1
|
Ellsay AC, Winston GP. Advances in MRI-based diagnosis of temporal lobe epilepsy: Correlating hippocampal subfield volumes with histopathology. J Neuroimaging 2024. [PMID: 39092876 DOI: 10.1111/jon.13225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/27/2024] [Accepted: 07/17/2024] [Indexed: 08/04/2024] Open
Abstract
Epilepsy, affecting 0.5%-1% of the global population, presents a significant challenge with 30% of patients resistant to medical treatment. Temporal lobe epilepsy, a common cause of medically refractory epilepsy, is often caused by hippocampal sclerosis (HS). HS can be divided further by subtype, as defined by the International League Against Epilepsy (ILAE). Type 1 HS, the most prevalent form (60%-80% of all cases), is characterized by cell loss and gliosis predominantly in the subfields cornu ammonis (CA1) and CA4. Type 2 HS features cell loss and gliosis primarily in the CA1 sector, and type 3 HS features cell loss and gliosis predominantly in the CA4 subfield. This literature review evaluates studies on hippocampal subfields, exploring whether observable atrophy patterns from in vivo and ex vivo magnetic resonance imaging (MRI) scans correlate with histopathological examinations with manual or automated segmentation techniques. Our findings suggest only ex vivo 1.5 Tesla (T) or 3T MRI with manual segmentation or in vivo 7T MRI with manual or automated segmentations can consistently correlate subfield patterns with histopathologically derived ILAE-HS subtypes. In conclusion, manual and automated segmentation methods offer advantages and limitations in diagnosing ILAE-HS subtypes, with ongoing research crucial for refining hippocampal subfield segmentation techniques and enhancing clinical applicability.
Collapse
Affiliation(s)
- Andrea C Ellsay
- Centre for Neuroscience Studies, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Gavin P Winston
- Centre for Neuroscience Studies, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
- Division of Neurology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| |
Collapse
|
2
|
Lee TH, Shih YC, Lu YJ, Chou CC, Lee CC, Yu HY, Peng SJ. Glucose Metabolism of Hippocampal Subfields in Medial Temporal Lobe Epilepsy. Clin Nucl Med 2024; 49:294-300. [PMID: 38382495 DOI: 10.1097/rlu.0000000000005105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
PURPOSE Reduced glucose metabolism in the hippocampus is commonly observed in cases of medial temporal lobe epilepsy (MTLE) with hippocampal sclerosis (HS). Glucose metabolism among the various hippocampal subfields has not been thoroughly investigated. PATIENTS AND METHODS This study examined 29 patients (18 females; 15-58 years) diagnosed with HS who underwent surgery for drug-resistant epilepsy. FreeSurfer 7.1.1 was used in the processing of MRI data and 18 F-FDG PET scans to derive volumetric data and the FDG SUVr in the whole hippocampus and hippocampal subfields, including the CA1, CA2-4, granule cell and molecular layer of the dentate gyrus (GC-ML-DG), and subiculum. Asymmetries in the volume and SUVr between the 2 sides from the subfields of the hippocampus were defined in terms of an asymmetry index. Comparisons of the asymmetry index among these regions were performed. The correlations between asymmetry index values and postoperative outcomes and presurgical neuropsychological test results were also evaluated. RESULT The CA1, CA2-4, subiculum, GC-ML-DG, and whole hippocampus presented reductions in volume and hypometabolism ipsilateral to MTLE. Asymmetries in volume and SUVr were significantly less pronounced in the CA1 and subiculum than in the CA2-4 or GC-ML-DG. Postoperative seizure outcomes were not correlated with the asymmetry index for volume or SUVr in any hippocampal subfield. In cases of left MTLE, scores of immediate logical memory and delayed logical memory were positively correlated with the asymmetry index for SUVr in the following subfields: CA1 ( R = 0.829, P = 0.021; R = 0.770, P = 0.043), CA2-4 ( R = 0.825, P = 0.022; R = 0.894, P = 0.007), subiculum ( R = 0.882, P = 0.009; R = 0.853, P = 0.015), GC-ML-DG ( R = 0.850, P = 0.015; R = 0.796, P = 0.032), and whole hippocampus ( R = 0.841, P = 0.018; R = 0.822, P = 0.023). In cases of right MTLE, the scores for delayed face memory were positively correlated with the asymmetry index for SUVr in the subiculum ( R = 0.935, P = 0.006). CONCLUSIONS In cases of HS, changes in glucose metabolism levels varied among the hippocampal subfields. Asymmetries in glucose metabolism among the CA-1, CA2-4, subiculum, and GC-ML-DG subregions were correlated with scores for verbal memory among patients with left MTLE. Asymmetric glucose metabolism in the subiculum was also correlated with visual memory scores among patients with right MTLE.
Collapse
Affiliation(s)
| | | | - Yi-Jiun Lu
- Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei
| | | | | | | | | |
Collapse
|
3
|
Filimonova EA, Pashkov AA, Moysak GI, Tropynina AY, Zhanaeva SY, Shvaikovskaya AA, Akopyan AA, Danilenko KV, Aftanas LI, Tikhonova MA, Rzaev JA. Brain but not serum BDNF levels are associated with structural alterations in the hippocampal regions in patients with drug-resistant mesial temporal lobe epilepsy. Front Neurosci 2023; 17:1217702. [PMID: 37539386 PMCID: PMC10395949 DOI: 10.3389/fnins.2023.1217702] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/03/2023] [Indexed: 08/05/2023] Open
Abstract
Mesial temporal lobe epilepsy is the most common type of focal epilepsy, imposing a significant burden on the health care system worldwide. Approximately one-third of patients with this disease who do not adequately respond to pharmacotherapy are considered drug-resistant subjects. Despite having some clues of how such epileptic activity and resistance to therapy emerge, coming mainly from preclinical models, we still witness a scarcity of human data. To narrow this gap, in this study, we aimed to estimate the relationship between hippocampal and serum levels of brain-derived neurotrophic factor (BDNF), one of the main and most widely studied neurotrophins, and hippocampal subfield volumes in patients with drug-resistant mesial temporal epilepsy undergoing neurosurgical treatment. We found that hippocampal (but not serum) BDNF levels were negatively correlated with the contralateral volumes of the CA1 and CA4 subfields, presubiculum, subiculum, dentate gyrus, and molecular layer of the hippocampus. Taken together, these findings are generally in accordance with existing data, arguing for a proepileptic nature of BDNF effects in the hippocampus and related brain structures.
Collapse
Affiliation(s)
- Elena A. Filimonova
- FSBI "Federal Center of Neurosurgery", Novosibirsk, Russia
- Department of Neurosurgery, Novosibirsk State Medical University, Novosibirsk, Russia
| | - Anton A. Pashkov
- FSBI "Federal Center of Neurosurgery", Novosibirsk, Russia
- Biomedical School, South Ural State University, Chelyabinsk, Russia
| | - Galina I. Moysak
- FSBI "Federal Center of Neurosurgery", Novosibirsk, Russia
- Department of Neuroscience, Institute of Medicine and Psychology, Novosibirsk State University, Novosibirsk, Russia
| | - Anastasia Y. Tropynina
- Department of Neuroscience, Institute of Medicine and Psychology, Novosibirsk State University, Novosibirsk, Russia
- Scientific Research Institute of Neurosciences and Medicine, Novosibirsk, Russia
| | - Svetlana Y. Zhanaeva
- Scientific Research Institute of Neurosciences and Medicine, Novosibirsk, Russia
| | | | - Anna A. Akopyan
- Scientific Research Institute of Neurosciences and Medicine, Novosibirsk, Russia
| | | | - Lyubomir I. Aftanas
- Department of Neuroscience, Institute of Medicine and Psychology, Novosibirsk State University, Novosibirsk, Russia
- Scientific Research Institute of Neurosciences and Medicine, Novosibirsk, Russia
| | - Maria A. Tikhonova
- Scientific Research Institute of Neurosciences and Medicine, Novosibirsk, Russia
| | - Jamil A. Rzaev
- FSBI "Federal Center of Neurosurgery", Novosibirsk, Russia
- Department of Neurosurgery, Novosibirsk State Medical University, Novosibirsk, Russia
- Department of Neuroscience, Institute of Medicine and Psychology, Novosibirsk State University, Novosibirsk, Russia
| |
Collapse
|
4
|
Ballerini A, Arienzo D, Stasenko A, Schadler A, Vaudano AE, Meletti S, Kaestner E, McDonald CR. Spatial patterns of gray and white matter compromise relate to age of seizure onset in temporal lobe epilepsy. Neuroimage Clin 2023; 39:103473. [PMID: 37531834 PMCID: PMC10415805 DOI: 10.1016/j.nicl.2023.103473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/29/2023] [Accepted: 07/06/2023] [Indexed: 08/04/2023]
Abstract
OBJECTIVE Temporal Lobe Epilepsy (TLE) is frequently a neurodevelopmental disorder, involving subcortical volume loss, cortical atrophy, and white matter (WM) disruption. However, few studies have addressed how these pathological changes in TLE relate to one another. In this study, we investigate spatial patterns of gray and white matter degeneration in TLE and evaluate the hypothesis that the relationship among these patterns varies as a function of the age at which seizures begin. METHODS Eighty-two patients with TLE and 59 healthy controls were enrolled. T1-weighted images were used to obtain hippocampal volumes and cortical thickness estimates. Diffusion-weighted imaging was used to obtain fractional anisotropy (FA) and mean diffusivity (MD) of the superficial WM (SWM) and deep WM tracts. Analysis of covariance was used to examine patterns of WM and gray matter alterations in TLE relative to controls, controlling for age and sex. Sliding window correlations were then performed to examine the relationships between SWM degeneration, cortical thinning, and hippocampal atrophy across ages of seizure onset. RESULTS Cortical thinning in TLE followed a widespread, bilateral pattern that was pronounced in posterior centroparietal regions, whereas SWM and deep WM loss occurred mostly in ipsilateral, temporolimbic regions compared to controls. Window correlations revealed a relationship between hippocampal volume loss and whole brain SWM disruption in patients who developed epilepsy during childhood. On the other hand, in patients with adult-onset TLE, co-occurring cortical and SWM alterations were observed in the medial temporal lobe ipsilateral to the seizure focus. SIGNIFICANCE Our results suggest that although cortical, hippocampal and WM alterations appear spatially discordant at the group level, the relationship among these features depends on the age at which seizures begin. Whereas neurodevelopmental aspects of TLE may result in co-occurring WM and hippocampal degeneration near the epileptogenic zone, the onset of seizures in adulthood may set off a cascade of SWM microstructural loss and cortical atrophy of a neurodegenerative nature.
Collapse
Affiliation(s)
- Alice Ballerini
- Department of Biomedical, Metabolic and Neural Science, University of Modena and Reggio Emilia, Modena, Italy; Department of Psychiatry, University of California, San Diego, USA
| | - Donatello Arienzo
- Department of Psychiatry, University of California, San Diego, USA; Center for Multimodal Imaging and Genetics, University of California, San Diego, USA
| | - Alena Stasenko
- Department of Psychiatry, University of California, San Diego, USA; Center for Multimodal Imaging and Genetics, University of California, San Diego, USA
| | - Adam Schadler
- Department of Psychiatry, University of California, San Diego, USA; Center for Multimodal Imaging and Genetics, University of California, San Diego, USA
| | - Anna Elisabetta Vaudano
- Department of Biomedical, Metabolic and Neural Science, University of Modena and Reggio Emilia, Modena, Italy; Neurology Unit, OCB Hospital, AOU Modena, Italy
| | - Stefano Meletti
- Department of Biomedical, Metabolic and Neural Science, University of Modena and Reggio Emilia, Modena, Italy; Neurology Unit, OCB Hospital, AOU Modena, Italy
| | - Erik Kaestner
- Department of Psychiatry, University of California, San Diego, USA; Center for Multimodal Imaging and Genetics, University of California, San Diego, USA
| | - Carrie R McDonald
- Department of Psychiatry, University of California, San Diego, USA; Center for Multimodal Imaging and Genetics, University of California, San Diego, USA; Department of Radiation Medicine & Applied Sciences, University of California, San Diego, USA.
| |
Collapse
|
5
|
Almeida LCA, Lobato VA, Santos MDCV, Moraes ACD, Costa BS. Surgical treatment of temporal lobe epilepsy: comparative results of selective amygdalohippocampectomy versus anterior temporal lobectomy from a referral center in Brazil. ARQUIVOS DE NEURO-PSIQUIATRIA 2023; 81:647-655. [PMID: 37494949 PMCID: PMC10658662 DOI: 10.1055/s-0043-1771172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 04/12/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Temporal lobe epilepsy (TLE) is a high prevalence neurological disorder. Surgery has emerged as a promising treatment. OBJECTIVE The objective of this work is to compare the surgical results of anterior temporal lobectomy (ATL) versus selective amygdalohippocampectomy (SAH) in a cohort of 132 patients. METHODS We performed a retrospective study of 146 patients operated for TLE from 2008 to 2019. Initially, 13 patients were excluded from the study due to insufficient medical record data or follow-up loss. One patient was excluded from the analysis of the results due to death in the first postoperative week. We used the ILAE scale to classify seizure control after surgery. In patients with left hippocampal sclerosis, SAH was performed and in right temporal lobe epilepsy, ATL was the approach of choice. RESULTS The mean follow-up time after surgery was 57.2 months (12-137). In our data analysis, we found that the group of patients undergoing ATL had a higher prevalence of being completely seizure-free (ILAE I) (57.1% versus 31%) and a higher rate of satisfactory seizure control (88.6% versus 69.3%) p = 0,006, when compared with patients undergoing SAH. CONCLUSION The literature is still controversial about seizure control concerning the technique used due to the lack of a robust methodology. Our data analysis identified the superiority of ATL over SAH in seizure outcomes. ATL may be the best option for adequately controlling seizures with minimal additional morbidity in countries with a cost limitation for extended propaedeutics.
Collapse
Affiliation(s)
| | - Vanessa Alves Lobato
- Santa Casa de Misericórdia de Belo Horizonte, Departamento de Neurologia e
Neurocirurgia, Belo Horizonte MG, Brazil.
| | | | - Aline Curcio de Moraes
- Santa Casa de Misericórdia de Belo Horizonte, Departamento de Neurologia e
Neurocirurgia, Belo Horizonte MG, Brazil.
| | - Bruno Silva Costa
- Santa Casa de Misericórdia de Belo Horizonte, Departamento de Neurologia e
Neurocirurgia, Belo Horizonte MG, Brazil.
| |
Collapse
|
6
|
Ballerini A, Tondelli M, Talami F, Molinari MA, Micalizzi E, Giovannini G, Turchi G, Malagoli M, Genovese M, Meletti S, Vaudano AE. Amygdala subnuclear volumes in temporal lobe epilepsy with hippocampal sclerosis and in non-lesional patients. Brain Commun 2022; 4:fcac225. [PMID: 36213310 PMCID: PMC9536297 DOI: 10.1093/braincomms/fcac225] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 05/12/2022] [Accepted: 09/05/2022] [Indexed: 11/28/2022] Open
Abstract
Together with hippocampus, the amygdala is important in the epileptogenic network of patients with temporal lobe epilepsy. Recently, an increase in amygdala volumes (i.e. amygdala enlargement) has been proposed as morphological biomarker of a subtype of temporal lobe epilepsy patients without MRI abnormalities, although other data suggest that this finding might be unspecific and not exclusive to temporal lobe epilepsy. In these studies, the amygdala is treated as a single entity, while instead it is composed of different nuclei, each with peculiar function and connection. By adopting a recently developed methodology of amygdala’s subnuclei parcellation based of high-resolution T1-weighted image, this study aims to map specific amygdalar subnuclei participation in temporal lobe epilepsy due to hippocampal sclerosis (n = 24) and non-lesional temporal lobe epilepsy (n = 24) with respect to patients with focal extratemporal lobe epilepsies (n = 20) and healthy controls (n = 30). The volumes of amygdala subnuclei were compared between groups adopting multivariate analyses of covariance and correlated with clinical variables. Additionally, a logistic regression analysis on the nuclei resulting statistically different across groups was performed. Compared with other populations, temporal lobe epilepsy with hippocampal sclerosis showed a significant atrophy of the whole amygdala (pBonferroni = 0.040), particularly the basolateral complex (pBonferroni = 0.033), while the non-lesional temporal lobe epilepsy group demonstrated an isolated hypertrophy of the medial nucleus (pBonferroni = 0.012). In both scenarios, the involved amygdala was ipsilateral to the epileptic focus. The medial nucleus demonstrated a volume increase even in extratemporal lobe epilepsies although contralateral to the seizure onset hemisphere (pBonferroni = 0.037). Non-lesional patients with psychiatric comorbidities showed a larger ipsilateral lateral nucleus compared with those without psychiatric disorders. This exploratory study corroborates the involvement of the amygdala in temporal lobe epilepsy, particularly in mesial temporal lobe epilepsy and suggests a different amygdala subnuclei engagement depending on the aetiology and lateralization of epilepsy. Furthermore, the logistic regression analysis indicated that the basolateral complex and the medial nucleus of amygdala can be helpful to differentiate temporal lobe epilepsy with hippocampal sclerosis and with MRI negative, respectively, versus controls with a consequent potential clinical yield. Finally, the present results contribute to the literature about the amygdala enlargement in temporal lobe epilepsy, suggesting that the increased volume of amygdala can be regarded as epilepsy-related structural changes common across different syndromes whose meaning should be clarified.
Collapse
Affiliation(s)
- Alice Ballerini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia , Modena 41125 , Italy
| | | | - Francesca Talami
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia , Modena 41125 , Italy
| | | | - Elisa Micalizzi
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia , Modena 41121 , Italy
| | - Giada Giovannini
- Neurology Unit, OCB Hospital, AOU Modena , Modena 41126 , Italy
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia , Modena 41121 , Italy
| | - Giulia Turchi
- Neurology Unit, OCB Hospital, AOU Modena , Modena 41126 , Italy
| | - Marcella Malagoli
- Neuroradiology Unit, OCB Hospital, AOU Modena , Modena 41126 , Italy
| | - Maurilio Genovese
- Neuroradiology Unit, OCB Hospital, AOU Modena , Modena 41126 , Italy
| | - Stefano Meletti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia , Modena 41125 , Italy
- Neurology Unit, OCB Hospital, AOU Modena , Modena 41126 , Italy
| | - Anna Elisabetta Vaudano
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia , Modena 41125 , Italy
- Neurology Unit, OCB Hospital, AOU Modena , Modena 41126 , Italy
| |
Collapse
|
7
|
Jo H, Kim J, Kim D, Hwang Y, Seo D, Hong S, Shon YM. Lateralizing Characteristics of Morphometric Changes to Hippocampus and Amygdala in Unilateral Temporal Lobe Epilepsy with Hippocampal Sclerosis. Medicina (B Aires) 2022; 58:medicina58040480. [PMID: 35454319 PMCID: PMC9029741 DOI: 10.3390/medicina58040480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 11/16/2022] Open
Abstract
Background andObjective: In the present study, a detailed investigation of substructural volume change in the hippocampus (HC) and amygdala (AMG) was performed and the association with clinical features in patients with mesial temporal lobe epilepsy with hippocampal sclerosis (TLE-HS) determined. Methods: The present study included 22 patients with left-sided TLE-HS (LTLE-HS) and 26 patients with right-sided TLE-HS (RTLE-HS). In addition, 28 healthy controls underwent high-resolution T2-weighted image (T2WI) and T1-weighted image (T1WI) MRI scanning. Subfield analysis of HC and AMG was performed using FreeSurfer version 6.0. Results: Patients with TLE-HS showed a decrease in the volume of substructures in both HC and AMG, and this change was observed on the contralateral side and the ipsilateral side with HS. The volume reduction pattern of substructures showed laterality-dependent characteristics. Patients with LTLE-HS had smaller volumes of the ipsilateral subiculum (SUB), contralateral SUB, and ipsilateral cortical nucleus of AMG than patients with RTLE-HS. Patients with RTLE-HS had reduced ipsilateral cornu ammonis (CA) 2/3 and contralateral cortico-amygdaloid transition area (CAT) volumes. The relationship between clinical variables and subregions was different based on the lateralization of the seizure focus. Focal to bilateral tonic-clonic seizures (FTBTCS) was associated with contralateral and ipsilateral side subregions only in LTLE-HS. The abdominal FAS was associated with the volume reduction of AMG subregions only in LTLE-HS, but the volume reduction was less than in patients without FAS. Conclusions: The results indicate that unilateral TLE-HS is a bilateral disease that shows different laterality-dependent characteristics based on the subfield analysis of HC and AMG. Subfield volumes of HC and AMG were associated with clinical variables, and the more damaged substructures depended on laterality in TLE-HS. These findings support the evidence that LTLE-HS and RTLE-HS are disparate epilepsy entities rather than simply identical syndromes harboring a mesial temporal lesion. In addition, the presence of FAS supports good localization value, and abdominal FAS has a high localization value, especially in patients with LTLE-HS.
Collapse
Affiliation(s)
- Hyunjin Jo
- Samsung Medical Center, Department of Neurology, Sungkyunkwan University School of Medicine, Seoul 06355, Korea; (H.J.); (J.K.); (D.S.); (S.H.)
| | - Jeongsik Kim
- Samsung Medical Center, Department of Neurology, Sungkyunkwan University School of Medicine, Seoul 06355, Korea; (H.J.); (J.K.); (D.S.); (S.H.)
| | - Dongyeop Kim
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul 03760, Korea;
| | - Yoonha Hwang
- Department of Neurology, The Catholic University of Korea Eunpyeong St. Mary’s Hospital, Seoul 07345, Korea;
| | - Daewon Seo
- Samsung Medical Center, Department of Neurology, Sungkyunkwan University School of Medicine, Seoul 06355, Korea; (H.J.); (J.K.); (D.S.); (S.H.)
| | - Seungbong Hong
- Samsung Medical Center, Department of Neurology, Sungkyunkwan University School of Medicine, Seoul 06355, Korea; (H.J.); (J.K.); (D.S.); (S.H.)
| | - Young-Min Shon
- Samsung Medical Center, Department of Neurology, Sungkyunkwan University School of Medicine, Seoul 06355, Korea; (H.J.); (J.K.); (D.S.); (S.H.)
- Department of Medical Device Management and Research, Samsung Advanced Institute for Health Sciences & Technology (SAHIST), Sunkyunkwan University, Seoul 06355, Korea
- Correspondence: ; Tel.: +82-2-3410-2701
| |
Collapse
|
8
|
Khlif MS, Werden E, Bird LJ, Egorova-Brumley N, Brodtmann A. Atrophy of Ipsilesional Hippocampal Subfields Vary Over First Year After Ischemic Stroke. J Magn Reson Imaging 2021; 56:273-281. [PMID: 34837426 DOI: 10.1002/jmri.28009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The structural integrity of hippocampal subfields has been investigated in many neurological disorders and was shown to be better associated with cognitive performance than whole hippocampus. In stroke, hippocampal atrophy is linked to cognitive impairment, but it is unknown whether the hippocampal subfields atrophy differently. PURPOSE To evaluate longitudinal hippocampal subfield atrophy in first year poststroke, in comparison with atrophy in healthy individuals. STUDY TYPE Cohort. SUBJECTS A total of 92 ischemic stroke (age: 67 ± 12 years, 63 men) and 39 healthy participants (age: 69 ± 7 years, 24 men). FIELD STRENGTH/SEQUENCE A3 T/T1-MPRAGE, T2-SPACE, and T2-FLAIR. ASSESSMENT FreeSurfer (6.0) was used to delineate 12 hippocampal subfields. Whole hippocampal volume was computed as sum of subfield volumes excluding hippocampal fissure volume. Separate assessments were completed for contralesional and ipsilesional hippocampi. STATISTICAL TESTS A mixed-effect regression model was used to compare subfield volumes cross-sectionally between healthy and stroke groups and longitudinally between 3-month and 12-month timepoints. False discovery rate at 0.05 significance level was used to correct for multiple comparisons. Also, a receiver operating characteristic (ROC) curve analysis was performed to assess differentiation between healthy and stroke participants based on subfield volumes. RESULTS There were no volume differences between groups at 3 months, but there was a significant difference (P = 0.027) in whole hippocampal volume reduction over time between control and stroke ipsilesionally. Thus, the ipsilesional whole hippocampal volume in stroke became significantly smaller (P = 0.035) at 12 months. The hippocampal tail was the highest single-region contributor (22.7%) to ipsilesional hippocampal atrophy (1.19%) over 9 months. The cornu ammonis areas (CA1) subfield volume reduction was minimal in controls and stroke contralesionally but significant ipsilesionally (P = 0.007). CA1 volume significantly outperformed whole hippocampal volume (P < 0.01) in discriminating between stroke participants and healthy controls in ROC curve analysis. DATA CONCLUSION Greater stroke-induced effects were observed in the ipsilesional hippocampus anteriorly in CA1 and posteriorly in the hippocampal tail. Atrophy of CA1 and hippocampal tail may provide a better link to cognitive impairment than whole hippocampal atrophy. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY STAGE: 3.
Collapse
Affiliation(s)
- Mohamed Salah Khlif
- The Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Emilio Werden
- The Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Laura J Bird
- The Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Natalia Egorova-Brumley
- The Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Amy Brodtmann
- The Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia.,Department of Neurology, Austin Health, Heidelberg, Victoria, Australia.,Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Eastern Cognitive Disorders Clinic, Box Hill Hospital, Monash University, Box Hill, Victoria, Australia
| |
Collapse
|
9
|
Mizutani M, Sone D, Sano T, Kimura Y, Maikusa N, Shigemoto Y, Goto Y, Takao M, Iwasaki M, Matsuda H, Sato N, Saito Y. Histopathological validation and clinical correlates of hippocampal subfield volumetry based on T2-weighted MRI in temporal lobe epilepsy with hippocampal sclerosis. Epilepsy Res 2021; 177:106759. [PMID: 34521044 DOI: 10.1016/j.eplepsyres.2021.106759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/13/2021] [Accepted: 09/07/2021] [Indexed: 12/01/2022]
Abstract
The objectives of this study were 1) to histologically validate the hippocampal subfield volumetry based on T2-weighted MRI, and 2) to explore its clinical impact on postsurgical memory function and seizure outcome in temporal lobe epilepsy (TLE) with hippocampal sclerosis (HS). We analyzed the cases of 24 patients with medial TLE (12 left, 12 right) and HS who were preoperatively examined with T2-weighted high-resolution MRI. The volume of each hippocampal subfield was calculated with an automatic segmentation of hippocampal subfields (ASHS) program. Hippocampal sclerosis patterns were determined pathologically, and the cross-sectional area and neuronal cell density of the CA1 and CA4 subfields were calculated using tissue specimens. Pre- and postoperative memory evaluations based on the Wechsler Memory Scale-Revised (WMS-R) were performed. We compared the presurgical MRI-based volumes with the pathological measurements in each subfield and then compared them with the change in the patients' neurocognitive function. As a result, there was a significant relationship between the presurgical MRI-based volume of CA4/dentate gyrus (DG) and the cross-sectional area of CA4 calculated with tissue specimens (Spearman's rs = 0.482, p = 0.023), and a similar trend-level correlation was observed in CA1 (rs = 0.455, p = 0.058). Some of MRI-based or pathology-based parameters in the subfields preliminarily showed relationships with the postsurgical memory changes. In conclusion, automated subfield volumetry for patients with hippocampal sclerosis moderately reflects their subfield atrophy and might be useful to predict the postsurgical change of memory function in these patients.
Collapse
Affiliation(s)
- Masashi Mizutani
- Department of Laboratory Medicine, National Center of Neurology and Psychiatry, Tokyo, Japan; Department of Neuropsychiatry, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan.
| | - Daichi Sone
- Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Tokyo, Japan; Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK; Department of Psychiatry, The Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato, Tokyo, 105-8461, Japan.
| | - Terunori Sano
- Department of Laboratory Medicine, National Center of Neurology and Psychiatry, Tokyo, Japan.
| | - Yukio Kimura
- Department of Radiology, National Center of Neurology and Psychiatry, Tokyo, Japan.
| | - Norihide Maikusa
- Department of Radiology, National Center of Neurology and Psychiatry, Tokyo, Japan.
| | - Yoko Shigemoto
- Department of Radiology, National Center of Neurology and Psychiatry, Tokyo, Japan.
| | - Yuichi Goto
- Medical Genome Center, National Center of Neurology and Psychiatry, Tokyo, Japan.
| | - Masaki Takao
- Department of Laboratory Medicine, National Center of Neurology and Psychiatry, Tokyo, Japan.
| | - Masaki Iwasaki
- Department of Neurosurgery, National Center of Neurology and Psychiatry, Tokyo, Japan.
| | - Hiroshi Matsuda
- Department of Radiology, National Center of Neurology and Psychiatry, Tokyo, Japan.
| | - Noriko Sato
- Department of Radiology, National Center of Neurology and Psychiatry, Tokyo, Japan.
| | - Yuko Saito
- Department of Laboratory Medicine, National Center of Neurology and Psychiatry, Tokyo, Japan; Department of Neuropathology, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.
| |
Collapse
|
10
|
Cho KH, Lee HJ, Heo K, Kim SE, Lee DA, Park KM. Intrinsic Thalamic Network in Temporal Lobe Epilepsy With Hippocampal Sclerosis According to Surgical Outcomes. Front Neurol 2021; 12:721610. [PMID: 34512532 PMCID: PMC8429827 DOI: 10.3389/fneur.2021.721610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/06/2021] [Indexed: 11/26/2022] Open
Abstract
Background: The aim of this study was to identify the differences of intrinsic amygdala, hippocampal, or thalamic networks according to surgical outcomes in temporal lobe epilepsy (TLE) patients with hippocampal sclerosis (HS). Methods: We enrolled 69 pathologically confirmed TLE patients with HS. All patients had pre-operative three-dimensional T1-weighted MRI using a 3.0 T scanner. We obtained the structural volumes of the amygdala nuclei, hippocampal subfields, and thalamic nuclei. Then, we investigated the intrinsic networks based on volumes of these structures using structural covariance and graph theoretical analysis. Results: Of the 69 TLE patients with HS, 21 patients (42.1%) had poor surgical outcomes, whereas 40 patients (57.9%) had good surgical outcomes. The volumes in the amygdala nuclei, hippocampal subfields, and thalamic nuclei were not different according to surgical outcome. In addition, the intrinsic amygdala and hippocampal networks were not different between the patients with poor and good surgical outcomes. However, there was a significant difference in the intrinsic thalamic network in the ipsilateral hemisphere between them. The eccentricity and small-worldness index were significantly increased, whereas the characteristic path length was decreased in the patients with poor surgical outcomes compared to those with good surgical outcomes. Conclusion: We successfully demonstrated significant differences in the intrinsic thalamic network in the ipsilateral hemisphere between TLE patients with HS with poor and good surgical outcomes. This result suggests that the pre-operative intrinsic thalamic network can be related with surgical outcomes in TLE patients with HS.
Collapse
Affiliation(s)
- Kyoo Ho Cho
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Ho-Joon Lee
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Kyoung Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Sung Eun Kim
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Dong Ah Lee
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Kang Min Park
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| |
Collapse
|
11
|
Riederer F, Seiger R, Lanzenberger R, Pataraia E, Kasprian G, Michels L, Kollias S, Czech T, Hainfellner JA, Beiersdorf J, Baumgartner C. Automated volumetry of hippocampal subfields in temporal lobe epilepsy. Epilepsy Res 2021; 175:106692. [PMID: 34175792 DOI: 10.1016/j.eplepsyres.2021.106692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/21/2021] [Accepted: 06/18/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Hippocampal sclerosis is the most frequent pathological substrate in drug resistant temporal lobe epilepsy (TLE). Recently 4 types of hippocampal sclerosis (HS) have been defined in a task force by the International League Against Epilepsy (ILAE), based on patterns of cell loss in specific hippocampal subfields. Type 1 HS is most frequent and has the most favorable outcome after epilepsy surgery. We hypothesized that volume loss in specific hippocampal subfields determined by automated volumetry of high resolution MRI would correspond to cell loss in histological reports. MATERIAL AND METHODS In a group of well characterized patients with drug resistant TLE (N = 26 patients, 14 with right-sided focus, 12 with left-sided focus) volumes of the right and left hippocampus and the hippocampal subfields CA1, CA2 + 3, CA4 and dentate gyrus (DG) were estimated automatically using FreeSurfer version 6.0 from high-resolution cerebral MRI and compared to a large group of healthy controls (N = 121). HS subtype classification was attempted based on histological reports. RESULTS Volumes of the whole hippocampus and all investigated hippocampal subfields (CA1, CA2 + 3, CA4 and DG) were significantly lower on the ipsilateral compared the contralateral side (p < 0.001) and compared to the healthy controls (p < 0.001). Conversely, whole hippocampal and hippocampal subfield volumes were not significantly different from healthy control values on the contralateral side. In 12 of 20 patients the pattern of hippocampal volume loss in specific subfields was in accordance with HS types from histology. The highest overlap between automated MRI and histology was achieved for type 1 HS (in 10 of 12 cases). CONCLUSION The automated volumetry of hippocampal subfields, based on high resolution MRI, may have the potential to predict the pattern of cell loss in hippocampal sclerosis before operation.
Collapse
Affiliation(s)
- Franz Riederer
- Department of Neurology, Clinic Hietzing & Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Vienna, Austria; Faculty of Medicine, University of Zurich, Zurich, Switzerland.
| | - René Seiger
- Neuroimaging Labs, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Rupert Lanzenberger
- Neuroimaging Labs, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | | | - Gregor Kasprian
- Department of Radiology and Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Lars Michels
- Clinic of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Spyros Kollias
- Clinic of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Czech
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Johannes A Hainfellner
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Austria
| | - Johannes Beiersdorf
- Department of Neurology, Clinic Hietzing & Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Vienna, Austria
| | - Christoph Baumgartner
- Department of Neurology, Clinic Hietzing & Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Vienna, Austria; Medical Faculty, Sigmund Freud Private University, Vienna, Austria
| |
Collapse
|
12
|
Sämann PG, Iglesias JE, Gutman B, Grotegerd D, Leenings R, Flint C, Dannlowski U, Clarke‐Rubright EK, Morey RA, Erp TG, Whelan CD, Han LKM, Velzen LS, Cao B, Augustinack JC, Thompson PM, Jahanshad N, Schmaal L. FreeSurfer
‐based segmentation of hippocampal subfields: A review of methods and applications, with a novel quality control procedure for
ENIGMA
studies and other collaborative efforts. Hum Brain Mapp 2020; 43:207-233. [PMID: 33368865 PMCID: PMC8805696 DOI: 10.1002/hbm.25326] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 11/26/2020] [Accepted: 12/13/2020] [Indexed: 12/11/2022] Open
Abstract
Structural hippocampal abnormalities are common in many neurological and psychiatric disorders, and variation in hippocampal measures is related to cognitive performance and other complex phenotypes such as stress sensitivity. Hippocampal subregions are increasingly studied, as automated algorithms have become available for mapping and volume quantification. In the context of the Enhancing Neuro Imaging Genetics through Meta Analysis Consortium, several Disease Working Groups are using the FreeSurfer software to analyze hippocampal subregion (subfield) volumes in patients with neurological and psychiatric conditions along with data from matched controls. In this overview, we explain the algorithm's principles, summarize measurement reliability studies, and demonstrate two additional aspects (subfield autocorrelation and volume/reliability correlation) with illustrative data. We then explain the rationale for a standardized hippocampal subfield segmentation quality control (QC) procedure for improved pipeline harmonization. To guide researchers to make optimal use of the algorithm, we discuss how global size and age effects can be modeled, how QC steps can be incorporated and how subfields may be aggregated into composite volumes. This discussion is based on a synopsis of 162 published neuroimaging studies (01/2013–12/2019) that applied the FreeSurfer hippocampal subfield segmentation in a broad range of domains including cognition and healthy aging, brain development and neurodegeneration, affective disorders, psychosis, stress regulation, neurotoxicity, epilepsy, inflammatory disease, childhood adversity and posttraumatic stress disorder, and candidate and whole genome (epi‐)genetics. Finally, we highlight points where FreeSurfer‐based hippocampal subfield studies may be optimized.
Collapse
Affiliation(s)
| | - Juan Eugenio Iglesias
- Centre for Medical Image Computing University College London London UK
- The Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology Massachusetts General Hospital/Harvard Medical School Boston Massachusetts US
- Computer Science and AI Laboratory (CSAIL), Massachusetts Institute of Technology (MIT) Cambridge Massachusetts US
| | - Boris Gutman
- Department of Biomedical Engineering Illinois Institute of Technology Chicago USA
| | | | - Ramona Leenings
- Department of Psychiatry University of Münster Münster Germany
| | - Claas Flint
- Department of Psychiatry University of Münster Münster Germany
- Department of Mathematics and Computer Science University of Münster Germany
| | - Udo Dannlowski
- Department of Psychiatry University of Münster Münster Germany
| | - Emily K. Clarke‐Rubright
- Brain Imaging and Analysis Center, Duke University Durham North Carolina USA
- VISN 6 MIRECC, Durham VA Durham North Carolina USA
| | - Rajendra A. Morey
- Brain Imaging and Analysis Center, Duke University Durham North Carolina USA
- VISN 6 MIRECC, Durham VA Durham North Carolina USA
| | - Theo G.M. Erp
- Clinical Translational Neuroscience Laboratory, Department of Psychiatry and Human Behavior University of California Irvine California USA
- Center for the Neurobiology of Learning and Memory University of California Irvine Irvine California USA
| | - Christopher D. Whelan
- Imaging Genetics Center Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California Los Angeles California USA
| | - Laura K. M. Han
- Department of Psychiatry Amsterdam University Medical Centers, Vrije Universiteit and GGZ inGeest, Amsterdam Neuroscience Amsterdam The Netherlands
| | - Laura S. Velzen
- Orygen Parkville Australia
- Centre for Youth Mental Health The University of Melbourne Melbourne Australia
| | - Bo Cao
- Department of Psychiatry, Faculty of Medicine & Dentistry University of Alberta Edmonton Canada
| | - Jean C. Augustinack
- The Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology Massachusetts General Hospital/Harvard Medical School Boston Massachusetts US
| | - Paul M. Thompson
- Imaging Genetics Center Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California Los Angeles California USA
| | - Neda Jahanshad
- Imaging Genetics Center Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California Los Angeles California USA
| | - Lianne Schmaal
- Orygen Parkville Australia
- Centre for Youth Mental Health The University of Melbourne Melbourne Australia
| |
Collapse
|
13
|
Sala-Padro J, Miró J, Rodriguez-Fornells A, Quintana M, Vidal N, Plans G, Santurino M, Falip M, Camara E. Hippocampal microstructural architecture and surgical outcome: Hippocampal diffusivity could predict seizure relapse. Seizure 2020; 76:84-88. [PMID: 32044692 DOI: 10.1016/j.seizure.2020.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 12/16/2019] [Accepted: 01/05/2020] [Indexed: 10/25/2022] Open
Abstract
PURPOSE Our aim was to study the microstructural architecture of the contralateral hippocampus to the affected side in patients with temporal lobe epilepsy with hippocampal sclerosis (TLE-HS) and its relation with surgical outcome. METHOD We included 33 consecutive patients evaluated in our epilepsy surgery program during a five-year period. They underwent a presurgical MRI with volumetric T1 and diffusion weighted sequences. 22 patients with TLE-HS (13 women, 12 right TLE-HS) were finally selected. Median follow-up after surgery was 6.25 years (4.5-8.83 years). We segmented the hippocampal subfields of the contralateral hippocampus using FreeSurfer and calculated the fractional anisotropy (FA) and the mean diffusivity (MD) of each subfield. We also scanned 18 healthy age-matched controls. RESULTS After surgery, 50 % of the patients (n = 11) remained seizure-free (SF) following surgery. Comparing non-SF to SF patients, the MD showed increased values of the CA1 (p = 0.035), the molecular layer (p = 0.010) and the dentate gyrus (p = 0.041) in the healthy hippocampus. Using a cut-off point for a survival analysis, we found that patients with lower values of MD of the molecular layer and the CA1 remained SF during long-term post-operative follow-up (p < 0.0001). CONCLUSIONS The contralateral hippocampal internal microstructure may have be implicated in post-surgery seizure freedom in patients with TLE-HS.
Collapse
Affiliation(s)
- Jacint Sala-Padro
- Epilepsy Unit, Hospital de Bellvitge, Spain; Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, 08097, Spain
| | - Júlia Miró
- Epilepsy Unit, Hospital de Bellvitge, Spain; Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, 08097, Spain
| | - Antoni Rodriguez-Fornells
- Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, 08097, Spain; Department of Cognition, Development and Educational Science, Campus Bellvitge, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, 08097, Spain; Catalan Institution for Research and Advanced Studies, ICREA, Barcelona, Spain
| | | | - Noemí Vidal
- Department of Pathology, Hospital de Bellvitge, Spain
| | | | | | | | - Estela Camara
- Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, 08097, Spain; Department of Cognition, Development and Educational Science, Campus Bellvitge, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, 08097, Spain.
| |
Collapse
|
14
|
Vos SB, Winston GP, Goodkin O, Pemberton HG, Barkhof F, Prados F, Galovic M, Koepp M, Ourselin S, Cardoso MJ, Duncan JS. Hippocampal profiling: Localized magnetic resonance imaging volumetry and T2 relaxometry for hippocampal sclerosis. Epilepsia 2019; 61:297-309. [PMID: 31872873 PMCID: PMC7065164 DOI: 10.1111/epi.16416] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 12/02/2019] [Accepted: 12/02/2019] [Indexed: 12/13/2022]
Abstract
Objective Hippocampal sclerosis (HS) is the most common cause of drug‐resistant temporal lobe epilepsy, and its accurate detection is important to guide epilepsy surgery. Radiological features of HS include hippocampal volume loss and increased T2 signal, which can both be quantified to help improve detection. In this work, we extend these quantitative methods to generate cross‐sectional area and T2 profiles along the hippocampal long axis to improve the localization of hippocampal abnormalities. Methods T1‐weighted and T2 relaxometry data from 69 HS patients (32 left, 32 right, 5 bilateral) and 111 healthy controls were acquired on a 3‐T magnetic resonance imaging (MRI) scanner. Automated hippocampal segmentation and T2 relaxometry were performed and used to calculate whole‐hippocampal volumes and to estimate quantitative T2 (qT2) values. By generating a group template from the controls, and aligning this so that the hippocampal long axes were along the anterior‐posterior axis, we were able to calculate hippocampal cross‐sectional area and qT2 by a slicewise method to localize any volume loss or T2 hyperintensity. Individual patient profiles were compared with normative data generated from the healthy controls. Results Profiling of hippocampal volumetric and qT2 data could be performed automatically and reproducibly. HS patients commonly showed widespread decreases in volume and increases in T2 along the length of the affected hippocampus, and focal changes may also be identified. Patterns of atrophy and T2 increase in the left hippocampus were similar between left, right, and bilateral HS. These profiles have potential to distinguish between sclerosis affecting volume and qT2 in the whole or parts of the hippocampus, and may aid the radiological diagnosis in uncertain cases or cases with subtle or focal abnormalities where standard whole‐hippocampal measurements yield normal values. Significance Hippocampal profiling of volumetry and qT2 values can help spatially localize hippocampal MRI abnormalities and work toward improved sensitivity of subtle focal lesions.
Collapse
Affiliation(s)
- Sjoerd B Vos
- Centre for Medical Image Computing, University College London, London, UK.,Epilepsy Society MRI Unit, Chalfont St Peter, UK.,Department of Clinical and Experimental Epilepsy, University College London, London, UK.,Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Gavin P Winston
- Epilepsy Society MRI Unit, Chalfont St Peter, UK.,Department of Clinical and Experimental Epilepsy, University College London, London, UK.,Division of Neurology, Department of Medicine, Queen's University, Kingston, Canada
| | - Olivia Goodkin
- Centre for Medical Image Computing, University College London, London, UK.,Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Hugh G Pemberton
- Centre for Medical Image Computing, University College London, London, UK.,Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, University College London, London, UK.,Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Frederik Barkhof
- Centre for Medical Image Computing, University College London, London, UK.,Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, University College London, London, UK.,Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, National Health Service Foundation Trust, London, UK.,Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London, London, UK.,Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Ferran Prados
- Centre for Medical Image Computing, University College London, London, UK.,Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London, London, UK.,eHealth Center, Open University of Catalonia, Barcelona, Spain
| | - Marian Galovic
- Epilepsy Society MRI Unit, Chalfont St Peter, UK.,Department of Clinical and Experimental Epilepsy, University College London, London, UK.,Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Matthias Koepp
- Epilepsy Society MRI Unit, Chalfont St Peter, UK.,Department of Clinical and Experimental Epilepsy, University College London, London, UK
| | - Sebastien Ourselin
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - M Jorge Cardoso
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - John S Duncan
- Epilepsy Society MRI Unit, Chalfont St Peter, UK.,Department of Clinical and Experimental Epilepsy, University College London, London, UK
| |
Collapse
|