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Imaging findings in hippocampal sclerosis: correlation with pathology
R A Bronen1, G Cheung, J T Charles
1Department of Diagnostic Imaging, Yale University School of Medicine, New Haven, CT 06510.
AJNR. American Journal of Neuroradiology
|September 1, 1991
Summary
Preoperative MRI can detect hippocampal sclerosis, a cause of epilepsy, by identifying hippocampal atrophy and changes in signal intensity. This imaging accurately correlates with pathological findings, aiding surgical treatment decisions for epilepsy.
Area of Science:
- Neurology
- Radiology
- Pathology
Background:
- Hippocampal sclerosis is a common cause of surgically treatable temporal lobe epilepsy.
- Pathologically, it involves neuronal cell loss and gliosis within the hippocampus.
- Previous studies correlated imaging with qualitative histology, but this study uses quantitative criteria.
Purpose of the Study:
- To evaluate the ability of preoperative magnetic resonance (MR) imaging to detect hippocampal sclerosis.
- To correlate MR findings with quantitative pathologic criteria (neuronal cell density).
- To assess the therapeutic implications of preoperative MR diagnosis.
Main Methods:
- Evaluated 31 epilepsy patients undergoing surgery for intractable epilepsy.
- Focused on 11 patients with cryptogenic temporal lobe epilepsy.
- Used quantitative pathologic criteria (neuronal cell density) for diagnosis.
- Compared MR imaging findings (atrophy, signal changes) with hippocampal neuronal density in surgical specimens.
Main Results:
- Nine of 11 patients with cryptogenic temporal lobe epilepsy had hippocampal sclerosis based on pathologic criteria.
- MR findings included unilateral hippocampal atrophy, increased signal on long TR scans, and adjacent white matter atrophy.
- A significant correlation was found between MR-measured hippocampal size and neuronal density in specific hippocampal subfields (CA3, CA4, granular cell layer).
Conclusions:
- Preoperative MR imaging can accurately detect hippocampal sclerosis using quantitative pathologic criteria.
- MR findings of hippocampal atrophy and signal changes correlate significantly with neuronal loss.
- Accurate preoperative diagnosis of hippocampal sclerosis via MR has significant therapeutic consequences, as surgery can eliminate seizures.