Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Usefulness of Single Voxel Proton MR Spectroscopy in the Evaluation of Hippocampal Sclerosis

  • Kee-Hyun Chang (Department of Radiology, Seoul National University College of Medicine ) ;
  • Hong Dae Kim (Department of Radiology, Seoul National University College of Medicine ) ;
  • Sun-Won Park (Department of Radiology, Seoul National University College of Medicine ) ;
  • In Chan Song (Institute of Radiation Medicine) ;
  • In Kyu Yu (Department of Radiology, Seoul National University College of Medicine ) ;
  • Moon Hee Han (Department of Radiology, Seoul National University College of Medicine ) ;
  • Sang Kun Lee (Neuroscience Research Institute, SNUMRC) ;
  • Chun-Kee Chung (Neuroscience Research Institute, SNUMRC) ;
  • Yang Hee Park (Department of Radiology, National Police Hospital)
  • Received : 1999.10.19
  • Accepted : 2000.02.09
  • Published : 2000.03.31
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Abstract

Objective: The purpose of our study was to determine the ability of H-1 MR spectroscopy (MRS) to lateralize the lesion in patients with hippocampal sclerosis. Materials and Methods: Twenty healthy volunteers and 25 patients with intractable temporal lobe epilepsy whose MR imaging diagnosis was unilateral hippocampal sclerosis were included. This diagnosis was based on the presence of unilateral atrophy and/or high T2 signal intensity of the hippocampus. Single-voxel H-1 MRS was carried out on a 1.5-T unit using PRESS sequence (TE, 136 msec). Spectra were obtained from hippocampal areas bilaterally with volumes of interest (VOIs) of 6.0 cm3 and 2.25 cm3 in healthy volunteers, and of either 6.0 cm3 (n = 14) or 2.25 cm3 (n = 11) in patients. Metabolite ratios of NAA/Cho and NAA/Cr were calculated from relative peak height measurements. The capability of MRS to lateralize the lesion and to detect bilateral abnormalities was compared with MR imaging diagnosis as a standard of reference. Results: In healthy volunteers, NAA/Cho and NAA/Cr ratios were greater than 0.8 and 1.0, respectively. In patients, the mean values of these ratios were significantly lower on the lesion side than on the contralateral side, and lower than those of healthy volunteers (p < .05). The overall correct lateralization rate of MRS was 72% (18/25); this rate was lower with a VOI of 6.0 cm3 than of 2.25 cm3 (64% versus 82%, p < .05). Bilateral abnormalities on MRS were found in 24% (6/25) of cases. Conclusion: Although its rate of correct lateralization is low, single-voxel H-1 MRS is a useful and promising diagnostic tool in the evaluation of hippocampal sclerosis, particularly for the detection of bilateral abnormalities. To improve the diagnostic accuracy of H-1 MRS, further investigation, including the use of a smaller VOI and measurement of the absolute amount of metabolites, are needed.

Keywords

Acknowledgement

This work was supported by a grant from Ministry of Health and Welfare, Seoul, Korea (HMP-99-N-02-0003).

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