Presurgical evaluation of mesial temporal lobe epilepsy with multiple advanced MR techniques at 3T

• DOI: 10.1016/j.neurad.2015.04.002
• Publication Date: 2015-05-28T22:09:19Z
• Authors: Bulent Eryurt; A. Yusuf Oner; Murat Ucar; Irem Capraz; Gokhan Kurt; Erhan Bilir; E. Turgut Tali
• Keywords: Adult; Male; Adolescent; Reproducibility of Results; Middle Aged; Image Enhancement; Hippocampus; Magnetic Resonance Imaging; Multimodal Imaging; Sensitivity and Specificity; 3. Good health; Young Adult; 03 medical and health sciences; 0302 clinical medicine; Epilepsy, Temporal Lobe; Preoperative Care; Humans; Female

Accurate localization of the epileptogenic zone is essential for successful surgical treatment of mesial temporal lobe epilepsy (MTLE). The aim of this study was to analyze and compare the hippocampal volumetry (HV), MR spectroscopy (MRS), Dynamic susceptibility contrast (DSC) and pulsed arterial spin labeling (pASL) perfusion techniques in a large sample size of refractory MTLE patients.Forty-two patients with medically refractory MTLE who underwent preoperative evaluation and eleven normal controls were studied. Pathologic and control hippocampi were compared in terms of hippocampal volume, metabolite ratios and relative hippocampal perfusion values. By using cut-off points and asymmetry indexes, percentages of performance indicators for each technique were calculated in groups of MR (+), MR (-) and bilateral MTLE.For all techniques, a statistically significant difference was found between the pathologic and control hippocampus groups (P<0.001). Also, all of them except HV had diagnostic value in groups of MR (-) and bilateral MTLE.HV, MRS, DSC and pASL have achieved comparable performance and each of them provides important information about the lateralization of epileptogenic focus. Among those, pASL and MRS may easily be used as an adjunct to conventional MR.