title: [Diagnosis of mesial temporal sclerosis with magnetic resonance imaging].
abstract: BACKGROUND
  Mesial temporal sclerosis (MTS) is a progressive drug-resistant epileptic syndrome which requires rapid, effective diagnosis and treatment. Histologically there is atrophy and gliosis of the hippocampus.
  
  
  OBJECTIVE
  To establish magnetic resonance (MR) imaging guidelines for correct diagnosis.
  
  
  METHODS
  We made a prospective study of 78 patients with drug-resistant temporal lobe epilepsy (44 women and 34 men; age 6-66 years, mean 31 years). Using a magnet of 1.5 Teslas paracoronal sections were made of the hippocampus with T1 volumetric with inversion-recovery, FLAIR (fluid-attenuated inversion-recovery) and T2 relaxometry. A control group of 30 healthy volunteers was established. The reduction in volume and hippocampal T2 hyperintensity were considered to be MTS diagnosed on MR.
  
  
  RESULTS
  No hippocampal differences were observed among the healthy volunteers. The confidence intervals (mean +/- 1.96 SD) were: right volume: 4.169-5.911 mm3; left volume: 4.097-5.940 mm3; time of T2 relaxation: 98-113 ms. MTS was observed in 42 patients (54%): 24 left, 14 right and four asymmetrical bilateral. The results of the diagnostic validity (sensitivity/specificity) were: T1 volumetric 91/92%, FLAIR 93.5/98% and T2 relaxometry 91/92%. There was atrophy of other extrahippocampal structures in five cases of MTS; 10 patients with MTS (23.5%) had another extrahippocampal lesion associated (dual pathology), particularly migration disorders; 21 patients (27%) had lesions without MTS (tumors, alterations of migration, nonspecific gliosis) and in 15 cases (19%) there were no abnormal findings. A total of 27 patients were operated on: 22 with MTS (21 had diagnostic MR, one case had no abnormal findings), four cases had tumors and one had cortical dysplasia.
  
  
  CONCLUSIONS
  The combination of quantitative techniques (T1 volumetric with inversion-recovery and T2 relaxometry) and FLAIR optimize MTS diagnosis using MR.
authors.affiliation: Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Granada, España.
authors.forename: J C
authors.initials: JC
authors.lastname: Sánchez-Alvarez
authors.forename: E
authors.initials: E
authors.lastname: Pastor-Pons
authors.forename: T
authors.initials: T
authors.lastname: García-Gómez
authors.forename: F
authors.initials: F
authors.lastname: Escamilla
authors.forename: A
authors.initials: A
authors.lastname: Galdón
authors.forename: H
authors.initials: H
authors.lastname: Busquier
authors.forename: M
authors.initials: M
authors.lastname: Castañeda
authors.forename: P J
authors.initials: PJ
authors.lastname: Serrano
authors.forename: D
authors.initials: D
authors.lastname: Aguilar
authors.forename: A
authors.initials: A
authors.lastname: Altuzarra
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002648:Child; D004351:Drug Resistance; D004833:Epilepsy, Temporal Lobe / Q000188:drug therapy / Q000473:pathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012598:Sclerosis; D013702:Temporal Lobe / Q000473:pathology*