines and found that 79% are acquiring the minimum set of MRI scans in all epilepsy patients. Standardization of MRI imaging serves to improve epilepsy diagnosis across Europe.

Collaborating Partner of the ERN EpiCARE Great Ormond Street Hospital London UK

Department of Neurology 2nd Faculty of Medicine and Motol University Hospital Member of the ERN EpiCARE Charles University Prague Czech Republic

Department of Radiology 2nd Faculty of Medicine and Motol University Hospital Member of the ERN EpiCARE Charles University Prague Czech Republic

Epilepsy Unit Child Neurology Department Hospital San Juan de Dios Member of the ERN EpiCARE Barcelona Spain

UCL Great Ormond Street Institute of Child Health London UK

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