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(Radiology. 2001;218:144-151.)
© RSNA, 2001

Neuroradiology

Temporal Lobe Epilepsy: Qualitative Reading of 1H MR Spectroscopic Images for Presurgical Evaluation1

Arístides A. Capizzano, MD 2, Peter Vermathen, PhD 3, Kenneth D. Laxer, MD, Gabriele R. Ende, PhD 4, David Norman, MD, Howard Rowley, MD, Gerald B. Matson, PhD, Andrew A. Maudsley, PhD, Mark R. Segal, PhD and Michael W. Weiner, MD

1 From the Magnetic Resonance Spectroscopy Unit (114M), Dept of Veterans Affairs Medical Center, 4150 Clement St, San Francisco, CA 94121 (A.A.C., P.V., G.R.E., G.B.M., A.A.M., M.W.W.); and Depts of Radiology (A.A.C., D.N., H.R., M.W.W.), Neurology (K.D.L., H.R., M.W.W.), Medicine (M.W.W.), Psychiatry (M.W.W.), and Div of Biostatistics (M.R.S.), University of California, San Francisco. Received Jul 12, 1999; revision requested Aug 24; final revision received Jun 22, 2000; accepted Jul 11. K.D.L. supported by NIH grant RO1-NS31966. A.A.M. supported by NIH grant 12119. Address correspondence to M.W.W. (e-mail:mweiner@itsa.ucsf.edu).

PURPOSE: To study the feasibility and clinical potential of visual inspection of hydrogen 1 magnetic resonance (MR) spectroscopic metabolite images for the lateralization of unilateral nonlesional temporal lobe epilepsy (TLE).

MATERIALS AND METHODS: MR imaging and 1H MR spectroscopic imaging were performed of the temporal lobes in 50 patients with TLE and 23 age-matched healthy volunteers. N-acetylaspartate (NAA) and creatine plus choline metabolite images were read by two neuroradiologists who determined lateralization according to the side of lower NAA signal intensity. Quantitative estimates of NAA were calculated by using an automated fitting program.

RESULTS: Agreement in lateralization between readers was significant with a {kappa} score of 0.53 for all patients with TLE and 0.63 for patients displaying mild or marked NAA asymmetry. Among the 50 patients with TLE, lateralization was determined correctly by reader 1 in 38 (76%) patients and by reader 2 in 31 (62%) patients. If limited to patients with mild or marked NAA asymmetry, correct lateralization improved to 30 (77%) of 39 and 16 (80%) of 20 patients, respectively. Combined qualitative reading and quantitative spectral fitting enabled lateralization in 34 (85%) of 40 patients with TLE for reader 1 and 30 (77%) of 39 for reader 2, including nine of 14 patients with TLE with negative MR images.

CONCLUSION: Reading of metabolite images is a feasible and fast means for noninvasive evaluation of patients with TLE who are candidates for surgery and enables lateralization in some patients with negative MR images.

Index terms: Brain, MR, 134.121411, 134.121412, 134.121413 • Epilepsy • Magnetic resonance (MR), comparative studies • Magnetic resonance (MR), spectroscopy, 134.12145




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