Abstract
RationaleQualitatively, FLAIR MR imaging is sensitive to the detection of hippocampal sclerosis (HS). Quantitative analysis of T2 maps provides a useful objective measure and increased sensitivity over visual inspection of T2-weighted scans. We aimed to determine whether quantification of normalised FLAIR is as sensitive as T2 mapping in detection of HS.MethodDual echo T2 and FLAIR MR images were retrospectively analysed in 27 patients with histologically confirmed HS and increased T2 signal in ipsilateral hippocampus and 14 healthy controls. Regions of interest were manually segmented in all hippocampi aiming to avoid inclusion of CSF. Hippocampal T2 values and measures of normalised FLAIR Signal Intensity (nFSI) were compared in healthy and sclerotic hippocampi.ResultsHS was identified on T2 values with 100% sensitivity and 100% specificity. HS was identified on nFSI measures with 60% sensitivity and 93% specificity.ConclusionT2 mapping is superior to nFSI for identification of HS.
Highlights
Increased signal intensity on T2 weighted MR images is one of the diagnostic criteria for hippocampal sclerosis (HS) (Cendes, 2013)
Quantification of hippocampal T2 signal is useful as an objective measure of hippocampal pathology (Woermann et al, 1998) that is useful for research purposes and clinically, both to identify subtle abnormalities and to determine if the contralateral hippocampus is normal when hippocampal resection is planned for treatment of epilepsy
We aimed to check if normalised Fluid Attenuated Inversion Recovery (FLAIR) technique is as sensitive and specific as clinically validated T2 mapping technique in the task of the detection of HS
Summary
Increased signal intensity on T2 weighted MR images is one of the diagnostic criteria for hippocampal sclerosis (HS) (Cendes, 2013). Hippocampal T2 mapping has been used to good effect for many years, and can be estimated using a dual echo sequence (Bartlett et al, 2007). It would be advantageous if quantification of FLAIR signal would achieve these aims, as the sequence is routinely acquired clinically. Mapping of normalised FLAIR signal intensity (nFSI) has been shown to be sensitive to detection of malformations of cortical development and assists the detection of subtle cortical lesions (Focke et al, 2008, 2009). In one study, mapping hippocampal FLAIR signal intensity (Huppertz et al, 2011) showed good separation between patients with HS and healthy controls
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