Comparative diagnostic utility of 1H MRS and DWI in evaluation of temporal lobe epilepsy

Objective: To compare the ability of diffusion-weighted MRI (DWI) and 1H MRS to lateralize to the temporal lobe of seizure onset and to predict postoperative seizure control in patients with temporal lobe epilepsy (TLE). Methods: Forty TLE patients who subsequently underwent epilepsy surgery and 20 normal subjects were studied with 1H MRS and DWI. Medial parietal and temporal lobe N-acetylaspartate (NAA)/creatine (Cr) ratios and hippocampal and temporal stem apparent diffusion coefficients (ADC) were obtained. Lateralization to either temporal lobe with each MR measurement was based on the threshold values derived from ±1-SD right/left ratios of normal subjects. Results: Temporal lobe NAA/Cr lateralized to the operated temporal lobe in 18 of 40 (45%), hippocampal ADC in 32 of 40 (80%), and temporal stem ADC in 26 of 40 (65%) patients. Almost all of the cases that lateralized to the surgical side with NAA/Cr ratios (94%) had an excellent postoperative seizure control (p = 0.01). Lateralization to the side of surgery was not associated with surgical outcome with hippocampal and temporal stem ADC (p > 0.05). Conclusion:1H MRS and DWI complement each other in the clinical setting. DWI more frequently lateralized to the operated side, and 1HMRS was a better predictor of postoperative seizure control.

[1]  E. Achten,et al.  Value of single-voxel proton MR spectroscopy in temporal lobe epilepsy. , 1997, AJNR. American journal of neuroradiology.

[2]  P. Barker,et al.  N‐Acetyl Aspartate—A Neuronal Marker? , 2001, Annals of neurology.

[3]  H. Duvernoy,et al.  The Human Hippocampus: Functional Anatomy, Vascularization and Serial Sections with MRI , 1997 .

[4]  J C Gore,et al.  Reversible, reproducible reduction of brain water apparent diffusion coefficient by cortical electroshocks , 1997, Magnetic resonance in medicine.

[5]  P M Matthews,et al.  Normalization of neuronal metabolic dysfunction after surgery for temporal lobe epilepsy , 1997, Neurology.

[6]  F Cendes,et al.  Prognostic value of proton magnetic resonance spectroscopic imaging for surgical outcome in patients with intractable temporal lobe epilepsy and bilateral hippocampal atrophy , 2000, Annals of neurology.

[7]  J. Kim.  Pathology of seizure disorders. , 1995, Neuroimaging clinics of North America.

[8]  J. Peeling,et al.  1H Magnetic resonance spectroscopy of extracts of human epileptic neocortex and hippocampus , 1993, Neurology.

[9]  E. Achten.  Aspects of proton MR spectroscopy in the seizure patient. , 1998, Neuroimaging clinics of North America.

[10]  J. E. Tanner,et al.  Spin diffusion measurements : spin echoes in the presence of a time-dependent field gradient , 1965 .

[11]  B Diehl,et al.  Periictal Diffusion‐Weighted Imaging in a Case of Lesional Epilepsy , 1999, Epilepsia.

[12]  M E Moseley,et al.  MRI abnormalities associated with partial status epilepticus , 1999, Neurology.

[13]  R. Kuzniecky,et al.  Postictal stability of proton magnetic resonance spectroscopy imaging (1H-MRSI) ratios in temporal lobe epilepsy , 2001, Neurology.

[14]  F Cendes,et al.  Medial temporal lobe neuronal damage in temporal and extratemporal lesional epilepsy , 2000, Neurology.

[15]  C. Jack,et al.  Subtraction ictal SPECT co‐registered to MRI improves clinical usefulness of SPECT in localizing the surgical seizure focus , 1998, Neurology.

[16]  P G Webb,et al.  Automated single‐voxel proton MRS: Technical development and multisite verification , 1994, Magnetic resonance in medicine.

[17]  G J Barker,et al.  Water diffusion in the human hippocampus in epilepsy. , 1999, Magnetic resonance imaging.

[18]  A G Sorensen,et al.  Diffusion-weighted MR imaging in acute stroke: theoretic considerations and clinical applications. , 1999, AJR. American journal of roentgenology.

[19]  P. Matthews,et al.  A proton magnetic resonance spectroscopy study of focal epilepsy in humans , 1990, Neurology.

[20]  D. Gadian,et al.  Magnetic resonance spectroscopy in temporal lobe epilepsy , 1994, Neurology.

[21]  R. Kuzniecky,et al.  Relative utility of 1H spectroscopic imaging and hippocampal volumetry in the lateralization of mesial temporal lobe epilepsy , 1998, Neurology.

[22]  M. Weiner,et al.  Metabolic and pathological effects of temporal lobe epilepsy in rat brain detected by proton spectroscopy and imaging , 1997, Brain Research.

[23]  G. Fein,et al.  Temporal lobe epilepsy: bilateral hippocampal metabolite changes revealed at proton MR spectroscopic imaging. , 1997, Radiology.

[24]  C. Pierpaoli,et al.  Brain parenchyma apparent diffusion coefficient alterations associated with experimental complex partial status epilepticus. , 1994, Magnetic resonance imaging.

[25]  G. Fein,et al.  Presurgical multimodality neuroimaging in electroencephalographic lateralized temporal lobe epilepsy , 1997, Annals of neurology.

[26]  C. Jack,et al.  MR imaging-based volume measurements of the hippocampal formation and anterior temporal lobe: validation studies. , 1990, Radiology.

[27]  Jerome Engel,et al.  Outcome with respect to epileptic seizures. , 1993 .

[28]  G J Barker,et al.  Wallerian Degeneration in the Optic Radiation After Temporal Lobectomy Demonstrated In Vivo with Diffusion Tensor Imaging , 1999, Epilepsia.

[29]  James W. Hugg,et al.  Diffusion mapping applied to mesial temporal lobe epilepsy , 1999, Neurology.

[30]  J. Coyle,et al.  N-Acetylaspartate in neuropsychiatric disorders , 1995, Progress in Neurobiology.

[31]  R. Kuzniecky,et al.  Predictive value of 1H MRSI for outcome in temporal lobectomy , 1999, Neurology.

[32]  F. Sharbrough,et al.  Assessing changes over time in temporal lobectomy: outcome by scoring seizure frequency 1 Presented at the 48th Annual Scientific Meeting of the American Epilepsy Society, New Orleans, LA. 1 , 1997, Epilepsy Research.

[33]  P. Grenier,et al.  MR imaging of intravoxel incoherent motions: application to diffusion and perfusion in neurologic disorders. , 1986, Radiology.

[34]  F. Hui,et al.  MRI of the fornix and mamillary body in temporal lobe epilepsy , 1997, Neuroradiology.

[35]  R. Kuzniecky,et al.  Normalization of contralateral metabolic function following temporal lobectomy demonstrated by 1H magnetic resonance spectroscopic imaging , 1996, Annals of neurology.

[36]  T. Takeuchi,et al.  Incorporation of Dietary Docosahexaenoic Acid into the Central Nervous System of the Yellowtail Seriola quinqueradiata , 1999, Brain, Behavior and Evolution.

[37]  Frederick Andermann,et al.  Neuroimaging evidence of progressive neuronal loss and dysfunction in temporal lobe epilepsy , 1999, Annals of neurology.

[38]  M. Symms,et al.  Diffusion changes in status epilepticus , 1997, The Lancet.

[39]  B Diehl,et al.  Postictal Diffusion‐Weighted Imaging for the Localization of Focal Epileptic Areas in Temporal Lobe Epilepsy , 2001, Epilepsia.

[40]  D. Arnold,et al.  Proton magnetic resonance spectroscopic imaging and magnetic resonance imaging volumetry in the lateralization of temporal lobe epilepsy: A series of 100 patients , 1997, Annals of neurology.