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a The MRI Unit, Epilepsy
Research Group, Institute of Neurology and National Society for
Epilepsy, Chelfont St Peter, SL9 0LR, UK, b NMR Research
Unit, Institute of Neurology, Queen Square, London WC1N 3BG, UK, c Epilepsy Centre Berlin,
Evang. Krankenhaus Herzberge and Virchow-Klinikum,
Humboldt-Universität, 10362 Berlin, Germany
Correspondence to: Professor JS Duncan, National Society for Epilepsy, National Hospital for Neurology and Neurosurgery, Chalfont St Peter, Gerrards Cross, Bucks SL9 0RJ, UK. Telephone 0044 (0) 1494 601300; fax 0044 (0) 1494 876294.
Received 23 September 1997 and in revised form 20 February 1998;
Accepted 27 April 1998
OBJECTIVE
The principal MRI features of
hippocampal sclerosis are volume loss and increased T2 weighted signal
intensity. Minor and localised abnormalities may be overlooked without
careful quantitation. Hippocampal T2 relaxation time (HT2) can be
quantified, but previously has only been measured on a few thick
coronal slices with interslice gaps. In this study HT2 was measured
along the entire length of the hippocampus on contiguous slices and
used, with quantitative measures of hippocampal volume (HV) and
distribution of atrophy, to better define the range of hippocampal sclerosis.
METHODSThirty patients with temporal lobe
epilepsy, 10 patients with extratemporal localisation related epilepsy
and extratemporal lesions, and 20 control subjects were studied using
MRI T2 relaxometry and volumetry.
RESULTSIn controls and patients, HT2 was higher
in the anterior than the posterior hippocampus. Using HV, morphometric,
and HT2 data, patients with temporal lobe epilepsy were classified as
unilateral diffuse hippocampal sclerosis (n=16), unilateral focal
(n=6), bilaterally affected (n=6), and normal (n=2). In patients with unilateral hippocampal sclerosis, the anterior hippocampus was always
affected. In three patients with normal HV, HT2 measurements disclosed
unilateral focal abnormalities that corresponded to the EEG
lateralisation of epileptic activity. Patients with bilateral hippocampal involvement had an earlier onset of epilepsy than patients
with unilateral hippocampal sclerosis.
CONCLUSIONSMeasurement of regional abnormalities
of HT2 along the length of the hippocampus provides further refinement
to the MRI assessment of the hippocampi in patients with temporal lobe
epilepsy and is complementary to volumetric and morphological data.
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