MRI-quality and morphometric MRI analysis to identify focal cortical dysplasia: An exploratory study

•We investigated the impact of MRI scans with reduced signal-to-noise ratio (SNR) and spatial resolution (SR) on focal cortical cysplasia (FCD) detection with MRI post-processing analysis by MAP18, aiming to improve the chances of achieving seizure freedom through epilepsy surgery.•This study suggest that lower SR and SNR negatively affect FCD detection by MAP18.•Reducing SR and SNR led to distorted z-scores and volumes of FCDs. Reducing SR and SNR also negatively impacts the total number of clusters and the z-score and volume of these clusters.•After six steps of reducing SR, FCD was no longer detected by MAP18 (voxel size 2.8 × 2.8 × 2.8 mm³). When reducing SNR, FCD became undetectable by MAP18 after two steps.•The MAP18 evaluator should screen MRI quality before post-processing, particularly for scans with significant visual noise or voxel sizes of 2.8 × 2.8 × 2.8 mm³ and upwards. In the pre-surgical evaluation of people with focal epilepsy and a normal MRI, Morphometric Analysis Program v2018 (MAP18) aids in detecting visually inconspicuous focal cortical dysplasia (FCD). We investigated the impact of MRI scans with reduced signal-to-noise ratio (SNR) and spatial resolution (SR) on FCD detection by MAP18, aiming to improve the chances of achieving seizure freedom through epilepsy surgery. Thirty MRI scans with the identified lesion using MAP18 radiologically confirmed as FCD by a neuroradiologist, were retrospective analysed. SNR and SR were artificially reduced in ten steps, and their impact on MAP18 outcomes was assessed using multilevel analysis. There was a significant effect after reducing SR and SNR for z-score and volume of the FCD cluster, the total number of detected clusters, and volume of these clusters. After SNR reduction, there was also a significant effect for z-score of the total number of detected clusters. FCD became undetectable by MAP18 after six steps of SR reduction (voxel size 2.8 × 2.8 × 2.8 mm³) and after two steps of SNR reduction. This exploratory study suggests that reduced SR and SNR negatively affect FCD detection with MRI post-processing (MAP18). The MAP18 evaluator should screen MRI quality before post-processing, particularly for scans with significant visual noise or voxel sizes of 2.8 × 2.8 × 2.8 mm³ and upwards, as repeating a low-quality MRI scan is less burdensome than the adverse effects of continued seizures due to failure to detect FCD.