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Published on: December 18, 2016
1H MR spectroscopy in histopathological subgroups of mesial temporal lobe epilepsy
Milan Hajek1, Pavel Krsek, Monika Dezortova
1MR Unit, Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
Abstract:
The aim of the study was to analyze the lateralizing value of proton magnetic resonance spectroscopy ((1)H MRS) in histopathologically different subgroups of mesial temporal lobe epilepsies (MTLE) and to correlate results with clinical, MRI and seizure outcome data. A group of 35 patients who underwent resective epilepsy surgery was retrospectively studied. Hippocampal (1)H MR spectra were evaluated. Metabolite concentrations were obtained using LCModel and NAA/Cr, NAA/Cho, NAA/(Cr+Cho), Cho/Cr ratios and coefficients of asymmetry were calculated. MRI correctly lateralized 89% of subjects and (1)H MRS 83%. MRI together with (1)H MRS correctly lateralized 100% of patients. Nineteen subjects had "classical" hippocampal sclerosis (HS), whereas the remaining 16 patients had "mild" HS. Nineteen patients had histopathologically proven malformation of cortical development (MCD) in the temporal pole; 16 subjects had only HS. No difference in (1)H MRS findings was found between patients in different histopathological subgroups of MTLE. Our results support the hypothesis that (1)H MRS abnormalities do not directly reflect histopathological changes in MTLE patients. Subjects with non-lateralized (1)H MRS abnormalities did not have a worse postoperative seizure outcome. We found no significant impact of contralateral (1)H MRS abnormality on post-surgical seizure outcome.
Insights
Proton magnetic resonance spectroscopy ((1)H MRS) combined with MRI accurately lateralizes mesial temporal lobe epilepsies (MTLE). (1)H MRS findings did not correlate with histopathology or impact seizure outcomes.
Area of Science:
- Neuroimaging
- Epilepsy Research
- Spectroscopy
Background:
- Mesial temporal lobe epilepsies (MTLE) are a common cause of drug-resistant epilepsy.
- Accurate lateralization of the seizure focus is crucial for successful surgical treatment.
- Proton magnetic resonance spectroscopy ((1)H MRS) offers metabolic information that may aid in epilepsy localization.
Purpose of the Study:
- To evaluate the lateralizing value of (1)H MRS in distinct histopathological subgroups of MTLE.
- To correlate (1)H MRS findings with clinical data, MRI, and postoperative seizure outcomes.
- To determine if (1)H MRS abnormalities reflect underlying histopathological changes.
Main Methods:
- Retrospective study of 35 patients undergoing resective epilepsy surgery for MTLE.
- Analysis of hippocampal (1)H MR spectra using LCModel to calculate metabolite ratios and asymmetry coefficients.
- Comparison of (1)H MRS lateralization with MRI findings and histopathological diagnoses (hippocampal sclerosis, cortical malformations).
Main Results:
- MRI achieved 89% lateralization; (1)H MRS achieved 83% lateralization.
- The combination of MRI and (1)H MRS correctly lateralized 100% of patients.
- No significant differences in (1)H MRS findings were observed across different histopathological subgroups.
- Non-lateralized (1)H MRS findings did not predict worse postoperative seizure outcomes.
Conclusions:
- Combined MRI and (1)H MRS provide excellent lateralization for MTLE.
- (1)H MRS abnormalities in MTLE may not directly mirror histopathological changes.
- Contralateral (1)H MRS findings did not significantly affect post-surgical seizure control.
