Contrast-enhanced perfusion and diffusion MRI accurately lateralize temporal lobe epilepsy: A pilot study

To undertake a pilot study to assess whether magnetic resonance (MR) contrast-enhanced perfusion imaging (CEPI) and diffusion-weighted imaging (DWI) provide lateralizing information in medically refractory temporal lobe epilepsy (TLE),and to compare this to standard quantitative hippocampal assessments (volumetric measurements and T2 relaxometry). Ten patients with ‘non-lesional’ TLE and 10 control subjects were studied. Quantification of the relative cerebral blood flow (rCBF) and apparent diffusion coefficient (ADC) was performed for the hippocampal regions. The ratios of the ipsilateral-to-contralateral side (to the EEG lateralization) were compared with the side-to-side ratios in the controls. Six patients (60%) had an ADC ratio outside the control range (the larger ADC ipsilateral to the EEG lateralization in all cases). The CBF ratios were outside the control range in all eight patients (100%) in whom CEPI was performed (the lower value ipsilateral to the EEG lateralization in all cases). The magnitude of the hippocampal volume (HV) ratios showed no significant correlation with the magnitude of the ADC ratios (R = −0.03, p = 0.93) or CBF ratios (R = 0.36, p = 0.39). There was a closer relationship with the T2 relaxometry ratios, but this was also not significant (R = −0.40, p = 0.32; R = 0.58, p = 0.08). DWI and CEPI show potential as reliable tools for the lateralization of non-lesional TLE. Further studies with larger numbers are necessary to determine whether these techniques provide independent data to established MR quantitative measures.