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Automated volumetry of hippocampal subfields in temporal lobe epilepsy
Franz Riederer1, René Seiger2, Rupert Lanzenberger2
1Department of Neurology, Clinic Hietzing & Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Vienna, Austria; Faculty of Medicine, University of Zurich, Zurich, Switzerland.
Insights
Automated MRI volumetry can predict hippocampal sclerosis patterns in epilepsy patients. This technique shows potential for identifying specific hippocampal subfield cell loss before surgery.
Area of Science:
- Neurology
- Radiology
- Pathology
Background:
- Hippocampal sclerosis (HS) is a common cause of drug-resistant temporal lobe epilepsy (TLE).
- The International League Against Epilepsy (ILAE) recently classified HS into four types based on cell loss patterns in specific hippocampal subfields.
- Type 1 HS, the most frequent, is associated with better outcomes after epilepsy surgery.
Purpose of the Study:
- To investigate if automated volumetry of hippocampal subfields using high-resolution MRI can correlate with histological findings of cell loss in TLE.
- To determine if MRI-based volume loss patterns can predict HS subtypes.
Main Methods:
- High-resolution MRI scans from 26 drug-resistant TLE patients and 121 healthy controls were analyzed using FreeSurfer 6.0.
- Volumes of the whole hippocampus and subfields (CA1, CA2+3, CA4, DG) were automatically estimated.
- HS subtype classification was attempted based on histological reports and compared with MRI findings.
Main Results:
- Patients with TLE showed significantly lower volumes in the ipsilateral hippocampus and its subfields compared to the contralateral side and healthy controls.
- Contralateral hippocampal and subfield volumes did not differ significantly from controls.
- MRI-based volume loss patterns corresponded to histological HS types in 12 of 20 patients, with the highest accuracy for Type 1 HS (10 of 12 cases).
Conclusions:
- Automated volumetry of hippocampal subfields using high-resolution MRI shows promise in predicting the pattern of cell loss in hippocampal sclerosis.
- This non-invasive imaging technique may aid in presurgical assessment and classification of HS subtypes.
Introduction:
Hippocampal sclerosis is the most frequent pathological substrate in drug resistant temporal lobe epilepsy (TLE). Recently 4 types of hippocampal sclerosis (HS) have been defined in a task force by the International League Against Epilepsy (ILAE), based on patterns of cell loss in specific hippocampal subfields. Type 1 HS is most frequent and has the most favorable outcome after epilepsy surgery. We hypothesized that volume loss in specific hippocampal subfields determined by automated volumetry of high resolution MRI would correspond to cell loss in histological reports.
Material And Methods:
In a group of well characterized patients with drug resistant TLE (N = 26 patients, 14 with right-sided focus, 12 with left-sided focus) volumes of the right and left hippocampus and the hippocampal subfields CA1, CA2 + 3, CA4 and dentate gyrus (DG) were estimated automatically using FreeSurfer version 6.0 from high-resolution cerebral MRI and compared to a large group of healthy controls (N = 121). HS subtype classification was attempted based on histological reports.
Results:
Volumes of the whole hippocampus and all investigated hippocampal subfields (CA1, CA2 + 3, CA4 and DG) were significantly lower on the ipsilateral compared the contralateral side (p < 0.001) and compared to the healthy controls (p < 0.001). Conversely, whole hippocampal and hippocampal subfield volumes were not significantly different from healthy control values on the contralateral side. In 12 of 20 patients the pattern of hippocampal volume loss in specific subfields was in accordance with HS types from histology. The highest overlap between automated MRI and histology was achieved for type 1 HS (in 10 of 12 cases).
Conclusion:
The automated volumetry of hippocampal subfields, based on high resolution MRI, may have the potential to predict the pattern of cell loss in hippocampal sclerosis before operation.
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