Silva Guilherme, Martins Cristina, Moreira da Silva Nádia, Vieira Duarte, Costa Dias, Rego Ricardo, Fonseca José, Silva Cunha João Paulo
1 Neuroradiology Department, São João Hospital Centre, Portugal.
2 INESC TEC - Science and Technology, Portugal.
Neuroradiol J. 2017 Aug;30(4):318-323. doi: 10.1177/1971400917709627. Epub 2017 Jun 20.
Background and purpose We evaluated two methods to identify mesial temporal sclerosis (MTS): visual inspection by experienced epilepsy neuroradiologists based on structural magnetic resonance imaging sequences and automated hippocampal volumetry provided by a processing pipeline based on the FMRIB Software Library. Methods This retrospective study included patients from the epilepsy monitoring unit database of our institution. All patients underwent brain magnetic resonance imaging in 1.5T and 3T scanners with protocols that included thin coronal T2, T1 and fluid-attenuated inversion recovery and isometric T1 acquisitions. Two neuroradiologists with experience in epilepsy and blinded to clinical data evaluated magnetic resonance images for the diagnosis of MTS. The diagnosis of MTS based on an automated method included the calculation of a volumetric asymmetry index between the two hippocampi of each patient and a threshold value to define the presence of MTS obtained through statistical tests (receiver operating characteristics curve). Hippocampi were segmented for volumetric quantification using the FIRST tool and fslstats from the FMRIB Software Library. Results The final cohort included 19 patients with unilateral MTS (14 left side): 14 women and a mean age of 43.4 ± 10.4 years. Neuroradiologists had a sensitivity of 100% and specificity of 73.3% to detect MTS (gold standard, k = 0.755). Automated hippocampal volumetry had a sensitivity of 84.2% and specificity of 86.7% (k = 0.704). Combined, these methods had a sensitivity of 84.2% and a specificity of 100% (k = 0.825). Conclusions Automated volumetry of the hippocampus could play an important role in temporal lobe epilepsy evaluation, namely on confirmation of unilateral MTS diagnosis in patients with radiological suggestive findings.
背景与目的 我们评估了两种识别内侧颞叶硬化（MTS）的方法：经验丰富的癫痫神经放射科医生基于结构磁共振成像序列进行的视觉检查，以及由基于FMRIB软件库的处理流程提供的自动海马体积测量法。方法 这项回顾性研究纳入了我们机构癫痫监测单元数据库中的患者。所有患者均在1.5T和3T扫描仪上进行了脑部磁共振成像，扫描协议包括薄层冠状位T2、T1和液体衰减反转恢复序列以及等距T1采集。两名具有癫痫诊断经验且对临床数据不知情的神经放射科医生评估磁共振图像以诊断MTS。基于自动方法的MTS诊断包括计算每位患者两侧海马之间的体积不对称指数，以及通过统计测试（受试者操作特征曲线）获得的用于定义MTS存在的阈值。使用FMRIB软件库中的FIRST工具和fslstats对海马进行分割以进行体积定量。结果 最终队列包括19例单侧MTS患者（14例左侧）：14名女性，平均年龄43.4±10.4岁。神经放射科医生检测MTS的灵敏度为100%，特异度为73.3%（金标准，k = 0.755）。自动海马体积测量法的灵敏度为84.2%，特异度为86.7%（k = 0.704）。综合起来，这些方法的灵敏度为84.2%，特异度为100%（k = 0.825）。结论 海马的自动体积测量在颞叶癫痫评估中可能发挥重要作用，即在对具有放射学提示性发现的患者进行单侧MTS诊断的确认方面。
