Contribution of Quantitative Amygdalar MR FLAIR Signal Analysis for Lateralization of Mesial Temporal Lobe Epilepsy
Jafari-Khouzani K, Elisevich K, Wasade VS, and Soltanian-Zadeh H. Contribution of quantitative amygdalar mr flair signal analysis for lateralization of mesial temporal lobe epilepsy. J Neuroimaging 2018; 28(6):666-675.
Journal of neuroimaging : official journal of the American Society of Neuroimaging
BACKGROUND AND PURPOSE: This study evaluates the contribution of an automated amygdalar fluid-attenuated inversion recovery (FLAIR) signal analysis for the lateralization of mesial temporal lobe epilepsy (mTLE).
METHODS: Sixty-nine patients (27 M, 42 F) who had undergone surgery and achieved an Engel class Ia postoperative outcome were identified as a pure cohort of mTLE cases. Forty-six nonepileptic subjects comprised the control group. The amygdala was segmented in T1-weighted images using an atlas-based segmentation. The right/left ratios of amygdalar FLAIR mean and standard deviation were calculated for each subject. A linear classifier (ie, discriminator line) was designed for lateralization using the FLAIR features and a boundary domain, within which lateralization was assumed to be less definitive, was established using the same features from control subjects. Hippocampal FLAIR and volume analysis was performed for comparison.
RESULTS: With the boundary domain in place, lateralization accuracy was found to be 70% with hippocampal FLAIR and 67% with hippocampal volume. Taking amygdalar analysis into account, 22% of cases that were found to have uncertain lateralization by hippocampal FLAIR analysis were confidently lateralized by amygdalar FLAIR. No misclassified case was found outside the amygdalar FLAIR boundary domain.
CONCLUSIONS: Amygdalar FLAIR analysis provides an additional metric by which to establish mTLE in those cases where hippocampal FLAIR and volume analysis have failed to provide lateralizing information.