Oblique proton chemical shift imaging for the presurgical localization of mesial temporal epilepsy

Precise localization of the epileptogenic zone in patients suffering from mesial temporal lobe epilepsies is a prerequisite for surgery. For this purpose, a scheme for selecting the volume of interest in an oblique plane covering the head, body, and tail of the hippocampal formation (HF) was implemented in a water-suppressed proton chemical shift imaging (CSI) acquisition. This approach, evaluated by consecutively acquired CSI spectra of both temporal lobes, demonstrates that it can potentially be a routine technique for clinical diagnosis. Since the method produces localized spectral detail of the HF, it facilitates a convenient comparison of CSI lateralization to that assessed by HF atrophy (due to sclerosis) using the MRI-volumetry technique.