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Evidence of Neuronal Injury Outside the Medial Temporal Lobe in Temporal Lobe Epilepsy: N-Acetylaspartate Concentration Reductions Detected with Multisection Proton MR Spectroscopic Imaging—Initial Experience¹

¹ From the MR Unit, Department of Veterans Affairs Medical Center (P.V., N.S., G.B.M., M.W.W.) and Departments of Neurology (K.D.L.), Radiology (M.W.W.), Pharmaceutical Chemistry (G.B.M.), and Medicine (M.W.W.), University of California, San Francisco. Received October 12, 2001; revision requested January 8, 2002; revision received April 17; accepted May 24. K.D.L., G.B.M., and M.W.W. supported by National Institutes of Health grant ROI-NS31966. P.V. supported by DFG Forschungsstipendium VE 190/1-1. Address correspondence to P.V., Department of Clinical Research, Magnetic Resonance Spectroscopy and Methodology, MR-Center 1, University and Inselspital, Inselheimmatte, CH-3010 Bern, Switzerland (e-mail: peter.vermathen@insel.ch).

View larger version (158K): [in a new window]   Figure 1. Upper left: Sagittal T1-weighted MR image (500/14; flip angle, 70°) indicates the positions of the three MR spectroscopic imaging sections (A-C). A-C, The three MR spectroscopic imaging sections are displayed on top of corresponding MR images. Two MR spectroscopic imaging sections (A, B) were acquired with angulation along the optic nerve. One section (C) was acquired with angulation along the long axes of the hippocampi. The positions in the MR spectroscopic imaging sections where the spectra were derived are also indicated. A and B were T2-weighted MR images (2,550/80), and C was a T1-weighted MR image (500/14; flip angle, 70°). AF = anterior frontal lobe, AH = anterior hippocampus, AP = anterior parietal lobe, CF = central frontal lobe, CO = central occipital, HB = hippocampal body, LF = lateral frontal lobe, LO = lateral occipital, MB = midbrain, MC = motor cortex, PC = parietal cortex, PF = posterior frontal lobe, PP = posterior parietal lobe, SC = sensory cortex.

View larger version (97K): [in a new window]   Figure 2. Multisection MR spectroscopic imaging measurements in a representative TLE patient. Top row: Three oblique transverse NAA metabolite images. Center row: Corresponding MR images displayed for anatomic guidance. The sections were acquired with angulation as stated for Figure 1. Bottom row: Two spectra obtained from hippocampal tissue as indicated by the arrows on the center MR image in the center row. Parameters for the MR images in the center row were 500/14 and flip angle of 70° for the center image and 2,550/80 for the left and right images.

View larger version (23K): [in a new window]   Figure 3. Graphic comparison of ipsilateral and contralateral hemispheric mean NAA/(Cr + Ch) ratios in all patients and whole-brain ratios in control subjects calculated without values from voxels that included the hippocampus. The boundaries of the boxes indicate the 25th and the 75th percentiles, and the line within the box marks the median. Error bars indicate the 90th and 10th percentiles. Ipsilateral and, to a lesser extent, contralateral hemispheric values for most patients were lower than they were in control subjects. The ipsilateral value is clearly reduced compared with the contralateral value in five patients. In five patients, the ipsilateral and contralateral hemispheric values were almost identical, and in one patient, the ipsilateral ratio was clearly higher than was the contralateral ratio.