title: Subfield atrophy pattern in temporal lobe epilepsy with and without mesial sclerosis detected by high-resolution MRI at 4 Tesla: preliminary results.
abstract: OBJECTIVE
  High-resolution magnetic resonance imaging (MRI) at 4 Tesla depicts details of the internal structure of the hippocampus not visible at 1.5 Tesla, and so allows for in vivo parcellation of different hippocampal subfields. The aim of this study was to test if distinct subfield atrophy patterns can be detected in temporal lobe epilepsy (TLE) with mesial temporal sclerosis (TLE-MTS) and without (TLE-no) hippocampal sclerosis.
  
  
  METHODS
  High-resolution T(2)-weighted hippocampal images were acquired in 34 controls: 15 TLE-MTS and 18 TLE-no. Entorhinal cortex (ERC), subiculum (SUB), CA1, CA2, and CA3, and dentate (CA3&DG) volumes were determined using a manual parcellation scheme.
  
  
  RESULTS
  TLE-MTS had significantly smaller ipsilateral CA1, CA2, CA3&DG, and total hippocampal volume than controls or TLE-no. Mean ipsilateral CA1 and CA3&DG z-scores were significantly lower than ipsilateral CA2, ERC, and SUB z-scores. There were no significant differences between the various subfield or hippocampal z-scores on either the ipsi- or the contralateral side in TLE-no. Using a z-score <or=-2.0 to identify severe volume loss, the following atrophy patterns were found in TLE-MTS: CA1 atrophy, CA3&DG atrophy, CA1 and CA3&DG atrophy, and global hippocampal atrophy. Significant subfield atrophy was found in three TLE-no: contralateral SUB atrophy, bilateral CA3&DG atrophy, and ipsilateral ERC and SUB atrophy.
  
  
  CONCLUSIONS
  Using a manual parcellation scheme on 4 Tesla high-resolution MRI, we found the characteristic ipsilateral CA1 and CA3&DG atrophy described in TLE-MTS. Seventeen percent of the TLE-no had subfield atrophy despite normal total hippocampal volume. These findings indicate that high-resolution MRI and subfield volumetry provide superior information compared to standard hippocampal volumetry.
authors.affiliation: Department of Radiology, Center for Imaging of Neurodegenerative Diseases, University of California, San Francisco, California 94121, USA. susanne.mueller@ucsf.edu
authors.forename: Susanne G
authors.initials: SG
authors.lastname: Mueller
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Laxer
authors.forename: Jerome
authors.initials: J
authors.lastname: Barakos
authors.forename: Ian
authors.initials: I
authors.lastname: Cheong
authors.forename: Paul
authors.initials: P
authors.lastname: Garcia
authors.forename: Michael W
authors.initials: MW
authors.lastname: Weiner
mesh_terms: D000328:Adult; D001284:Atrophy / Q000473:pathology; D004833:Epilepsy, Temporal Lobe / Q000145:classification / Q000150:complications / Q000473:pathology*; D005260:Female; D006624:Hippocampus / Q000473:pathology*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012598:Sclerosis / Q000473:pathology; D055815:Young Adult