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MRI evidence of mesial temporal sclerosis in subjects without seizures
Selim R Benbadis1, Jennifer Wallace, F Reed Murtagh
1Department of Neurology, University of South Florida College of Medicine, Tampa, FL 33606, USA. sbenbadi@hsc.usf.edu
Abstract:
The identification of mesial temporal sclerosis (MTS) on magnetic resonance imaging (MRI) is critical in the evaluation for temporal lobectomy. The purpose of this study was to estimate the prevalence of MTS by MRI in the general population. We reviewed the charts of patients undergoing MRI scans over an 18-month period. In order to be included, patients had to have no history of seizures, and the MRIs had to read as 'normal'. Patients were excluded if there was a history of seizures, mental illness, or alcohol abuse, and if they had a family history of seizures. Ages had to be from 5 to 50 years. All patients had MRI scans performed in three planes on 1.5 T systems. MRI diagnosis of MTS was based on standard visual diagnostic criteria analyzing: (1) hippocampal atrophy and (2) increased hippocampal T2 signal. Out of 375 charts reviewed, 204 met the inclusion criteria. Of the 204, 29 (14%) had abnormal and asymmetric mesial temporal structures consistent with a diagnosis of unilateral MTS. Nineteen (9.3%) had hippocampal atrophy only, two (1%) had T2 signal abnormalities, and eight (4%) met both criteria. There are some 'false positives' and MRI evidence for MTS is only meaningful in the proper clinical context.
Insights
Mesial temporal sclerosis (MTS) prevalence in the general population is estimated using MRI. A significant percentage of individuals without seizures showed MRI evidence of MTS, highlighting the need for clinical context in diagnosis.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Mesial temporal sclerosis (MTS) diagnosis via MRI is crucial for epilepsy surgery evaluation.
- Accurate prevalence data in the general population is needed.
Purpose of the Study:
- To estimate the prevalence of mesial temporal sclerosis (MTS) using MRI in a general population sample.
- To assess the frequency of MRI findings suggestive of MTS in individuals without a history of seizures.
Main Methods:
- Retrospective chart review of 375 patients undergoing MRI over 18 months.
- Inclusion criteria: age 5-50, no history of seizures, normal MRI. Exclusion criteria: mental illness, alcohol abuse, family history of seizures.
- MRI diagnosis of MTS based on hippocampal atrophy and/or increased T2 signal in three planes on 1.5 T systems.
Main Results:
- 204 patients met inclusion criteria.
- 14% (29/204) showed unilateral MTS findings.
- 9.3% had hippocampal atrophy only, 1% had T2 signal abnormalities, and 4% met both criteria.
Conclusions:
- MRI evidence of MTS can be present in individuals without seizures.
- Findings suggest potential for 'false positives' in MTS diagnosis.
- MRI findings for MTS require careful interpretation within the appropriate clinical context.