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Higher signal-to-noise ratio and spatial resolution offered by ultra-high-field 7T MRI and surface-based graph-neural-network (GNN) analysis may improve detection of subtle cortical abnormalities. We evaluated whether combining 7T MRI with a surface-based GNN classifier improves lesion detection in focal epilepsy of suspected structural origin.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed paired 7T and 3T MRI datasets from 87 patients with focal epilepsy (78.1% pediatric) and 10 internal healthy control individuals. We processed T1-weighted and Fluid-Attenuated-Inversion-Recovery MRI using a surface-based framework and a pre-trained GNN classifier developed within the Multi-centre-Epilepsy-Lesion-Detection project. We compared classifier outputs with expert visual MRI assessment, clinical and surface electroencephalography (EEG) localization (all patients), stereo-EEG (ten patients) and histopathological (17 patients) findings. We evaluated diagnostic yield and lesion conspicuity, and performed within-subject comparisons between 7T and 3T.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Following quality controls, we included 70 patients. The 7T MRI-based classifier identified lesion clusters concordant with visual 3T MRI and electroclinical localization in 25\/37 (67.6%) MRI-positive patients, electroclinical-concordant clusters in 15\/33 (45.4%) 3T MRI-negatives, stereo-EEG-concordant clusters in 7\/10 (70.0%) patients and surgically-concordant clusters in 11\/17 (64.7%). Among classifier-positive patients (40\/70, 57.1%), 7T allowed detection of previously hidden lesions in 15\/40 (37.5%) patients, and improved detection of known lesions in 11\/40 (27.5%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Combining 7T MRI with surface-based GNN analysis improves detection and characterization of FCD-like abnormalities in focal epilepsy, particularly in patients with unrevealing 3T MRI, supporting the adoption of advanced neuroimaging in presurgical epilepsy assessment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00234-026-04103-8","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T07:41:37Z","timestamp":1783323697000},"page":"2241-2256","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Enhanced detection of subtle cortical abnormalities in focal epilepsy using 7\u2009T MRI surface-based models and graph neural networks"],"prefix":"10.1007","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2848-621X","authenticated-orcid":false,"given":"Matteo","family":"Lenge","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0933-6120","authenticated-orcid":false,"given":"Simona","family":"Fiori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8421-4799","authenticated-orcid":false,"given":"Pietro","family":"Cappelletto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Droghini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9350-7614","authenticated-orcid":false,"given":"Elisa","family":"Barbi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4993-0765","authenticated-orcid":false,"given":"Anna Maria","family":"Buccoliero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5325-0746","authenticated-orcid":false,"given":"Graziella","family":"Donatelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2515-7560","authenticated-orcid":false,"given":"Michela","family":"Tosetti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9006-9225","authenticated-orcid":false,"given":"Flavio","family":"Giordano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5445-5842","authenticated-orcid":false,"given":"Carmen","family":"Barba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7272-7079","authenticated-orcid":false,"given":"Renzo","family":"Guerrini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,6]]},"reference":[{"key":"4103_CR1","doi-asserted-by":"publisher","first-page":"1669","DOI":"10.1111\/epi.13200","volume":"56","author":"R Guerrini","year":"2015","unstructured":"Guerrini R, Duchowny M, Jayakar P et al (2015) Diagnostic methods and treatment options for focal cortical dysplasia. 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