Institute of Neurology, University Magna Graecia, 88100 Catanzaro, Italy.
Neurology. 2010 Feb 16;74(7):553-7. doi: 10.1212/WNL.0b013e3181cff747. Epub 2010 Jan 20.
To prospectively assess the frequency of mesiotemporal abnormalities seen on brain MRI in healthy subjects in comparison with patients with temporal lobe epilepsy (TLE).
Ninety-nine consecutive patients (48 women, mean age 36.1 +/- 16.1 years; range 10 to 75) with TLE and 51 healthy volunteers (26 women, mean age 39.3 +/- 10.8 years) prospectively underwent the same MRI protocol, specific for TLE. Images were reviewed independently by 2 neuroradiologists blinded to clinical information. Cortical atrophy and signal intensities in the amygdala, hippocampus, cingulate gyrus, subcallosal area, insula, temporal parietal, and occipital lobe were graded relative to cortical signal intensity in the frontal lobe. Intrarater and interrater reliability were also assessed.
Interrater and intrarater measurements demonstrated consistent and repeatable results. Forty-seven of 99 (47.5%) patients showed either unilateral or bilateral major T2/fluid-attenuated inversion recovery hyperintensities of the hippocampus, and 19 patients (19.2%) showed hippocampal atrophy seen at T1/inversion recovery sequences. In the controls, 15/51 (29.4%) individuals had unilateral or bilateral hyperintensities, which did not differ from the rate of occurrence in patients (p = 0.08). Conversely, unilateral hippocampal atrophy was found in 1 control, which was significantly different (p = 0.005) from the rate of occurrence in patients. Hyperintensity plus structural hippocampal atrophy were only seen in patients.
On brain MRI, either unilateral or bilateral hippocampal hyperintensities are frequently encountered in healthy volunteers. Conversely, hippocampal atrophy, especially when associated with concomitant hyperintensity, was seen exclusively in the epilepsy group, indicating that the combination of these 2 variables represents the strongest and most reliable indicator of epilepsy.
前瞻性评估脑 MRI 中健康受试者与颞叶癫痫（TLE）患者间出现颞叶异常的频率。
99 例连续 TLE 患者（48 例女性，平均年龄 36.1±16.1 岁；范围 10 至 75 岁）和 51 例健康志愿者（26 例女性，平均年龄 39.3±10.8 岁）前瞻性接受了相同的 TLE 特定 MRI 方案。2 位神经放射学家独立对图像进行了审查，对临床信息不知情。相对于额叶皮质信号强度，对杏仁核、海马体、扣带回、胼胝体下区、脑岛、颞顶叶和枕叶的皮质萎缩和信号强度进行分级。还评估了内部和外部的可靠性。
内部和外部测量结果一致且可重复。99 例患者中有 47 例（47.5%）出现单侧或双侧海马体 T2/液体衰减反转恢复高信号，19 例（19.2%）出现 T1/反转恢复序列中的海马体萎缩。在对照组中，15/51（29.4%）个体出现单侧或双侧高信号，与患者的发生率无差异（p=0.08）。相反，在 1 名对照者中发现单侧海马体萎缩，这与患者的发生率有显著差异（p=0.005）。高信号加结构海马体萎缩仅见于患者。
在脑 MRI 上，健康志愿者中经常出现单侧或双侧海马体高信号。相反，海马体萎缩，特别是当伴有并发高信号时，仅见于癫痫组，表明这两个变量的组合是癫痫的最强和最可靠的指标。
