Anterior temporal lobe white matter abnormal signal (ATLAS) as an indicator of seizure focus laterality in temporal lobe epilepsy: comparison of double inversion recovery, FLAIR and T2W MR imaging.
OBJECTIVE
To investigate the diagnostic capability of anterior temporal lobe white matter abnormal signal (ATLAS) for determining seizure focus laterality in temporal lobe epilepsy (TLE) by comparing different MR sequences.


METHODS
This prospective study was approved by the institutional review board and written informed consent was obtained. Three 3D sequences (double inversion recovery (DIR), fluid-attenuated inversion recovery (FLAIR) and T2-weighted imaging (T2WI)) and two 2D sequences (FLAIR and T2WI) were acquired at 3 T. Signal changes in the anterior temporal white matter of 21 normal volunteers were evaluated. ATLAS laterality was evaluated in 21 TLE patients. Agreement of independent evaluations by two neuroradiologists was assessed using κ statistics. Differences in concordance between ATLAS laterality and clinically defined seizure focus laterality were analysed using McNemar's test with multiple comparisons.


RESULTS
Pre-amygdala high signals (PAHS) were detected in all volunteers only on 3D-DIR. Inter-evaluator agreement was moderate to almost perfect for each sequence. Correct diagnosis of seizure laterality was significantly more frequent on 3D-DIR than on any other sequences (P ≤ 0.031 for each evaluator).


CONCLUSIONS
The most sensitive sequence for detecting ATLAS laterality was 3D-DIR. ATLAS laterality on 3D-DIR can be a good indicator for determining seizure focus localization in TLE.
Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyoku, Kyoto, 606-8507, Japan.
Emiko
E
Morimoto
Mitsunori
M
Kanagaki
Tomohisa
T
Okada
Akira
A
Yamamoto
Nobuyuki
N
Mori
Riki
R
Matsumoto
Akio
A
Ikeda
Nobuhiro
N
Mikuni
Takeharu
T
Kunieda
Dominik
D
Paul
Susumu
S
Miyamoto
Ryosuke
R
Takahashi
Kaori
K
Togashi
D000293:Adolescent; D000328:Adult; D000368:Aged; D000679:Amygdala / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography; D004833:Epilepsy, Temporal Lobe / Q000473:pathology*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007223:Infant; D008279:Magnetic Resonance Imaging / Q000379:methods*; D015225:Magnetoencephalography; D008297:Male; D008875:Middle Aged; D009413:Nerve Fibers, Myelinated / Q000473:pathology*; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D012640:Seizures / Q000473:pathology; D012680:Sensitivity and Specificity; D013702:Temporal Lobe / Q000473:pathology