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Hippocampal microstructural alterations in temporal lobe epilepsy with hippocampal sclerosis assessed using diffusion
Xiao-Nan Zhang1, Cheng-Ru Song1, Ke-Ran Ma1
1Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Neuroradiology
|July 25, 2026
Summary
Diffusion kurtosis imaging (DKI) reveals significant microstructural changes in the hippocampus of patients with temporal lobe epilepsy with hippocampal sclerosis (TLE-HS). These findings highlight DKI
Area of Science:
- Neuroimaging
- Epilepsy Research
- Diffusion Tensor Imaging
Background:
- Temporal lobe epilepsy with hippocampal sclerosis (TLE-HS) is a common cause of drug-resistant epilepsy.
- Accurate assessment of hippocampal microstructural integrity is crucial for diagnosis and management.
- Diffusion kurtosis imaging (DKI) offers advanced insights into tissue microstructure beyond conventional diffusion tensor imaging (DTI).
Purpose of the Study:
- To investigate hippocampal microstructural alterations in TLE-HS using DKI.
- To evaluate the diagnostic performance of DKI parameters in differentiating affected hippocampi from unaffected ones and healthy controls.
- To explore the association between DKI metrics and clinical variables in TLE-HS.
Main Methods:
- Brain MRI including DKI was performed on 53 TLE-HS patients and 53 healthy controls (HC).
- DKI-derived parameters and FLAIR signal intensity ratio were compared between affected/unaffected hippocampi in TLE-HS and HC.
- Receiver operating characteristic (ROC) curve analyses assessed diagnostic utility; clinical variable associations were explored.
Main Results:
- Affected hippocampi in TLE-HS showed increased diffusivity (MD, AD, RD) and decreased kurtosis (AK, MK, RK) compared to unaffected hippocampi and HC.
- Fractional anisotropy (FA) did not differ between affected and unaffected hippocampi but was altered in unaffected hippocampi versus HC.
- A multi-parameter DKI model achieved perfect differentiation (AUC=1.000) of affected hippocampi from HC, while axial kurtosis (AK) and mean kurtosis (MK) correlated with age at onset.
Conclusions:
- DKI-derived metrics are sensitive indicators of hippocampal microstructural disruption in unilateral TLE-HS.
- DKI demonstrates significant diagnostic potential for evaluating hippocampal integrity in TLE-HS.
- DKI serves as a valuable adjunctive tool in the neuroimaging assessment of TLE-HS.
