title: Presurgical evaluation of mesial temporal lobe epilepsy with multiple advanced MR techniques at 3T.
abstract: OBJECTIVE
  Accurate localization of the epileptogenic zone is essential for successful surgical treatment of mesial temporal lobe epilepsy (MTLE). The aim of this study was to analyze and compare the hippocampal volumetry (HV), MR spectroscopy (MRS), Dynamic susceptibility contrast (DSC) and pulsed arterial spin labeling (pASL) perfusion techniques in a large sample size of refractory MTLE patients.
  
  
  METHODS
  Forty-two patients with medically refractory MTLE who underwent preoperative evaluation and eleven normal controls were studied. Pathologic and control hippocampi were compared in terms of hippocampal volume, metabolite ratios and relative hippocampal perfusion values. By using cut-off points and asymmetry indexes, percentages of performance indicators for each technique were calculated in groups of MR (+), MR (-) and bilateral MTLE.
  
  
  RESULTS
  For all techniques, a statistically significant difference was found between the pathologic and control hippocampus groups (P<0.001). Also, all of them except HV had diagnostic value in groups of MR (-) and bilateral MTLE.
  
  
  CONCLUSIONS
  HV, MRS, DSC and pASL have achieved comparable performance and each of them provides important information about the lateralization of epileptogenic focus. Among those, pASL and MRS may easily be used as an adjunct to conventional MR.
authors.affiliation: Department of Radiology, Gazi University School of Medicine, 06560 Ankara, Turkey. Electronic address: beryurt@gmail.com.
authors.forename: Bulent
authors.initials: B
authors.lastname: Eryurt
authors.affiliation: Department of Radiology, Gazi University School of Medicine, 06560 Ankara, Turkey.
authors.forename: A Yusuf
authors.initials: AY
authors.lastname: Oner
authors.affiliation: Department of Radiology, Gazi University School of Medicine, 06560 Ankara, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Ucar
authors.affiliation: Department of Neurology, Gazi University School of Medicine, Ankara, Turkey.
authors.forename: Irem
authors.initials: I
authors.lastname: Capraz
authors.affiliation: Department of Neurosurgery, Gazi University School of Medicine, Ankara, Turkey.
authors.forename: Gokhan
authors.initials: G
authors.lastname: Kurt
authors.affiliation: Department of Neurology, Gazi University School of Medicine, Ankara, Turkey.
authors.forename: Erhan
authors.initials: E
authors.lastname: Bilir
authors.affiliation: Department of Radiology, Gazi University School of Medicine, 06560 Ankara, Turkey.
authors.forename: E Turgut
authors.initials: ET
authors.lastname: Tali
mesh_terms: D000293:Adolescent; D000328:Adult; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis* / Q000601:surgery*; D005260:Female; D006624:Hippocampus / Q000473:pathology*; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D011300:Preoperative Care / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D055815:Young Adult
keywords: Dynamic susceptibility contrast; MR spectroscopy; MRI; Mesial temporal lobe epilepsy; Pulsed arterial spin labeling