Meiners L C, van Gils A, Jansen G H, de Kort G, Witkamp T D, Ramos L M, Valk J, Debets R M, van Huffelen A C, van Veelen C W
Department of Radiology, University Hospital, Utrecht, The Netherlands.
AJNR Am J Neuroradiol. 1994 Sep;15(8):1547-55.
To determine the frequency of appearance of various MR signs in mesial temporal sclerosis, to determine the optimal scanning planes for their visualization, and to propose a histologic explanation for the diminished demarcation between gray and white matter in the temporal lobe, a frequent MR finding in patients with mesial temporal sclerosis.
MR scans of 14 surgically treated patients with epilepsy and histologically proven mesial temporal sclerosis were assessed for the presence of six features: feature 1, high signal intensity in the hippocampus; 2, reduced hippocampal size; 3, ipsilateral atrophy of the hippocampal collateral white matter; 4, enlarged temporal horn; 5, reduced gray-white matter demarcation in the temporal lobe; and 6, decreased temporal lobe size.
Feature 1 was present in 14 patients and was best appreciated on the T2-weighted images in planes parallel to the long axes of the hippocampi. Feature 2, present in 12 patients, and feature 6, present in 9 patients, were optimally seen in the coronal planes and on the inversion-recovery sequences in particular. Feature 3, present in 12 patients, was optimally seen on the coronal T2-weighted images. Feature 4, seen in 11 patients, was equally well seen in all planes (transverse, coronal, and parallel to the long axes of the hippocampi). Feature 5, seen in 10 patients, was best appreciated on the T2-weighted images in the planes of the long axes of the hippocampi. Histologic investigation of the temporal lobe white matter in the 10 patients with feature 5 demonstrated on the MR scan showed abnormalities in 7 cases. Oligodendroglia cell clusters were found in 6, with concomitant corpora amylacea in 1 case and perivascular macrophages with pigment a sole finding in another case.
Of the six features found in cases of mesial temporal sclerosis on MR, increased hippocampal signal intensity is the most consistent. A decreased gray-white matter demarcation in the temporal lobe parenchyma is also a frequent feature of this disease. A combination of multiple scanning planes results in an optimal demonstration of lesions.
确定内侧颞叶硬化中各种磁共振（MR）征象的出现频率，确定显示这些征象的最佳扫描平面，并对颞叶灰质与白质分界不清这一内侧颞叶硬化患者常见的MR表现提出组织学解释。
对14例接受手术治疗的癫痫患者进行MR扫描，这些患者经组织学证实为内侧颞叶硬化，评估其是否存在以下六个特征：特征1，海马高信号强度；2，海马体积减小；3，海马旁侧白质同侧萎缩；4，颞角扩大；5，颞叶灰质与白质分界不清；6，颞叶体积减小。
特征1在14例患者中均存在，在与海马长轴平行的平面上的T2加权图像上显示最佳。特征2存在于12例患者中，特征6存在于9例患者中，在冠状平面尤其是反转恢复序列上显示最佳。特征3存在于12例患者中，在冠状T2加权图像上显示最佳。特征4在11例患者中可见，在所有平面（横轴、冠状轴以及与海马长轴平行的平面）上显示效果相同。特征5在10例患者中可见，在与海马长轴平行的平面上的T2加权图像上显示最佳。对MR扫描显示有特征5的10例患者的颞叶白质进行组织学研究，发现7例有异常。6例发现少突胶质细胞簇，1例伴有淀粉样体，另1例仅发现血管周围含色素巨噬细胞。
在MR检查发现的内侧颞叶硬化的六个特征中，海马信号强度增加最为一致。颞叶实质内灰质与白质分界不清也是该病的常见特征。多个扫描平面相结合可最佳显示病变。
