Hanamiya Mai, Korogi Yukunori, Kakeda Shingo, Ohnari Norihiro, Kamada Koji, Moriya Junji, Sato Toru, Kitajima Mika, Akamatsu Naoki, Tsuji Sadatoshi
Department of Radiology, University of Occupational and Environmental Health School of Medicine, Iseigaoka 1-1, Yahatanishi-ku, Kitakyushu 807-8555, Japan.
Radiology. 2009 Jun;251(3):873-81. doi: 10.1148/radiol.2513080445. Epub 2009 Apr 3.
To determine whether partial loss of the hippocampal striation (PLHS) at 3.0 T is more accurate than the currently accepted methods of using conventional magnetic resonance (MR) imaging to detect hippocampal sclerosis in medial temporal lobe epilepsy (MTLE).
This retrospective study had institutional review board approval, and informed consent was waived. Fluid-attenuated inversion-recovery (FLAIR) MR images and T2-weighted MR images in the oblique coronal plane in 22 consecutive patients (10 men, 12 female patients; mean age, 41.0 years; range, 14-76 years) (25 hemispheres) with a clinical diagnosis of MTLE were retrospectively evaluated. Twenty-five hippocampi in 15 subjects without epilepsy were evaluated as age-matched controls. The volumes and thicknesses of the four anatomic sections of the hippocampi were quantitatively measured on the T2-weighted images. Two radiologists independently reviewed the MR imaging findings of the hippocampus regarding atrophy, abnormal signal intensity, and PLHS on each side separately, without comparing both sides. Sensitivity and specificity were calculated among the MR imaging findings.
Signal intensity abnormality on FLAIR images had a sensitivity of 36%, a specificity of 96%, and an accuracy of 66% for the diagnosis of hippocampal sclerosis. PLHS on T2-weighted MR images had a sensitivity of 76% and a specificity of 80% for the diagnosis of hippocampal sclerosis. The sensitivity for PLHS was higher than that for atrophy (44%) and abnormal signal intensity (48%) of the hippocampus on T2-weighted MR images. Although the mean volume of the hippocampus and the thickness of the hippocampal body were significantly smaller for patients with MTLE than for control subjects (P < .001 for both), there was no clear distinguishing threshold value between abnormal and normal hippocampi.
PLHS showed the highest sensitivity for MTLE. This MR imaging feature might improve the accuracy of the diagnosis of bilateral hippocampal sclerosis, although further research is required.
确定在3.0T时海马条纹部分缺失（PLHS）是否比目前公认的使用传统磁共振（MR）成像检测内侧颞叶癫痫（MTLE）中海马硬化的方法更准确。
本回顾性研究经机构审查委员会批准，且无需知情同意。对22例连续临床诊断为MTLE的患者（10例男性，12例女性；平均年龄41.0岁；范围14 - 76岁）（25个半球）的液体衰减反转恢复（FLAIR）MR图像和斜冠状面T2加权MR图像进行回顾性评估。将15例无癫痫患者的25个海马作为年龄匹配的对照进行评估。在T2加权图像上定量测量海马四个解剖部分的体积和厚度。两名放射科医生分别独立审查海马的MR成像结果，包括萎缩、异常信号强度和PLHS，不进行双侧比较。计算MR成像结果中的敏感性和特异性。
FLAIR图像上的信号强度异常对海马硬化诊断的敏感性为36%，特异性为96%，准确性为66%。T2加权MR图像上的PLHS对海马硬化诊断的敏感性为76%，特异性为80%。PLHS的敏感性高于T2加权MR图像上海马萎缩（44%）和异常信号强度（48%）的敏感性。虽然MTLE患者海马的平均体积和海马体厚度明显小于对照受试者（两者P <.001），但正常与异常海马之间没有明确的区分阈值。
PLHS对MTLE显示出最高的敏感性。尽管需要进一步研究，但这种MR成像特征可能会提高双侧海马硬化诊断的准确性。
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