F Riederer1,2, R Seiger3, R Lanzenberger3, E Pataraia4, G Kasprian5, L Michels6, J Beiersdorf7, S Kollias6, T Czech8, J Hainfellner9, C Baumgartner7,10. 1. From the Hietzing Hospital with Neurological Center Rosenhügel & Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology (F.R., J.B., C.B.), Vienna, Austria franz.riederer@uzh.ch. 2. Faculty of Medicine (F.R.), University of Zurich, Zurich, Switzerland. 3. Neuroimaging Labs, Department of Psychiatry and Psychotherapy (R.S., R.L.). 4. Departments of Neurology (E.P.). 5. Radiology and Nuclear Medicine (G.K.). 6. Clinic of Neuroradiology (L.M., S.K.), University Hospital Zurich, Zurich, Switzerland. 7. From the Hietzing Hospital with Neurological Center Rosenhügel & Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology (F.R., J.B., C.B.), Vienna, Austria. 8. Neurosurgery (T.C.). 9. and Institute of Neurology (J.H.), Medical University of Vienna, Vienna, Austria. 10. Medical Faculty (C.B.), Sigmund Freud Private University, Vienna, Austria.
Abstract
BACKGROUND AND PURPOSE: Automated volumetry of the hippocampus is considered useful to assist the diagnosis of hippocampal sclerosis in temporal lobe epilepsy. However, voxel-based morphometry is rarely used for individual subjects because of high rates of false-positives. We investigated whether an approach with high dimensional warping to the template and nonparametric statistics would be useful to detect hippocampal atrophy in patients with hippocampal sclerosis. MATERIALS AND METHODS: We performed single-subject voxel-based morphometry with nonparametric statistics within the framework of Statistical Parametric Mapping to compare MRI from 26 well-characterized patients with temporal lobe epilepsy individually against a group of 110 healthy controls. The following statistical threshold was used: P < .05 corrected for multiple comparisons with family-wise error over the region of interest right and left hippocampus. RESULTS: The sensitivity for the detection of atrophy related to hippocampal sclerosis was 0.92 (95% CI, 0.67-0.99) for the right hippocampus and 0.60 (0.31-0.83) for the left, and the specificity for volume changes was 0.98 (0.93-0.99). All clusters of decreased hippocampal volumes were correctly lateralized to the seizure focus. Hippocampal volume decrease was in accordance with neuronal cell loss on histology reports. CONCLUSIONS: Nonparametric voxel-based morphometry is sensitive and specific for hippocampal atrophy in patients with mesial temporal lobe epilepsy and may be useful in clinical practice.
BACKGROUND AND PURPOSE: Automated volumetry of the hippocampus is considered useful to assist the diagnosis of hippocampal sclerosis in temporal lobe epilepsy. However, voxel-based morphometry is rarely used for individual subjects because of high rates of false-positives. We investigated whether an approach with high dimensional warping to the template and nonparametric statistics would be useful to detect hippocampal atrophy in patients with hippocampal sclerosis. MATERIALS AND METHODS: We performed single-subject voxel-based morphometry with nonparametric statistics within the framework of Statistical Parametric Mapping to compare MRI from 26 well-characterized patients with temporal lobe epilepsy individually against a group of 110 healthy controls. The following statistical threshold was used: P < .05 corrected for multiple comparisons with family-wise error over the region of interest right and left hippocampus. RESULTS: The sensitivity for the detection of atrophy related to hippocampal sclerosis was 0.92 (95% CI, 0.67-0.99) for the right hippocampus and 0.60 (0.31-0.83) for the left, and the specificity for volume changes was 0.98 (0.93-0.99). All clusters of decreased hippocampal volumes were correctly lateralized to the seizure focus. Hippocampal volume decrease was in accordance with neuronal cell loss on histology reports. CONCLUSIONS: Nonparametric voxel-based morphometry is sensitive and specific for hippocampal atrophy in patients with mesial temporal lobe epilepsy and may be useful in clinical practice.
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