Bilateral mesial temporal sclerosis: MRI with high-resolution fast spin-echo and fluid-attenuated inversion-recovery sequences

Oppenheim, Catherine; Dormont, Didier; Hasboun, Dominique; Bazin, B.; Samson, Séverine; Lehericy, Stéphane; Baulac, Michel; Marsault, C.

doi:10.1007/s002340050786

Cited by 13 publications

(5 citation statements)

References 42 publications

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“…Most patients present with complex partial seizure. Bilateral involvement is seen in 10% [7]. Classic MRI findings include volume loss and an abnormal increased T 2 and FLAIR signal of the hippocampus as a result of underlying gliosis (Figure 4a) and the subsequent increase in free water content.…”

Section: Epilepsy Syndromementioning

confidence: 99%

Clinico-radiological spectrum of bilateral temporal lobe hyperintensity: a retrospective review

Sureka¹,

Jakkani²

2012

BJR

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ABSTRACT. Bilateral temporal lobe hyperintensity (BTH) is a commonly encountered MRI finding in a wide spectrum of clinical conditions and often poses a diagnostic challenge to the radiologist. The purpose of this paper is to elucidate several diseases that manifest as BTH on MRI, based on a retrospective review of cranial MRI of 65 cases seen in our institution between October 2007 and September 2010. We found BTH in different clinical scenarios that included infective diseases (herpes simplex virus, congenital cytomegalovirus infection), epileptic syndrome (mesial temporal sclerosis), neurodegenerative disorders (Alzheimer's disease, frontotemporal dementia, Type 1 myotonic dystrophy), neoplastic conditions (gliomatosis cerebri), metabolic disorders (mitochondrial encephalopathy, lactic acidosis and stroke-like episodes, Wilson's disease, hyperammonemia), dysmyelinating disease (megalencephalic leukoencephalopathy with subcortical cysts), and vascular (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) and paraneoplastic (limbic encephalitis) disorders. The conventional MRI findings with advanced MRI such as diffusion-weighted imaging, susceptibility-weighted imaging and MR spectroscopy along with laboratory results are potentially helpful in distinguishing the different clinical conditions and thus affect the early diagnosis and clinical outcome. MRI is the most sensitive imaging technique to depict brain lesions as altered signal intensities. Most of the lesions are demonstrated as hyperintensities on T 2 weighted and fluid-attenuated inversion-recovery (FLAIR) MR images, and the signal intensity itself is non-specific. Characteristic distribution of lesions and associated imaging findings, however, can suggest the diagnosis or narrow the differential diagnosis. Bilateral temporal lobe hyperintensity (BTH) is a commonly observed finding on MRI in different neurological disorders. We considered BTH as increased signal intensity on T 2 weighted or FLAIR MR images involving the grey or white matter or both. Compared with fast spin-echo T 2 weighted sequence, FLAIR has greater sensitivity for detection of BTH because of suppression of the cerebrospinal fluid (CSF) signal with preservation of T 2 characteristics [1]. Several neurological disorders have a distinctive propensity to involve the temporal lobes. The spectrum includes infective, epileptic syndrome, neurodegenerative, neoplastic, metabolic, dysmyelinating, vascular and paraneoplastic disorders. Associated MRI features like gyral haemorrhages, hippocampal, mamillary body and forniceal atrophy, basal ganglia (BG) hyperintensity, temporal lobe cysts, pachygyria-agyria complex and lacunar infarcts help in narrowing the differential diagnosis. Advanced MRI including diffusion-weighted imaging (DWI), susceptibility-weighted imaging (SWI) and MR spectroscopy (MRS) have an added value. Knowledge of key MRI features in the appropriate clinical setting and lab parameters can help to reach the definitive diagnosis. We retro...

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Section: Epilepsy Syndromementioning

confidence: 99%

Clinico-radiological spectrum of bilateral temporal lobe hyperintensity: a retrospective review

Sureka¹,

Jakkani²

2012

BJR

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“…We retrospectively reviewed 27 FP lesions (for both readers) and found that most (77.8%) showed loss of internal structure in a single slice but were normal in successive slices, which diminished the specificity for TLE. Since additional findings, including atrophy, T2 signal intensity abnormalities, and loss of digitations of the hippocampal head, are frequently detected in hippocampal sclerosis [ 29 30 ], a single finding of loss of internal structure in a single slice should be cautiously interpreted.…”

Section: Discussionmentioning

confidence: 99%

Improving Diagnostic Performance of MRI for Temporal Lobe Epilepsy With Deep Learning-Based Image Reconstruction in Patients With Suspected Focal Epilepsy

Suh,

Park,

Roh

et al. 2024

Korean J Radiol

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Objective To evaluate the diagnostic performance and image quality of 1.5-mm slice thickness MRI with deep learning-based image reconstruction (1.5-mm MRI + DLR) compared to routine 3-mm slice thickness MRI (routine MRI) and 1.5-mm slice thickness MRI without DLR (1.5-mm MRI without DLR) for evaluating temporal lobe epilepsy (TLE). Materials and Methods This retrospective study included 117 MR image sets comprising 1.5-mm MRI + DLR, 1.5-mm MRI without DLR, and routine MRI from 117 consecutive patients (mean age, 41 years; 61 female; 34 patients with TLE and 83 without TLE). Two neuroradiologists evaluated the presence of hippocampal or temporal lobe lesions, volume loss, signal abnormalities, loss of internal structure of the hippocampus, and lesion conspicuity in the temporal lobe. Reference standards for TLE were independently constructed by neurologists using clinical and radiological findings. Subjective image quality, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were analyzed. Performance in diagnosing TLE, lesion findings, and image quality were compared among the three protocols. Results The pooled sensitivity of 1.5-mm MRI + DLR (91.2%) for diagnosing TLE was higher than that of routine MRI (72.1%, P < 0.001). In the subgroup analysis, 1.5-mm MRI + DLR showed higher sensitivity for hippocampal lesions than routine MRI (92.7% vs. 75.0%, P = 0.001), with improved depiction of hippocampal T2 high signal intensity change ( P = 0.016) and loss of internal structure ( P < 0.001). However, the pooled specificity of 1.5-mm MRI + DLR (76.5%) was lower than that of routine MRI (89.2%, P = 0.004). Compared with 1.5-mm MRI without DLR, 1.5-mm MRI + DLR resulted in significantly improved pooled accuracy (91.2% vs. 73.1%, P = 0.010), image quality, SNR, and CNR (all, P < 0.001). Conclusion The use of 1.5-mm MRI + DLR enhanced the performance of MRI in diagnosing TLE, particularly in hippocampal evaluation, because of improved depiction of hippocampal abnormalities and enhanced image quality.

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“…In these instances, other regions of archicortex, such as paralimbic cortex or insula, should serve as internal reference. Identification of bilateral pathology will have important treatment consequences, for example, bilateral MTS may preclude surgical resection in many cases 38,39 …”

Section: Hippocampal Digitationsmentioning

confidence: 99%

Anatomical Variations, Mimics, and Pitfalls in Imaging of Patients with Epilepsy

Hassankhani

Stein

Haboosheh³

et al. 2020

Journal of Neuroimaging

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Epilepsy is among one of the most common neurologic disorders. The role of magnetic resonance imaging (MRI) in the diagnosis and management of patients with epilepsy is well established, and most patients with epilepsy are likely to undergo at least one or more MRI examinations in the course of their disease. Recent advances in high‐field MRI have enabled high resolution in vivo visualization of small and intricate anatomic structures that are of great importance in the assessment of seizure disorders. Familiarity with normal anatomic variations is essential in the accurate diagnosis and image interpretation, as these variations may be mistaken for epileptogenic foci, leading to unnecessary follow‐up imaging, or worse, unnecessary treatment. After a brief overview of normal imaging anatomy of the mesial temporal lobe, this article will review a few important common and uncommon anatomic variations, mimics, and pitfalls that may be encountered in the imaging evaluation of patients with epilepsy.

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Bilateral mesial temporal sclerosis: MRI with high-resolution fast spin-echo and fluid-attenuated inversion-recovery sequences

Cited by 13 publications

References 42 publications

Clinico-radiological spectrum of bilateral temporal lobe hyperintensity: a retrospective review

Clinico-radiological spectrum of bilateral temporal lobe hyperintensity: a retrospective review

Improving Diagnostic Performance of MRI for Temporal Lobe Epilepsy With Deep Learning-Based Image Reconstruction in Patients With Suspected Focal Epilepsy

Anatomical Variations, Mimics, and Pitfalls in Imaging of Patients with Epilepsy

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