Related Experiment Videos
White-matter change in mesial temporal sclerosis: correlation of MRI with PET, pathology, and clinical features
1Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Purpose:
To assess the magnetic resonance imaging (MRI), positron emission tomography (PET), pathology, and clinical findings of patients with the MRI feature of white-matter change (WMC) in the anterior temporal lobe.
Methods:
Fifty-six patients with pathologically proven mesial temporal sclerosis were included in this study. MRI and 18F-2-deoxyglucose-(FDG) PET images were obtained before surgery in all patients. The patients were divided into two groups according to the presence of WMC on their MRI. WMC consists of an indistinct gray-white matter demarcation and an increased signal intensity of the anterior temporal lobe on T2-weighted images. The two groups were then compared in terms of MRI, PET, pathology, and clinical features.
Results:
The MRI feature of WMC was observed in 18 (32%) of the 56 patients. PET images of those patients revealed more severe hypometabolism of the ipsilateral temporal lobes (p< 0.05). In terms of histologic findings, larger numbers of heterotopic neurons were observed in the anterior temporal lobe white matter of these patients who also shared the following clinical features: earlier seizure onset, frequent history of febrile convulsions, and favorable surgical outcomes.
Conclusions:
The MRI feature of WMC is an additive sign for correct seizure lateralization and may be related to a favorable surgical outcome in patients with temporal lobe epilepsy.
Insights
White-matter change (WMC) on MRI in the anterior temporal lobe indicates more severe temporal lobe epilepsy. This MRI finding may help predict favorable surgical outcomes.
Area of Science:
- Neurology
- Radiology
- Pathology
Background:
- Mesial temporal sclerosis is a common cause of epilepsy.
- Accurate lateralization of seizure focus is crucial for surgical planning.
- Magnetic resonance imaging (MRI) features can aid in diagnosis and prognosis.
Observation:
- White-matter change (WMC) on T2-weighted MRI, characterized by indistinct gray-white matter demarcation and increased signal intensity in the anterior temporal lobe, was identified in 32% of patients.
- Patients with WMC showed more severe ipsilateral temporal lobe hypometabolism on 18F-2-deoxyglucose-positron emission tomography (FDG-PET).
- Histological examination revealed increased heterotopic neurons in the white matter of the anterior temporal lobe in patients with WMC.
Findings:
- Patients with WMC experienced earlier seizure onset and a history of febrile convulsions.
- These patients also demonstrated a favorable outcome after epilepsy surgery.
- WMC on MRI serves as an additional marker for seizure lateralization.
Implications:
- The presence of WMC on MRI can improve the accuracy of seizure lateralization in temporal lobe epilepsy.
- WMC may predict a positive surgical outcome for patients with temporal lobe epilepsy.
- Integrating MRI, PET, and pathological findings enhances understanding of epilepsy subtypes.