Article Figures & Data
Figures
- Fig 1.
Parasagittal scout MR images. A, Section positioning of the PRESS sequence. B, Multisection 1H-MRS imaging sequence.
- Fig 2.
Oblique axial proton density–weighted image corresponding to the temporal section of the multisection 1H-MRS sequence of a patient with right mTLE shows regions for voxel selection: 1, insula; 2, temporal operculum; 3, lateral temporal cortex; 4, hippocampal body; 5, cerebellar hemisphere.
- Fig 3.
Scout axial MR image (center) for PRESS sequence, encompassing both hippocampi. Spectra from right and left hippocampus are shown with NAA reduction on the left side in this case of left mTLE. a.u., absolute units.
- Fig 4.
NAA metabolite images obtained in a control subject. A, Ventricular section (note the low signal intensity from the lateral ventricles). B, Supraventricular section as defined on sagittal scout images (see Fig 1B).
- Fig 5.
NAA metabolite image of a left mTLE shows reduced NAA signal intensity on the anterior left temporal lobe.
Tables
- TABLE 1:
|NAA| in control subjects and patients in the hippocampus versus other brain regions
Brain Region Controls Temporal Lobe Epilepsy Ipsilateral* Contralateral† Hippocampus (PRESS) 3.63 ± 0.79 3.05 ± 0.47 (P < .05) 3.38 ± 0.62 (P < .01) Hippocampal body (multisection MRS) 1.06 ± 0.15 0.77 ± 0.20 (P < .001) 0.94 ± 0.28 (P < .01) Temporal operculum (multisection (MRS) 1.07 ± 0.06 0.89 ± 0.15 (P < .001) 1.08 ± 0.16 (P < .001) Insular cortex (multisection MRS) 1.13 ± 0.08 0.90 ± 0.20 (P < .01) 1.11 ± 0.17 (P < .0001) Lateral temporal cortex (multisection MRS) 1.23 ± 0.06 0.93 ± 0.16 (P < .001) 1.14 ± 0.19 (P < .05) Cerebellar hemisphere (multisection MRS) 1.34 ± 0.18 1.38 ± 0.19 (N.S.) 1.34 ± 0.19 (N.S.) Cerebral hemisphere (multisection MRS) 1.30 ± 0.09 1.20 ± 0.11 (P < .01) 1.21 ± 0.10 (N.S.) Note.—All values are expressed in institutional units as mean ± SD. |NAA| magnitudes between point-resolved spectroscopy (PRESS) and multisection MR spectroscopy (MRS) differ because of differences in technique.
* P values reflect significantly reduced |NAA| in patients compared with |NAA| in control subjects.
† P values reflect significantly reduced |NAA| in the ipsilateral side compared with |NAA| in the contralateral side of patients.
- TABLE 2:
NAA/(Cr + Cho) in patients and control subjects in the hippocampus versus other brain regions
Brain Region Controls Temporal Lobe Epilepsy Ipsilateral* Contralateral† Hippocampus (PRESS) 1.27 ± 0.19 1.10 ± 0.15 (P < .01) 1.20 ± 0.16 (P < .05) Hippocampal body (multisection MRS) 1.34 ± 0.23 1.09 ± 0.21 (P < .01) 1.30 ± 0.24 (P < .0001) Temporal operculum (multisection (MRS) 1.50 ± 0.16 1.20 ± 0.22 (P < .001) 1.46 ± 0.18 (P < .001) Insular cortex (multisection MRS) 1.44 ± 0.13 1.17 ± 0.18 (P < .001) 1.43 ± 0.21 (P < .001) Lateral temporal cortex (multisection MRS) 1.69 ± 0.16 1.36 ± 0.35 (P < .05) 1.76 ± 0.25 (P < .05) Cerebellar hemisphere (multisection MRS) 1.33 ± 0.19 1.34 ± 0.19 (N.S.) 1.33 ± 0.18 (N.S.) Cerebral hemisphere (multisection MRS) 1.99 ± 0.14 1.85 ± 0.10 (P < .01) 1.92 ± 0.08 (P < .001) Note.—All values are expressed in institutional units as mean ± SD.
* P values reflect significantly reduced ratios in patients compared with ratios in control subjects.
† P values reflect significantly reduced ratios in the ipsilateral side compared with ratios in the contralateral side of patients.
- TABLE 3:
EEG, clinical MR imaging, and 1H-MRS lateralization based on asymmetry factors (AF) and combined scores (CS) of |NAA| and NAA/(Cr+Cho) in 15 patients with TLE
Case (no.) EEG MR Imaging Engel classification 1H-MRS PRESS AF Multisection CSAF CS|NAA| CSRATIO |NAA| Ratio |NAA| Ratio Ipsilateral Contralateral Ipsilateral Contralateral 1 right right hippo 1 right −25.9 −33.5 −8.6 −2.5 0.9 0.9 1.3 1.3 2 right right hippo 1 right −9.0 1.6 −3.4 −21 0.9 0.9 1.2 1.5 3 right right hippo 1 right −27.2 −31.2 −31.4 −39.0 0.6 0.8 0.8 1.2 4 left left 1 left −25.0 −3.2 −19.0 −15.9 0.9 1.1 1.3 1.5 5 left left 2 left 2.6 8.7 −27.8 −42.8 1.0 1.3 1.2 1.9 6 left left 1 left −13.1 −19.7 −34.2 −34.7 0.8 1.2 1.0 1.4 7 left left 1 left 2.4 −14.8 −28.7 −29.9 0.8 1.0 1.0 1.3 8 left left 1 Non-lat −1.5 −6.4 −13.4 −8.1 1.0 1.1 1.3 1.5 9 left left 3 left −11.5 −6.9 −26.5 −17.0 0.8 1.1 1.1 1.3 10 left left 1 left −29.7 −23.0 −5.7 −20.6 1.0 1.0 1.3 1.6 11 left left 2 left −6.5 −12.0 −36.8 −30.0 0.8 1.2 1.0 1.4 12 left left 2 left 2.3 13.8 −23.0 −8.8 0.7 0.8 1.0 1.1 13 left normal 1 right −6.3 3.8 −12.9 18.4 1.1 1.3 1.6 1.3 14 left normal 1 left 5.6 2.2 −7.5 −6.5 0.9 1.0 1.2 1.3 15 left normal 1 Non-lat −7.5 −14.0 −11.6 −10.8 1.1 1.2 1.5 1.7 Note.—Negative AFs and CSAFs indicate lower |NAA| or ratio on the ipsilateral side. Bold characters denote values above 2 SD of the mean of hippocampal values.
