title: Temporal lobe epilepsy: qualitative reading of 1H MR spectroscopic images for presurgical evaluation.
abstract: OBJECTIVE
  To study the feasibility and clinical potential of visual inspection of hydrogen 1 magnetic resonance (MR) spectroscopic metabolite images for the lateralization of unilateral nonlesional temporal lobe epilepsy (TLE).
  
  
  METHODS
  MR imaging and 1H MR spectroscopic imaging were performed of the temporal lobes in 50 patients with TLE and 23 age-matched healthy volunteers. N-acetylaspartate (NAA) and creatine plus choline metabolite images were read by two neuroradiologists who determined lateralization according to the side of lower NAA signal intensity. Quantitative estimates of NAA were calculated by using an automated fitting program.
  
  
  RESULTS
  Agreement in lateralization between readers was significant with a kappa score of 0.53 for all patients with TLE and 0.63 for patients displaying mild or marked NAA asymmetry. Among the 50 patients with TLE, lateralization was determined correctly by reader 1 in 38 (76%) patients and by reader 2 in 31 (62%) patients. If limited to patients with mild or marked NAA asymmetry, correct lateralization improved to 30 (77%) of 39 and 16 (80%) of 20 patients, respectively. Combined qualitative reading and quantitative spectral fitting enabled lateralization in 34 (85%) of 40 patients with TLE for reader 1 and 30 (77%) of 39 for reader 2, including nine of 14 patients with TLE with negative MR images.
  
  
  CONCLUSIONS
  Reading of metabolite images is a feasible and fast means for noninvasive evaluation of patients with TLE who are candidates for surgery and enables lateralization in some patients with negative MR images.
authors.affiliation: Magnetic Resonance Spectroscopy Unit (114M), Dept of Veterans Affairs Medical Center, 4150 Clement St, San Francisco, CA 94121, USA.
authors.forename: A A
authors.initials: AA
authors.lastname: Capizzano
authors.forename: P
authors.initials: P
authors.lastname: Vermathen
authors.forename: K D
authors.initials: KD
authors.lastname: Laxer
authors.forename: G R
authors.initials: GR
authors.lastname: Ende
authors.forename: D
authors.initials: D
authors.lastname: Norman
authors.forename: H
authors.initials: H
authors.lastname: Rowley
authors.forename: G B
authors.initials: GB
authors.lastname: Matson
authors.forename: A A
authors.initials: AA
authors.lastname: Maudsley
authors.forename: M R
authors.initials: MR
authors.lastname: Segal
authors.forename: M W
authors.initials: MW
authors.lastname: Weiner
mesh_terms: D000328:Adult; D003903:Deuterium; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis* / Q000378:metabolism; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D011300:Preoperative Care
chemical_list: D003903:Deuterium