title: The role of voxel-based morphometry in the detection of cortical dysplasia within the temporal pole in patients with intractable mesial temporal lobe epilepsy.
abstract: OBJECTIVE
  To determine whether voxel-based morphometry (VBM) might contribute to the detection of cortical dysplasia within the temporal pole in patients with mesial temporal lobe epilepsy and hippocampal sclerosis (MTLE/HS).
  
  
  METHODS
  Eighteen patients with intractable MTLE/HS and 30 sex- and age-matched healthy controls were included in the study. All of the patients fulfilled the diagnostic criteria for MTLE/HS and underwent anteromedial temporal resection. VBM without a modulation step was applied to the magnetic resonance (MR) images of the brain. Statistical parametric maps were used to compare structural characteristics such as gray matter concentration (GMC) within the temporal pole among patients and controls separately. The acquired data were then statistically analyzed to determine the congruency between visually inspected MR imaging (MRI) scans and VBM results in the detection of morphologic abnormalities in the temporal pole compared to postoperative histopathologic findings of cortical dysplasia.
  
  
  RESULTS
  Histopathologic examination revealed cortical dysplasia within the temporal pole in 11 patients. In detail, according to Palmini's classification, mild malformations of cortical development (mMCDs) were disclosed in three patients, focal cortical dysplasia (FCD) type Ia in three patients, and FCD type Ib in five patients. Some type of structural temporal pole abnormality was suggested by VBM in 14 patients and by visually inspected MRI scans in 11 patients. The results of VBM were in agreement with the presence/absence of cortical dysplasia in 13 patients (72.2%); this correspondence was significant (p = 0.047). In one case, VBM was false negative and in four cases it was false positive. There was congruence between the results of visual analysis and histologic proof in 55.6% of examined patients, which was not significant.
  
  
  CONCLUSIONS
  We found that VBM made a superior contribution to the detection of temporopolar structural malformations (cortical dysplasia) compared to visual inspection. The agreement with postoperative histopathologic proof was clearly significant for VBM results and nonsignificant for visual inspection.
authors.affiliation: Brno Epilepsy Center, Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic. m.pail@seznam.cz
authors.forename: Martin
authors.initials: M
authors.lastname: Pail
authors.forename: Radek
authors.initials: R
authors.lastname: Mareček
authors.forename: Markéta
authors.initials: M
authors.lastname: Hermanová
authors.forename: Bronislava
authors.initials: B
authors.lastname: Slaná
authors.forename: Ivana
authors.initials: I
authors.lastname: Tyrlíková
authors.forename: Robert
authors.initials: R
authors.lastname: Kuba
authors.forename: Milan
authors.initials: M
authors.lastname: Brázdil
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001931:Brain Mapping; D004172:Diplopia / Q000175:diagnosis* / Q000209:etiology*; D004833:Epilepsy, Temporal Lobe / Q000150:complications* / Q000175:diagnosis; D005260:Female; D007839:Functional Laterality; D006624:Hippocampus / Q000473:pathology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013702:Temporal Lobe / Q000473:pathology*; D055815:Young Adult