Identification of subtle epilepsy-causing focal cortical dysplasias (FCD) on MRI remains an outstanding challenge during presurgical assessment of patients. The Multi-centre Epilepsy Lesion Detection (MELD) project created an MRI lesion detection algorithm using a large, heterogenous cohort. The algorithm had a sensitivity of 67%, performing well on unseen test sites. Analysis of MRI lesions revealed distinct subgroups, with differing histopathological subtypes, imaging features and detection rates. Individual patient reports highlight a predicted lesion’s location, imaging features and their relative saliency to the classifier. This tool has the potential to improve presurgical lesion identification on MRI from patients with epileptogenic FCD.
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