The British Journal of Radiology, Vol 69, Issue 817 15-24, Copyright © 1996 by British Institute of Radiology

ARTICLES

Evaluation of 1H magnetic resonance spectroscopic imaging as a diagnostic tool for the lateralization of epileptogenic seizure foci

I Constantinidis, JA Malko, SB Peterman, RC Long, CM Epstein, D Boor, JC Hoffman, L Shutter and JD Weissman
Department of Radiology, Frederik Philips Magnetic Resonance Research Center, Atlanta, GA 30322, USA.

The purpose of this study was to assess whether a visual examination of 1H spectroscopic images could correctly lateralize patients with intractable temporal lobe epilepsy. 20 patients with intractable temporal lobe epilepsy and 10 volunteers were included in this study. Spectroscopic images were analysed using a protocol based on visual inspection. Images of the metabolites N-acetyl aspartate (NAA), choline (Cho), creatine (Cr) and lactate were obtained from a transverse plane oriented along the sylvian fissure. Images from each individual were evaluated independently by six reviewers. Results of the lateralization procedure obtained from the visual examinations were compared with those obtained from quantitative analysis of the spectra and with those obtained by magnetic resonance imaging (MRI), positron emission tomography (PET), neuropsychological examinations, and electroencephalographic (EEG) recordings. NAA images were found to be the most effective, amongst metabolite images, in lateralizing the epileptogenic lobe. Using the site selected for resection as the definition of the correct lateralization, 70% of the patients who underwent temporal lobectomy were correctly lateralized by the majority of the examiners using the visual inspection protocol. Based on the results of this study it is concluded that visual examination of 1H spectroscopic images is potentially valid in lateralizing patients with intractable temporal lobe seizures. Confidence in the visual interpretation increased as the difference in NAA signal intensity between the temporal lobes increased. The threshold above which the majority of the examiners correctly lateralized the patients was approximately 15% in NAA signal loss in the ipsilateral lobe.

This article has been cited by other articles:

				S.-W. Park, K.-H. Chang, H.-D. Kim, I. C. Song, D. S. Lee, S. K. Lee, C.-K. Chung, I. K. Yu, M. H. Han, and Y. H. Park Lateralizing Ability of Single-voxel Proton MR Spectroscopy in Hippocampal Sclerosis: Comparison with MR Imaging and Positron Emission Tomography AJNR Am. J. Neuroradiol., April 1, 2001; 22(4): 625 - 631. [Abstract] [Full Text]

				G. Sinson, L. J. Bagley, K. M. Cecil, M. Torchia, J. C. McGowan, R. E. Lenkinski, T. K. McIntosh, and R. I. Grossman Magnetization Transfer Imaging and Proton MR Spectroscopy in the Evaluation of Axonal Injury: Correlation with Clinical Outcome after Traumatic Brain Injury AJNR Am. J. Neuroradiol., January 1, 2001; 22(1): 143 - 151. [Abstract] [Full Text] [PDF]

				A. A. Capizzano, P. Vermathen, K. D. Laxer, G. R. Ende, D. Norman, H. Rowley, G. B. Matson, A. A. Maudsley, M. R. Segal, and M. W. Weiner Temporal Lobe Epilepsy: Qualitative Reading of Radiology, January 1, 2001; 218(1): 144 - 151. [Abstract] [Full Text]