BY CorTechs LabsFebruary 12, 2016

Case Study: The Role of Volumetric Neuroimaging in the Evaluation of Temporal Lobe Epilepsy

Asym_head-01.png

Neuroimaging is one of several important tools for physicians to help provide an objective assessment and treatment plan for patients with epilepsy. Utilizing MRI scans and analyzing the MRI images using sophisticated software tools has become a significant element in the evaluation of patients with epilepsy and can be especially helpful in assessing the possibility of surgery. MRI scans together with software analysis tools, such as  NeuroQuant®,  allow for brain structures to be segmented and measured, thereby providing anatomic and structural information about the brain in a non-invasive fashion.

NeuroQuant is a leading medical device software that automatically and accurately segments and calculates brain structure volumes from the 3D MRI images. The use of volumetric measurements of temporal lobe structures on MRI can help physicians facilitate the recognition of subtle hippocampal atrophy, not identified by visual exam. Since the arrival of MRI of the brain, hippocampal atrophy has been recognized as the most frequently seen neuroradiologic abnormality in temporal lobe epilepsy. Using NeuroQuant for volumetric imaging of patients with temporal lobe epilepsy (TLE) provides physicians with an objective and precise measurement in their assessment of hippocampal atrophy.

Neuroimaging studies suggest that TLE is associated with pathologic changes in hippocampal physiology and morphology. A history of febrile seizures is associated with hippocampal volume reductions in patients with TLE. Asymmetric hippocampal atrophy, beyond what is considered normal hippocampal asymmetry, may be a sign that the atrophied hippocampus could be the source of the epileptic seizures.

While sometimes moderate to severe hippocampal atrophy can be detected easily by visual examination of the MRI scan by a radiologist or neuroradiologist, volumetric analysis of the MRI scan provides objective quantitative measurements that are consistent and do not rely on subjective assessment This can help highlight cases where there is slight hippocampal or bilateral volume loss. A 2015 study, Mesial Temporal Sclerosis: Accuracy of NeuroQuant versus Neuroradiologist, found that NeuroQuant performed slightly better than expert Johns Hopkins Hospital trained neuroradiologists, with NeuroQuant having a hippocampal asymmetry classification accuracy of 79.4% versus the neuroradiologists’ accuracy of 72.6%.

For physicians evaluating TLE, the NeuroQuant Hippocampal Volume Asymmetry report provides volume measurements of the left and right hippocampi, the asymmetry between the left and right hippocampi and it also indicates the patient’s brain structure volume measurements as compared to a healthy population via a normative database. This allows NeuroQuant to deliver a precise indication of where that individual’s brain structure volume and the asymmetry lie within an age- and sex-based reference chart. The NeuroQuant Hippocampal Volume Asymmetry report delivers precise and critical information to aid physicians in their assessment of temporal lobe epilepsy.

X