Jackson G D, Berkovic S F, Tress B M, Kalnins R M, Fabinyi G C, Bladin P F
Department of Neurology, Austin Hospital, Heidelberg, Victoria, Australia.
Neurology. 1990 Dec;40(12):1869-75. doi: 10.1212/wnl.40.12.1869.
Two independent blinded observers reported the preoperative MRIs in a series of 81 consecutive patients with intractable temporal lobe epilepsy who were undergoing temporal lobectomy. We then compared the nature and lateralization of the MRI abnormalities with the pathologic diagnosis and the side of lobectomy. The MRI criteria of hippocampal sclerosis were an increased T2-weighted signal and the signal's confinement to a unilaterally small hippocampus. Imaging was performed in coronal and axial planes, specially orientated along and perpendicular to the long axis of the hippocampal body. We found diagnostic MRI abnormalities in 25 of the 27 cases with pathologically proven hippocampal sclerosis (sensitivity 93%, specificity 86%). In addition, we detected all 13 foreign tissue lesions on MRI. Overall, we detected lateralized lesions on MRI that correctly predicted the side of the epileptogenic temporal lobe in 72 cases (89%), with 2 possible errors. A learning effect in appreciating the relatively subtle MRI changes of hippocampal sclerosis was apparent in our later cases, as shown by an improved correlation between the 2 observers. This study demonstrates that hippocampal sclerosis can be identified on MRI with a high degree of sensitivity and specificity.
两名独立的盲法观察者对一系列连续81例接受颞叶切除术的难治性颞叶癫痫患者的术前磁共振成像（MRI）进行了报告。然后，我们将MRI异常的性质和定位与病理诊断以及叶切除术的一侧进行了比较。海马硬化的MRI标准为T2加权信号增加且信号局限于单侧小海马。成像在冠状面和轴位面上进行，特别是沿着海马体的长轴并与之垂直进行定向。我们在27例经病理证实为海马硬化的病例中发现了25例具有诊断意义的MRI异常（敏感性93%，特异性86%）。此外，我们在MRI上检测到了所有13个外来组织病变。总体而言，我们在MRI上检测到的定位病变在72例（89%）中正确预测了致痫性颞叶的一侧，有2例可能的错误。正如两名观察者之间相关性的改善所示，在我们后来的病例中，在识别海马硬化相对细微的MRI变化方面存在学习效应。这项研究表明，MRI能够以高度的敏感性和特异性识别海马硬化。
