Van Paesschen W, Sisodiya S, Connelly A, Duncan J S, Free S L, Raymond A A, Grünewald R A, Revesz T, Shorvon S D, Fish D R
Epilepsy Research Group, National Hospital for Neurology and Neurosurgery, London, UK.
Neurology. 1995 Dec;45(12):2233-40. doi: 10.1212/wnl.45.12.2233.
To evaluate and compare T2 relaxometry and volumetrics of hippocampus in the presurgical evaluation of patients with intractable temporal lobe epilepsy (TLE), and to correlate these quantitative MRI measures with the pathology of the resected hippocampus.
Forty patients with intractable TLE who underwent presurgical evaluation and subsequent temporal lobe surgery.
Hippocampal T2 (HCT2), volumes of hippocampi and hippocampal volume ratio (HCVR) (volume of hippocampus with higher HCT2 divided by volume of hippocampus with lower HCT2), and qualitative pathology.
Thirty-two patients had hippocampal sclerosis, three patients had end-folium sclerosis, one patient had amygdala sclerosis, and four patients had a foreign tissue lesion in the temporal lobe. HCT2 (R/L) correlated inversely with the ratio of hippocampal volumes (R/L) (r = -0.91; p < 0.0001). A high T2 signal in an atrophic hippocampus was characteristic of hippocampal sclerosis. All patients with hippocampal sclerosis had an HCVR below control values, and only one of these had an HCT2 in the normal range. HCVR produced one false-positive result. The patients with end-folium sclerosis had normal HCT2 and HCVR. The patient with amygdala sclerosis had a normal hippocampus on qualitative and quantitative assessment. Of the four patients with a lesion, one had a mildly increased HCT2 and one had mild volume asymmetry. Hippocampal volume asymmetry could be reliably detected on visual inspection of the MRI with an HCVR of 0.85 or less, and an increase of HCT2 with a T2 of 115 msec or higher.
Quantitative MRI combining HCT2 and HCVR is a reliable method for diagnosing hippocampal sclerosis noninvasively. End-folium sclerosis and amygdala sclerosis should be considered in patients with intractable TLE and negative findings on MRI studies, including quantitative measures of the hippocampus.
在难治性颞叶癫痫（TLE）患者的术前评估中，评估并比较海马的T2弛豫测量法和体积测量法，并将这些定量MRI测量结果与切除海马的病理学结果相关联。
40例接受术前评估及随后颞叶手术的难治性TLE患者。
海马T2（HCT2）、海马体积及海马体积比（HCVR）（HCT2较高的海马体积除以HCT2较低的海马体积），以及定性病理学结果。
32例患者有海马硬化，3例患者有终叶硬化，1例患者有杏仁核硬化，4例患者颞叶有异物病变。HCT2（右/左）与海马体积比（右/左）呈负相关（r = -0.91；p < 0.0001）。萎缩海马中的高T2信号是海马硬化的特征。所有海马硬化患者的HCVR均低于对照值，其中只有1例HCT2在正常范围内。HCVR产生了1例假阳性结果。终叶硬化患者的HCT2和HCVR正常。杏仁核硬化患者在定性和定量评估中显示海马正常。4例有病变的患者中，1例HCT2轻度升高，1例有轻度体积不对称。当HCVR为0.85或更低且T2为115毫秒或更高时，HCT2升高，通过MRI视觉检查可可靠检测到海马体积不对称。
结合HCT2和HCVR的定量MRI是一种可靠的无创诊断海马硬化的方法。对于难治性TLE且MRI研究（包括海马定量测量）结果为阴性的患者，应考虑终叶硬化和杏仁核硬化。
