Clinical Study White Matter Atrophy in Patients with Mesial Temporal Lobe Epilepsy: Voxel-Based Morphometry Analysis of T1- and T2-Weighted MR Images

Introduction. Mesial temporal lobe epilepsy (MTLE) associated with hippocampal sclerosis is highly refractory to clinical treatment. MRI voxel-based morphometry (VBM) of T1-weighted images has revealed a widespread pattern of gray matter (GM) and white matter (WM) atrophy in MTLE. Few studies have investigated the role of T2-weighted images in revealing WM atrophy using VBM. Objectives. To compare the results of WM atrophy between T1- and T2-weighted images through VBM. Methods. We selected 28 patients with left and 27 with right MTLE and 60 normal controls. We analyzed T1- and T2- weighted images with SPM8, using VBM/DARTEL algorithm to extract maps of GM and WM. The second level of SPM was used to investigate areas of WM atrophy among groups. Results. Both acquisitions showed bilateral widespread WM atrophy. T1-weighted images showed higher sensibility to detect areas of WM atrophy in both groups of MTLE. T2-weighted images also showed areas of WM atrophy in a more restricted pattern, but still bilateral and with a large area of superposition with T1-weighted images. Conclusions. In MTLE, T1-weighted images are more sensitive to detect subtle WM abnormalities using VBM, compared to T2 images, although both present a good superposition of statistical maps. 1. Introduction The mesial temporal lobe epilepsy (MTLE) is highly refractory to pharmacological treatment [1], and it is the main group of epilepsy referred to the tertiary care hospitals for surgical treatment [2]. MTLE shows a good surgical prognosis, with satisfactory seizures control in 60-80% of the patients [3]. In approximately 65%