Detection of hippocampal pathology in intractable partial epilepsy

Jackson, Graeme D.; Connelly, Alan; Duncan, John S.; Grünewald, R. A.; Gadian, David G.

doi:10.1212/wnl.43.9.1793

Cited by 300 publications

(198 citation statements)

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“…Thirteen of the 25 patients and 11 healthy controls (2 females and 8 males; age range, 23-56 years) had hippocampal T2 measured using a procedure similar to that reported by Jackson and co-workers [21] and Grunewald and associates [22]. A multi-spin echo sequence (16 echoes) with TR 2,000 msec and TE 22.5, 45 ⋯ 360 msec from an 8-mm-thick slice of the anterior hippocampus was performed.…”

Section: T2 Relaxometrymentioning

confidence: 97%

Presurgical multimodality neuroimaging in electroencephalographic lateralized temporal lobe epilepsy

Knowlton

Laxer

Ende

et al. 1997

Annals of Neurology

127

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The purpose of this study was to compare 2-[ 18 F]fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET), hippocampal volumetry (HV), T2 relaxometry, and proton magnetic resonance spectroscopic imaging ( 1 H-MRSI) in the presurgical neuroimaging lateralization of patients with nonlesional, electroencephalogram (EEG)-defined unilateral temporal lobe epilepsy (TLE). Twenty-five patients were prospectively studied, along with age-matched controls. T2 relaxometry examinations were performed in 13 patients. Comparison of FDG-PET, HV, and 1 H-MRSI was possible in 23 patients. FDG-PET lateralized 87% of patients, HV 65%, N-acetyl aspartate (NAA)/(choline [Cho] + creatine [Cr]) 61%, and [NAA] 57%. Combined HV and NAA/(Cho + Cr) results lateralized 83% of the patients, a value similar to PET. Of 10 patients with normal magnetic resonance imaging (MRI) scans, 2 were lateralized with HV, 6 with FDG-PET, 4 with NAA/(Cho + Cr), and 3 with [NAA]. T2 relaxometry lateralized no patients without hippocampal atrophy. Bilateral abnormality was present in 29 to 33% of patients with 1 H-MRSI measures and 17% with HV. Only hippocampal atrophy correlated with postoperative seizure-free outcome. FDG-PET remains the most sensitive imaging method to correlate with EEG-lateralized TLE. Both FDG-PET and 1 H-MRSI can lateralize patients with normal MRI, but only the presence of relative unilateral hippocampal atrophy is predictive of seizure-free outcome. Bilaterally abnormal MRI and 1 H-MRSI measures do not preclude good surgical outcome.Multiple imaging methods are available to help lateralize temporal lobe epilepsy (TLE). To minimize the requirement for intracranial electrodes and to localize the epileptogenic zone with increased confidence, 2-[ 18 F]fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) and magnetic resonance imaging (MRI) are used to provide confirmatory localizing information. Relative temporal lobe (TL) hypometabolism on FDG-PET and hippocampal atrophy or prolonged T2 signal on MRI predict reliably lateralization of the epileptogenic temporal lobe [1][2][3][4][5]. Localized TL hypometabolism on FDG-PET is reported to be more sensitive than the detection of lateralized abnormality on MRI [3]; however, little has been published on the direct comparison of FDG-PET to advanced MRI and magnetic resonance spectroscopic imaging (MRSI) techniques. Gaillard and colleagues [6] compared FDG-PET with MRI-based hippocampal volumetry (HV) and showed that although FDG-PET was more Copyright © 1997 Patients and Methods Patients and Epilepsy EvaluationPatient selection commenced in April 1994 as part of a prospective imaging project with PET and MRSI at University of California, San Francisco (UCSF). Informed consent was obtained from all subjects according to guidelines of the UCSF Committee on Human Research. All surgical candidates suspected to have seizures arising from the TLs between April 1994 and June 1995 were screened for selection. After scalp-sphenoidal EEG/video telemetry, 36 patients were su...

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Section: T2 Relaxometrymentioning

confidence: 97%

Presurgical multimodality neuroimaging in electroencephalographic lateralized temporal lobe epilepsy

Knowlton

Laxer

Ende

et al. 1997

Annals of Neurology

127

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“…Surgical intervention can be highly effective in this population, provided there is accurate lateralization and localization of the epileptogenic tissue. Over the past decade, a variety of methods for lateralizing and localizing seizure foci, MR imaging (2-13), PET (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13), and MR spectroscopy (13,14 -19) have shown themselves to be valuable tools. Unlike conventional MRI studies, MR spectroscopy provides specific biochemical information, including measures of metabolite levels, pH, and bioenergetic status.…”

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confidence: 99%

¹H and ³¹P spectroscopy and bioenergetics in the lateralization of seizures in temporal lobe epilepsy

Hetherington

Pan

Spencer

2002

Magnetic Resonance Imaging

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Over the past decade, 1 H and 31 P spectroscopy measurements have demonstrated that significant metabolic alterations occur in temporal lobe epilepsy. However, to most accurately interpret these changes, metabolic heterogeneity and differences between gray and white matter must be accounted for. These alterations, decreased NAA and the ratio of phosphocreatine/inorganic phosphate, can be reversed with successful treatment of seizures. The reversibility of these two measures is consistent with the localization of NAA synthesis to neuronal mitochondria and the important role for bioenergetics in the pathophysiology of temporal lobe epilepsy.

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“…MEASUREMENTS OF HIPPOCAMPAL T2 (HCT2) have been shown to be useful in the assessment of hippocampal sclerosis (HS) in patients with medically intractable temporal lobe epilepsy (TLE) (1,2). In addition to the increased signal on T2-weighted images of HS utilized in these T2 relaxometric approaches, hippocampal atrophy is a hallmark for the diagnosis of HS on MRI and in pathology (3).…”

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confidence: 99%

A fast FLAIR dual‐echo technique for hippocampal T2 relaxometry: First experiences in patients with temporal lobe epilepsy

Woermann

Steiner

Barker

et al. 2001

Magnetic Resonance Imaging

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To evaluate the use of cerebrospinal fluid (CSF) signal nulling in MR T2 measurements of the hippocampus in normal control subjects and patients with temporal lobe epilepsy (TLE), dual-echo acquisitions covering the whole brain were used. T2 relaxation times were estimated in 12 standard Eurospin II MR test objects and in the hippocampi of 10 control subjects, using T2 maps constructed from conventional spin-echo (CSE), fast spin-echo (FSE), and fast FLAIR (FF) dual-echo sequences on a 1.5-T MR scanner. Hippocampal T2 values (HCT2) were measured on contiguous coronal 5-mm slices throughout the antero-posterior extent of each hippocampus in the 10 controls and 12 TLE patients, using both CSE and FF. Scan-rescan reproducibility in Eurospin II standard MR test objects was high for all sequences. There was a good correlation between T2 values from CSE, FF, and FSE sequences in test objects and in control hippocampi. In controls, the coefficient of variation of mean HCT2 values differed between slice positions, but was lowest for FF, followed by CSE data. The intrarater coefficient of reliability between repeated measurements in control subjects was lowest for FF HCT2, at 2.3%. The interrater coefficient of reliability for CSE HCT2 measurements in controls (4.8%) was slightly lower than the interrater coefficient for FF HCT2 (5.4%). HCT2 measurement with both CSE and FF identified abnormal values in the same 10 hippocampi of 12 patients. Hippocampal dualecho T2 relaxometry using CSF nulling is reliable in control subjects, and identifies the abnormal hippocampi in patients with TLE. The increases in hippocampal T2 signal demonstrated using FF HCT2 measurements are unlikely to be partial volume effects from CSF. J. Magn. Reson. Imaging 2001;13:547-552.

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Detection of hippocampal pathology in intractable partial epilepsy

Cited by 300 publications

References 0 publications

Presurgical multimodality neuroimaging in electroencephalographic lateralized temporal lobe epilepsy

Presurgical multimodality neuroimaging in electroencephalographic lateralized temporal lobe epilepsy

¹H and ³¹P spectroscopy and bioenergetics in the lateralization of seizures in temporal lobe epilepsy

A fast FLAIR dual‐echo technique for hippocampal T2 relaxometry: First experiences in patients with temporal lobe epilepsy

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Detection of hippocampal pathology in intractable partial epilepsy

Cited by 300 publications

References 0 publications

Presurgical multimodality neuroimaging in electroencephalographic lateralized temporal lobe epilepsy

Presurgical multimodality neuroimaging in electroencephalographic lateralized temporal lobe epilepsy

1H and 31P spectroscopy and bioenergetics in the lateralization of seizures in temporal lobe epilepsy

A fast FLAIR dual‐echo technique for hippocampal T2 relaxometry: First experiences in patients with temporal lobe epilepsy

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¹H and ³¹P spectroscopy and bioenergetics in the lateralization of seizures in temporal lobe epilepsy