Abstract
PurposeHippocampal sclerosis, a common cause of refractory focal epilepsy, requires hippocampal volumetry for accurate diagnosis and surgical planning. Manual segmentation is time-consuming and subject to interrater/intrarater variability. Automated algorithms perform poorly in patients with temporal lobe epilepsy. We validate and make freely available online a novel automated method.MethodsManual hippocampal segmentation was performed on 876, 3T MRI scans and 202, 1.5T scans. A template database of 400 high-quality manual segmentations was used to perform automated segmentation of all scans with a multi-atlas–based segmentation propagation method adapted to perform label fusion based on local similarity to ensure accurate segmentation regardless of pathology. Agreement between manual and automated segmentations was assessed by degree of overlap (Dice coefficient) and comparison of hippocampal volumes.Key FindingsThe automated segmentation algorithm provided robust delineation of the hippocampi on 3T scans with no more variability than that seen between different human raters (Dice coefficients: interrater 0.832, manual vs. automated 0.847). In addition, the algorithm provided excellent results with the 1.5T scans (Dice coefficient 0.827), and automated segmentation remained accurate even in small sclerotic hippocampi. There was a strong correlation between manual and automated hippocampal volumes (Pearson correlation coefficient 0.929 on the left and 0.941 on the right in 3T scans).SignificanceWe demonstrate reliable identification of hippocampal atrophy in patients with hippocampal sclerosis, which is crucial for clinical management of epilepsy, particularly if surgical treatment is being contemplated. We provide a free online Web-based service to enable hippocampal volumetry to be available globally, with consequent greatly improved evaluation of those with epilepsy.
Highlights
The hippocampus is located within the medial temporal lobe and plays a key role in learning and episodic, semantic, and spatial memory
All clinical scans acquired on the 3T scanner between July 2004 and April 2012 with bilateral manual segmentations performed with this protocol were retrieved (n = 884)
Template database The 400 patients (199 male) in the template database had a median age of 34 years, median age of onset of epilepsy 12 years (IQR 7–21), and median duration of epilepsy 18 years (IQR 10–28)
Summary
The hippocampus is located within the medial temporal lobe and plays a key role in learning and episodic, semantic, and spatial memory. Dysfunction has been reported in neurologic and psychiatric disorders including epilepsy (Wu et al, 2005), Alzheimer’s disease (Apostolova et al, 2006), schizophrenia (Tanskanen et al, 2005), and depression (Bremner et al, 2000)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
