Neuro

European Radiology

, Volume 23, Issue 1, pp 3-11

First online:

Anterior temporal lobe white matter abnormal signal (ATLAS) as an indicator of seizure focus laterality in temporal lobe epilepsy: comparison of double inversion recovery, FLAIR and T2W MR imaging

  • Emiko MorimotoAffiliated withDepartment of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine
  • , Mitsunori KanagakiAffiliated withDepartment of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine Email author 
  • , Tomohisa OkadaAffiliated withDepartment of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine
  • , Akira YamamotoAffiliated withDepartment of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine
  • , Nobuyuki MoriAffiliated withDepartment of Radiology, Tenri Hospital
  • , Riki MatsumotoAffiliated withDepartment of Neurology, Kyoto University Graduate School of Medicine
  • , Akio IkedaAffiliated withDepartment of Neurology, Kyoto University Graduate School of Medicine
  • , Nobuhiro MikuniAffiliated withDepartment of Neurosurgery, Sapporo Medical University
  • , Takeharu KuniedaAffiliated withDepartment of Neurosurgery, Kyoto University Graduate School of Medicine
    • , Dominik PaulAffiliated withSiemens AG Healthcare Sector
    • , Susumu MiyamotoAffiliated withDepartment of Neurosurgery, Kyoto University Graduate School of Medicine
    • , Ryosuke TakahashiAffiliated withDepartment of Neurology, Kyoto University Graduate School of Medicine
    • , Kaori TogashiAffiliated withDepartment of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine

Rent the article at a discount

Rent now

* Final gross prices may vary according to local VAT.

Get Access

Abstract

Objectives

To investigate the diagnostic capability of anterior temporal lobe white matter abnormal signal (ATLAS) for determining seizure focus laterality in temporal lobe epilepsy (TLE) by comparing different MR sequences.

Methods

This prospective study was approved by the institutional review board and written informed consent was obtained. Three 3D sequences (double inversion recovery (DIR), fluid-attenuated inversion recovery (FLAIR) and T2-weighted imaging (T2WI)) and two 2D sequences (FLAIR and T2WI) were acquired at 3 T. Signal changes in the anterior temporal white matter of 21 normal volunteers were evaluated. ATLAS laterality was evaluated in 21 TLE patients. Agreement of independent evaluations by two neuroradiologists was assessed using κ statistics. Differences in concordance between ATLAS laterality and clinically defined seizure focus laterality were analysed using McNemar’s test with multiple comparisons.

Results

Pre-amygdala high signals (PAHS) were detected in all volunteers only on 3D-DIR. Inter-evaluator agreement was moderate to almost perfect for each sequence. Correct diagnosis of seizure laterality was significantly more frequent on 3D-DIR than on any other sequences (P ≤ 0.031 for each evaluator).

Conclusions

The most sensitive sequence for detecting ATLAS laterality was 3D-DIR. ATLAS laterality on 3D-DIR can be a good indicator for determining seizure focus localization in TLE.

Key Points

Magnetic resonance imaging is widely used to investigate temporal lobe epilepsy.

Numerous MR sequences can show anterior temporal lobe white matter abnormal signal.

ATLAS on 3D-DIR can frequently indicate seizure focus laterality in TLE.

3D-DIR is more sensitive about ATLAS laterality than T2WI or FLAIR.

Keywords

Epilepsy Magnetic resonance imaging Brain Temporal lobe Sequence inversion