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A Multimodal Imaging- and Stimulation-based Method of Evaluating Connectivity-related Brain Excitability in Patients with Epilepsy
Published on: November 13, 2016
Quantification of hippocampal signal intensity in patients with mesial temporal lobe epilepsy
Ana Carolina Coan1, Eliane Kobayashi, Li Min Li
1Department of Neurology, Campinas State University (UNICAMP), Campinas, SP, Brazil.
Background:
Refractory mesial temporal lobe epilepsy (MTLE) is frequently associated with hippocampal atrophy (HA) and an abnormal hippocampal signal (Hsig) on magnetic resonance imaging (MRI).
Objective:
To quantify Hsig on MRI using a simplified technique.
Methods:
The authors included 15 patients with refractory MTLE who underwent surgery and had preoperative MRI with hippocampal volumetry. Hsig was quantified on preoperative coronal T1-weighted and T2-weighted MRI using the NIH-Image program. Hsig was determined for the head, tail, and entire hippocampal extension. Abnormal Hsig was defined when values were above (for T2) or below (for T1) 2 standard deviations from the mean of normal control group.
Results:
The lateralization of abnormal Hsig values was concordant with electroencephalograms and HA in all patients. There was a significant difference in ipsilateral T2 Hsig between patients and controls (P < .0001), but not for contralateral T2 Hsig. T1 Hsig showed bilateral abnormalities more frequently, whereas T2 Hsig could lateralize better hippocampal abnormalities. Overall, there were no differences when comparing T2 Hsig for the entire hippocampus, head, or tail only. However, there were some individual differences. T2 Hsig abnormalities involved the entire hippocampus in most patients but were restricted to the head in one patient and to the tail in another.
Conclusions:
This simplified method for the quantification of Hsig using NHI-Image is an efficient method for the identification and quantification of hippocampal abnormalities in patients with MTLE. The assessment of the entire extension of the hippocampal formation may provide important additional data, compared to T2 relaxometry maps limited to one segment of the hippocampus.
Insights
This study introduces a simplified MRI technique to quantify abnormal hippocampal signals (Hsig) in refractory mesial temporal lobe epilepsy (MTLE). The method efficiently identifies hippocampal abnormalities, aiding in diagnosis and treatment planning for MTLE patients.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Refractory mesial temporal lobe epilepsy (MTLE) often presents with hippocampal atrophy (HA) and abnormal hippocampal signals (Hsig) on MRI.
- Accurate quantification of Hsig is crucial for understanding MTLE pathophysiology and guiding treatment.
Purpose of the Study:
- To develop and validate a simplified technique for quantifying Hsig on MRI in patients with refractory MTLE.
- To assess the utility of this method in identifying and characterizing hippocampal abnormalities.
Main Methods:
- A cohort of 15 patients with refractory MTLE underwent preoperative MRI, including T1-weighted and T2-weighted sequences.
- Hippocampal signal (Hsig) was quantified using the NIH-Image program, analyzing head, tail, and entire hippocampal extension.
- Abnormal Hsig was defined based on deviations from a normal control group's mean values.
Main Results:
- The simplified Hsig quantification method demonstrated concordance with electroencephalograms and HA in lateralization.
- Significant differences in ipsilateral T2 Hsig were observed between MTLE patients and controls (P < .0001).
- T2 Hsig showed better lateralization of hippocampal abnormalities compared to T1 Hsig, which frequently presented bilateral findings.
Conclusions:
- The simplified NIH-Image based Hsig quantification is an efficient tool for identifying and quantifying hippocampal abnormalities in MTLE.
- Assessing the entire hippocampal formation provides valuable data, potentially surpassing segment-specific analyses like T2 relaxometry maps.
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