International Journal of Science and Research (IJSR)

ISSN: 2319-7064
ResearchGate Impact Factor (2018): 0.28 | SJIF (2018): 7.426

Hippocampal Abnormalities in Adults with

Unilateral Temporal Lobe Epilepsy: A Diffusion
Tensor Imaging Study
Dr. P. Kalaivani1, Dr. N. Sundareswaran2

Abstract: Aims & objectives: To compare the fractional anisotropy and mean diffusivity of ipsilateral and contralateral hippocampus
of unilateral temporal lobe epilepsy patients with age matched normal controls. Materials and methods: The study was conducted in the
department of Radiology, Government Mohan Kumaramangalam Medical College, Salem. This study was done as an analytic,
prospective case control study for a period of 3years from September 2016 to August 2019. Patients with a clinical picture of temporal
lobe epilepsy, with either structural abnormalities in temporal lobe on MR imaging or EEG consistent with temporal lobe epilepsy were
included. Our control group consisted of 30 adults. Imaging protocol: The examinations were performed in 1.5T Philips MRI system.
Results: This study reveals increased mean diffusivity (ADC) and decreased fractional anisotropy (FA) in ipsilateral and contralateral
hippocampi in patients with unilateral hippocampal sclerosis. Conclusion: In patients with clinical history of temporal lobe epilepsy and
equivocal conventional MRI, significantly altered DTI values adds to the diagnosis.

1. Introduction
A seizure is defined as the signs/symptoms due to the 1.2 Need for the Study
abnormal excessive neuronal activity in the brain. Epilepsy
is the tendency to have unprovoked seizures. About 1% of To explore the role of diffusion tensor imaging of
people worldwide have epilepsy6 and the sensitivity of hippocampus in temporal lobe epilepsy and establish the
conventional MRI in identifying the epileptogenic focus diagnostic value in regular epilepsy protocol.
with the current epilepsy protocol is only slightly greater
than 50%3. So there is a need for additional sequences like 1.3 Aims & Objectives
diffusion tensor imaging in cryptogenic cases of epilepsy.
To compare the fractional anisotropy and mean diffusivity of
Temporal lobe epilepsy is the most common form of focal ipsilateral and contralateral hippocampus of unilateral
epilepsy. The etiology can be varied like hippocampal temporal lobe epilepsy patients with age matched normal
sclerosis, malformations of cortical development, mass controls.
lesions, AV malformations, gliosis etc. Previous studies with
diffusion tensor imaging have shown increased apparent 2. Review of Literature
diffusion coefficient and decreased fractional anisotropy in
the seizure focus3. 2.1 Anatomy of the limbic system:27

Diffusion weighted imaging was introduced in 1986 by Le Limbic lobe is phylogenetically older cortex and contains
Bihan et al. By introducing directionality into diffusion few layers than the neocortex. It plays a major role in
weighted images, diffusion tensor images are obtained 1. It memory, olfaction and emotion. It is composed of the
assesses the molecular and biochemical environment of hippocampus, the parahippocampal gyrus, dentate gyrus,
cerebral tissue noninvasively and is capable of subiculum, cingulate gyrus and the subcallosal area. Limbic
demonstrating microstructural alterations in a variety of system consists of the limbic lobe and some subcortical
disorders. structures like the amygdala, mammillary bodies and the
septal nuclei.
We have intended to explore the utility of diffusion tensor
imaging in temporal lobe epilepsy, and depict the focal The limbic lobe consists of three arches surrounding the
abnormalities that occur in our population. The study might diencephalon and the basal ganglia.
establish the diagnostic value of diffusion tensor imaging in
epilepsy, and incorporate it in routine protocol. DTI might The outer arch extends from the temporal to frontal lobes
show the extent of microstructural alterations when the and consists of the uncus, parahippocampal gyrus, cingulate
imaging features are normal. gyrus and the subcallosal area. The middle arch consists of
the hippocampus proper (ammons horn), dentate gyrus,
1.1 Hypothesis indusium greiseum and the paraterminal gyrus. The inner
arch is the smallest and consists of fornix and fimbria, and
Mean diffusivity is increased and fractional anisotropy is extends from the temporal lobes to mamillary bodies.
decreased in hippocampus in patients with mesial temporal
sclerosis.

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ISSN: 2319-7064
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Diagrammatic representation of the limbic system

2.2 Imaging anatomy27:

Amygdala is a large grey matter nucleus which is situated
Hippocampus lies on the medial aspect of temporal lobe and anterior and superior to the hippocampus, lateral to uncus.
bulges into floor of the temporal horn. It consists of two Uncinate gyrus connects amygdala to the hippocampus.
interlocking U shaped grey matter structures, the
hippocampus proper or the Ammons horn and the dentate The fimbria thickens posteriorly and splits off from the
gyrus. It has a head which consists of 3-4 digitations on the hippocampus to form the crus. The crus of the fornix
superior surface, a cylindrical body oriented parasagitally, attaches to the anterior surface of the splenium of corpus
and a tail. The Ammons horn continues laterally into the callosum. The crura of both sides unite to form the
subiculum. Subiculum is the transition into the hippocampal commisure, and continues anteriorly as the
parahippocampal gyrus or the entorhinal cortex, which is body.
part of the neocortex. A thin layer of white matter covers the
hippocampus called alveus, which consists of the efferent
fibres continuing as the fimbria and fornix.

Coronal diagrammatic representation of the hippocampus

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Coronal T1 IR image at the level of hippocampal head

2.3 Connections of the hippocampus:26 amygdala through the uncinate gyrus. Two major
hippocampal pathways are the fornix and the para
The hippocampus is directly connected to the para hippocampal gyrus.
hippocampal gyrus through the subiculum, and to the

Output pathways of the hippocampus

The crus of fornix contacts the contralateral fornix and

forms the hippocampal commissure, through which bilateral The cingulate cortex in turn projects to the entorhinal cortex
hippocampi connect with each other. They then continue as or the para hippocampal gyrus, completing the Papez circuit.
body of the fornix to the anterior commissure where it splits The Papez circuit is involved in learning, memory, emotion
into three parts. and social behaviour.
1) Pre commissural fornix, just before the commissure
which goes to the septal nuclei, preoptic nuclei, orbital Para hippocampal gyrus is a major source of input to the
cortex, anterior cingulate cortex and the ventral striatum. hippocampus. The cingulate gyrus, neocortex, amygdala,
2) Anterior commissure, the second pathway connecting orbital cortex and the olfactory bulb have inputs through the
bilateral hippocampi. para hippocampal gyrus to the hippocampus.
3) Post commissural fornix going to mammillary bodies and
the anterior nucleus of the thalamus. Anterior thalamic
nuclei connect to the cingulate cortex.

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Input pathways of the hippocampus

Physics:1,8,22 ADCi = -ln ( Si/S0 )/b

Diffusion is a process of random motion of molecules called
as Brownian motion1. It is thermally driven, the rate of ln is the natural logarithm
diffusion given by the equation, Si is the signal intensity in a given voxel in direction i with a
<r2> = 6Dt given b value
<r2> denotes the mean squared displacement of the S0 is the signal intensity in a given voxel without diffusion
molecules, t the diffusion time and D the diffusion constant. sensitising gradients.
The diffusion constant is the average displacement of the
molecule in the observed time. Higher values indicate more Isotropy and anisotropy
mobility. The tendency of molecules to move equally in all directions
is called isotropy. In brain, isotropic diffusion is seen in CSF
In the clinical setting, ADC is measured which reflects in spaces. In clinical range of b values, grey matter is
vivo diffusion that cannot be separated from active transport, considered to show isotropic diffusion. Here, the direction of
changes in membrane permeability and movement along the diffusion sensitising gradient is considered unimportant
pressure gradient. because ADCi is same for all directions i.

Stejskal – Tanner Diffusion Encoding: In white matter, diffusion is strongly anisotropic, occurring
A pair of diffusion sensitising, equal and opposite motion maximally in the same direction as white matter tracts.
probing gradients, are applied to a T2-weighted spin-echo Larger ADC values are seen in the direction parallel to the
sequence, before and after the 180 degree refocusing pulse. tracts compared to the orthogonal direction. It is a property
If there is molecular motion, there is change in phase of the integrity of myelin sheath and axonal membrane 1. So,
position during the application of diffusion sensitising more than one direction is required to characterise
gradients, resulting in incomplete rephasing and signal loss. anisotropic diffusion. To overcome this problem,
The diffusion contrast is given by the equation, rotationally invariant measures like trace ADC and
Si = S0 . e-b.ADCi geometric mean DWI are used. It is derived from the DWIs
Si is the signal intensity along the direction i in minimum of three directions S1, S2 and S3
S0 is the signal intensity without the diffusion gradient SDWI = S0 . e- b.ADC
ADCi is the ADC in the direction i Where ADC = (ADC1 + ADC2+ ADC3 )/3.
b is given by the formula, ADC is the average of three ADCs along three orthogonal
b = 𝛾2G2𝛿 2(∆ - 𝛿/3) directions and is rotationally invariant. It is also known as
where 𝛾 is the gyromagnetic ratio the mean diffusivity, trace ADC or ADC.
G is the amplitude of diffusion measured in millitesla per
meter ADC mapping in healthy brain and pathology:
𝛿 is the duration of diffusion gradient in milliseconds In clinical range of b values, in healthy adult brain, there is
∆ is the interval between the onset of diffusion gradient little difference between grey and white matter. Mean
before and after the rephasing pulse. diffusivity of grey matter is 0.67- 0.83 x 10-3mm2/s and 0.64
Units of b is seconds per square millimeter, ADC is – 0.71 x 10-3mm2/s for white matter. In neonates, ADC is
millimeter square per second. very high at term, dropping steeply in first 2 years, gradually
Raising b values increases the diffusion weighting. reaching the normal values in adulthood, at varying rates in
ADC is the apparent diffusion coefficient given by the different parts of the brain. ADC values tend to increase
formula, again after the age of 40.
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The diffusion tensor
White matter tracts are highly anisotropic and this property Decreased anisotropy is a common feature of white matter
can be exploited for characterisation and anatomic mapping tract disease. Diffusion tensor imaging exploits this property
of these tracts. White matter is subjected to motion probing, of reduced anisotropy to recognise diseased neurons before
diffusion sensitising gradients in at least 6 non collinear they show up on conventional imaging.
directions, and with one b 0 image, a tensor is obtained. The
tensor, 3 x 3 matrix of vectors is a mathematical model of 3 Diffusion tensor imaging in seizures:
D diffusion anisotropy. During the ictal phase of seizures, there is an increase in
oxygen consumption in the seizure focus, which is more
The diffusion ellipsoid that describes the ADC of water than the increased blood flow. It results in relative ischemia
molecules at a particular time, is defined by 6 variables in and cytotoxic edema which is shown to result in increased
different directions. It is a sphere for isotropic diffusion, and ADC. As time progresses, epilepsy results in neuroglia,
ellipsoid for anisotropic diffusion. The elements of a tensor increased extracellular space and increased interictal ADC9.
above the diagonal are same as that below the diagonal,
termed as conjugate symmetry. Diffusion tensor imaging of Hippocampal formation in
temporal lobe epilepsy:
The hippocampus is an important structure in temporal lobe
epilepsy, and hippocampal sclerosis is the etiology in non
lesional temporal lobe epilepsy.2 In addition to visual
inspection of high resolution MR images taken orthogonal to
hippocampal formation, quantification of hippocampal
volume and T2 signal can increase the sensitivity of
detection of hippocampal sclerosis19. Assaf et al 2 in 2003
analysed the mean diffusivity and fractional anisotropy of 12
patients with unilateral temporal lobe epilepsy and compared
them with 14 healthy controls. They found significant
increase in mean diffusivity and decreased fractional
anisotropy in the Hippocampal formation of ipsilateral side
compared to contralateral side in patients. Comparing with
the controls, the mean diffusivity remained statistically
higher but the fractional anisotropy did not reach significant
differences, though they were lower.

Thivard L et al in 200517 with 35 patients of TLE with

hippocampal sclerosis found increased diffusivity in the
epileptogenic hippocampus and temporal lobe structures.
Diffusion tensor parameters: The anisotropy was reduced in the ipsilateral temporal lobe.
By subjecting the tensor matrix to diagonalization, a set of Contralateral Hippocampal formation, amygdala and rest of
three Eigen values representing major, medium and minor temporal lobe showed reduced diffusion. They found no
principle axes are obtained with their corresponding Eigen correlation between the age at onset, duration of epilepsy
vectors. They describe the directions and lengths of the three and the frequency of seizures.
diffusion ellipsoids axes. The largest vector is the primary
Eigen vector, with its Eigen value 𝜆1, denotes the magnitude Correlation of Diffusion tensor imaging with
and direction of the greatest water diffusion. It is also termed histopathology of fimbria - fornix in temporal lobe
longitudinal diffusivity and used in fibre tractography epilepsy patients:
indicating the orientation of axons. The second and third Fimbria - fornix is a major afferent- efferent pathway of the
vectors, λ2 and λ3 are orthogonal to the primary vectors and hippocampus. Concha L et al 24 in 2010 studied the
their mean represents radial diffusivity. histopathology of fimbria - fornix in 11 medically intractable
temporal lobe epilepsy patients with and without mesial
Trace D is the sum of the three eigen values, D = λ1 + λ2 + temporal sclerosis. They found strong positive correlation
λ3. The mean diffusivity is the mean of the three eigen between the fractional anisotropy of fimbria – fornix with
values and is given by the formula, cumulative axonal membrane circumference and axonal
𝜆1+𝜆2+𝜆3
ADC = Dav = density. The myelin thickness was negatively correlated.
3
The changes were bilateral suggesting etiology other than
Fractional anisotropy (FA): degeneration alone. Their study provides a strong validation
FA is derived from the standard deviation of the three Eigen for DTI as a measure of white matter pathology.
values and is given by the formula,
3 (𝜆1−𝜆)2 +(𝜆2−𝜆)2 +(𝜆3−𝜆)2 3. Materials and methods
FA=√ 𝑥
2 √𝜆12 +𝜆2 2 +𝜆3 2
𝜆1, 𝜆2, 𝜆3 𝑎𝑟𝑒 𝑡ℎ𝑒 𝑡ℎ𝑟𝑒𝑒 𝑒𝑖𝑔𝑒𝑛 𝑣𝑎𝑙𝑢𝑒𝑠 𝑎𝑛𝑑 𝜆 𝑖𝑠 Study area: The study was conducted in the department of
𝑡ℎ𝑒 𝑚𝑒𝑎𝑛 𝑣𝑎𝑙𝑢𝑒. Radiology, Government Mohan Kumaramangalam Medical
College, Salem.
Fractional anisotropy FA ranges from 0 to 1 1.
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Study design and period: This study was done as an Imaging protocol
analytic, prospective case control study for a period of The examinations were performed in 1.5T Philips MRI
3years from September 2016 to August 2019. system, using the head coil. Our conventional imaging
protocol consists of T1W sequence in the sagittal plane,
Study population: Patients with a clinical picture of T2W in the axial plane and FLAIR in the coronal plane.
temporal lobe epilepsy, referred to our department for an Temporal lobe protocol for epilepsy consists of 3 mm
MRI examination. The patients were referred from oblique coronal sections orthogonal to hippocampus in
neurologists, neurosurgeons and general physicians. T2W, T1 inversion recovery and FLAIR sequences.
Irrespective of treatment status, both previously treated and
untreated patients were included in the study. DTI images were acquired in the axial plane using spin echo
– echo planar imaging sequence. Diffusion sensitive
4. Cases gradients are applied in 15 directions.T1W 3D TFE imaging
was done for superimposing over the colour coded FA maps.
Inclusion criteria: Imaging is performed after a minimum of 7 days after the
Adults, both males and females, with a clinical history of ictus as ADC values are known to alter in the peri ictal
unilateral temporal lobe epilepsy and with either structural period.
abnormalities in temporal lobe on MR imaging or EEG
consistent with temporal lobe epilepsy. Imaging analysis:
All DTI images were transferred to a workstation where
Exclusion criteria: image reconstruction and post processing analysis was
1) Presence of intra axial structural abnormalities in performed. ROIs of similar size were placed in colour coded
locations other than temporal lobe, as it might interfere FA map superimposed over isotropic T1W images over
with the diffusion tensor imaging values. bilateral hippocampi and body of fornix. FA and ADC
2) Presence of a major psychiatric disorder, as uncinate values from each of these ROI from coronal images was
fasciculus is shown to be involved in psychiatric recorded.
disorders.
Statistical analysis
Of the 39 patients referred to us with a clinical picture of  All the continuous variables were tested for the normality
temporal lobe epilepsy, patients with lesions in regions other using Shapiro Wilk’s test. Variables were normally
than temporal lobe and patients with bilateral hippocampal distributed and expressed as mean ± SD. Categorical
sclerosis were excluded from the study. variables were expressed either as percentage or
proportion.
Finally, our case group consisted of 30 patients with  Comparison of categorical variables (age) was done by
unilateral temporal lobe epilepsy, 14 males and 16 females, Chi - square test or Fisher’s exact test based on the
aged between 22 to 49 years, with a mean of 29.9 yrs. 19 number of observations.
(63%) patients had unilateral hippocampal sclerosis, four  Comparison of normally distributed continuous variables
(13%) had gliosis of the temporal lobe, four (13%) had focal between cases and controls was done by independent
cortical dysplasia, one (3%) had dysplastic neuro epithelial sample T test.
tumour, one (3%) had infiltrative glioma and one (3%)had  Comparison of right and left sided variables within
persistent seizures after temporal lobectomy for controls was done by paired T test.
hippocampal sclerosis. 18 cases had EEG localised to the  All the P values less than 0.05 were considered
ipsilateral temporal lobe. All patients underwent statistically significant.
conventional MRI, temporal lobe protocol and diffusion  Data entry was done in MS excel worksheet.
tensor imaging. All of them were seizure free for more than  Data analysis was done by SPSS software version 11.0.
a week at the time of imaging. The duration of seizures
ranged from one month to 15 years. 5. Result
Controls: The FA and ADC values of right and left sides of controls
Our control group consisted of age matched adults with no
were compared. There was no statistically significant
neurologic deficit and normal by MR imaging.
difference between the two. Their mean was used to
represent the controls.
Our control group consisted of 30 adults, of whom 19 were
males and 11 were females, aged between 23 to 46 years,
Table 1: FA of Hippocampus and Fornix
with a mean of 32.9 years. Site Cases Cases Controls Controls P
(30) (30) (30) (30) value
There was no statistically significant difference between the Mean SD Mean SD
ages of the two groups. FA of ipsilateral .14 .06 .18 .05 .005*
hippocampus
The control group underwent conventional MRI and FA of contralateral .13 .05 .18 .05 .001*
diffusion tensor imaging. hippocampus
FA of ipsilateral fornix .37 .21 .33 .16 .398
FA of contralateral fornix .38 .19 .33 .16 .304
*statistically significant
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Compared to controls, patients’ bilateral hippocampi had 2010 with 11 medically intractable TLE patients with and
significantly reduced FA values, the values of fornix were without hippocampal sclerosis, found positive correlation
not statistically significant. between diffusivity of fimbria - fornix and histology. DTI
was acquired following an inversion pulse (TI 2200 ms at
Table 2: ADC of Hippocampus and Fornix 1.5T) to suppress the cerebrospinal fluid signal, which likely
Site
Cases Cases Controls Controls yielded them accurate results.
(30) (30) (30) (30) P value
Mean SD Mean SD 7. Conclusion
ADC of ipsilateral
1.18 .22 .909 .186 .000*
hippocampus
This study reveals increased mean diffusivity (ADC) and
ADC of contralateral
1.05 .17 .909 .186 .004* decreased fractional anisotropy (FA) in ipsilateral and
hippocampus
ADC of ipsilateral contralateral hippocampi in patients with unilateral
1.67 .71 1.81 .51 .412 hippocampal sclerosis. In patients with clinical history of
fornix
ADC of contralateral temporal lobe epilepsy and equivocal conventional MRI,
1.86 .79 1.81 .51 .726 significantly altered DTI values adds to the diagnosis.
fornix
*statistically significant
8. Recommendations
Compared to controls, patients’ bilateral hippocampi had
significantly increased ADC values, the values of ipsilateral Diffusion tensor imaging can be incorporated in routine
fornix was lower and contralateral fornix was higher but did epilepsy protocol as altered hippocampal values adds to the
not achieve statistical significance. diagnosis in equivocal cases.

6. Discussion Representative Images

Hippocampal diffusivity and anisotropy Case 1: Right hippocampal sclerosis

The hippocampal indices of 30 patients with hippocampal
sclerosis were compared with the 30 age matched controls.
Patients’ both ipsilateral and contralateral hippocampi had
statistically significant reduced FA and increased ADC
values. The results of our ipsilateral hippocampus is in line
with the results of Thivard et al17 and Assaf et al2 in 2003
who also found increased mean diffusivity(ADC) in the
ipsilateral hippocampus. Assaf et al 2 with 12 patients of
unilateral temporal lobe epilepsy found diffusivity
measurements more sensitive than anisotropy. They
observed that the selection of region of interest (ROI) in the
anterior body of hippocampus yielded accurate and
consistent measurement. ROI was placed in the anterior
body of hippocampus in our study as per their
recommendations. Bilateral hippocampi are connected with
each other through the hippocampal commissure and the
anterior commissure through the fornices27. Many studies FLAIR Coronal showing right hippocampal sclerosis
have demonstrated widespread propagation of seizure
activity through the neuronal networks9,10,11,12,13. We have
observed increased ADC and reduced FA in the contralateral
hippocampus, the electrical activity possibly utilising the
commissures. Previous studies with contralateral
hippocampus have yielded varying results as observed by
Thivard et al17. The results were either normal or reduced
mean diffusivity. All our patients had visually recognisable
mesial temporal sclerosis, compared to Assaf et al2 where
one third had normal conventional MR findings. This
reflects higher degree of structural damage in our cases and
explain the bilaterally significant hippocampal values.

Though the contralateral hippocampus shows statistically

significant diffusion tensor imaging indices, no such changes
could be demonstrated in the fornices in our study. We had
technical difficulties in placing the voxel exclusively within
the fornix without contamination from the CSF, which might Colour coded FA map superimposed on isotropic T1W
be responsible for the insignificant values. But our results image – coronal showing ROIs at hippocampus, uncinate
concur with those of Thivard et al17 who did not find fasciculus, para hippocampal gyrus and fornix
significant values in bilateral fornices. Concha L et al 24 in
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Case 2: Right hippocampal sclerosis

Coronal image with ROI at fornix

Coronal T1W IR showing hippocampal sclerosis
References
[1] Nucifora G.P, Verma R, Lee S-K, Melhem E.R.
Diffusion tensor Imaging and Tractography: Exploring
Brain Microstructure and Connectivity Radiology:
Volume 245: Number 2—November 2007.
[2] Assaf B.A, Mohamed F.B, Abou- Khaled K.J, Williams
J.M, Yazeji M.S, Haselgrove J et al. Diffusion Tensor
Imaging of the Hippocampal
[3] Formation in Temporal Lobe Epilepsy. AJNR Am J
Neuroradiol 24:1857–1862, October 2003.
[4] Lerner A, Mogensen M.A, Kim P.E, Shiroishi M.S,
Hwang D.H, Law M. Clinical Applications of Diffusion
Tensor Imaging. j.wneu.2013.07.083
[5] Yun-ting Z, Chun- yan Z, Jing Z, Wei L. Age related
changes of normal adult brain structre: analysed with
diffusion tensor imaging. Chinese Medical Journal
Colour coded FA map superimposed on isotropic T1W 2005; 118(13): 1059-1065.
image - Coronal showing ROIs at hippocampus, uncinate [6] Trivedi R, Rathore R.K.S, Gupta R.K. Review: Clinical
fasciculus, parahippocampal gyrus and fornix applications of diffusion tensor imaging. Indian J Radiol
Imaging / February 2008 / Vol 18 / Issue 1.
Case 3: Left hippocampal sclerosis [7] http://en.wikipedia.org/wiki/Epilepsy
[8] Davidson S, Walker B.R, Colledge N.R, Ralston S.H,
Penman I.D. Davidsons principles and practice of
medicine 22nd edition. Elsevier 2014.
[9] Jellison B.J, Field A.S, Medow J, Lazar M, Salamat S,
Alexander A.L. Diffusion Tensor Imaging of Cerebral
White Matter: A Pictorial Review of Physics, Fiber
Tract Anatomy, and Tumor Imaging Patterns. AJNR
Am J Neuroradiol 25:356–369, March 2004
[10] Yin X.-y, Qiu S.-j, Liu. Z.-y, Wang H.-z, Xiong W.-f,
Li S.-s, Wang Y Extratemporal abnormalities of brain
parenchyma in young adults with temporal lobe
epilepsy: A diffusion tensor imaging study. Clinical
Radiology 69 (2014) 589e596.
[11] Kim C.H, Koo B-B, Chung C.K, Lee J-M, Kim J.S,
Lee S.K Thalamic changes in temporal lobe epilepsy
with and without hippocampal sclerosis: A diffusion
tensor imaging study. Epilepsy Research (2010) 90,
21—27.
[12] Kim H, Piao Z, Liu P, Bingaman W, Diehl B.
Coronal Flair image showing left hippocampal sclerosis Secondary white matter degeneration of the corpus
callosum in patients with intractable temporal lobe

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epilepsy: A diffusion tensor imaging study. Epilepsy patients with TLE and hippocampal sclerosis, Epileptic
Research (2008) 81, 136—142. Disord 2009; 11 (3): 244-50
[13] Meng L, Xiang J, Kotecha R, Rose D, Zhao H, Zhao D. [30] Bihan D.L, Mangin J-F, Poupon C, Clark C.A, Pappata
White matter abnormalities in children and adolescents S, Molko N et al . Diffusion Tensor Imaging: Concepts
with temporal lobe epilepsy. Magnetic Resonance and Applications. Journal of Magnetic resonance
Imaging 28 (2010) 1290–1298. imaging 13:534-546 (2001)
[14] Chen Q, Lui S, Li C-X, Jiang L-J, Ou-Yang L, Tang H-
H et al MRI- negative refractive partial epilepsy: Role
for diffusion tensor imaging in high field MRI. Epilepsy
Research (2008)80, 83-89
[15] Diehl B, Busch R.M, Duncan J.S, Piao Z, Tkach J,
Luders H. O. Abnormalities in diffusion tensor imaging
of the uncinate fasciculus relate to reduced memory in
temporal lobe epilepsy. Epilepsia: 1-10,2008
[16] http://en.wikipedia.org/wiki/Uncinate_fasciculus
[17] Riley J.D, Franklin D.L, Choi V, Kim C, Binder D.K,
Cramer S.C et al Diffusion tensor imaging in medial
temporal lobe epilepsy with hippocampal sclerosis.
Epilepsia, 51(4):536–545, 2010
[18] Thivard L, Lehericy S, Krainik A, Adam C, Dormonr
D, Chiras J et al. Diffusion tensor imaging in medial
temporal lobe epilepsy with hippocampal sclerosis.
J.neuroimage.2005.06.04
[19] Wang X-Q, Lang S-L, Hong L.U, Lim M.A, Yan-ling
M.A.O, Yang F. Changes in extra temporal integrity
and cognition in temporal lobe epilepsy: A diffusion
tensor imaging study. Epilepsia, 51(4):536–545, 2010.
[20] Coan A.C, Kubota B, Bergo F.P.G, Campos B.M,
Cendes F. 3T MRI Quantification of Hippocampal
Volume and Signal in Mesial Temporal Lobe Epilepsy
Improves Detection of Hippocampal Sclerosis. AJNR
Am J Neuroradiol 35: 77-83 Jan 2014.
[21] Gross D.W. Diffusion tensor imaging in temporal lobe
epilepsy. Epilepsia, 52(Suppl.4):32-34, 2011
[22] Eriksson S.H, Rugg-Gunn F.J, Symms M.R, Barker G.J,
Duncan J.S. Diffusion tensor imaging in patients with
epilepsy and malformations of cortical development.
Brain(2001), 124,617 - 626
[23] Mukherjee. P, Berman J.I, Chung S.W, Hess C.P, Henry
R.G Diffusion Tensor Imaging and Fiber Tractography:
Theoretic Underpinnings. AJNR 29/ Apr 2008
[24] Duncan J. S. Imaging the brain’s highways - Diffusion
tensor imaging in epilepsy. Epilepsy Currents, Vol.8,
No.4 2008 pp. 85 – 89.
[25] Concha L, Livy D.J, Beaulieu C, Wheatley B.M, Gross
D.W In vivo diffusion tensor imaging and
histopathology of the fimbria-fornix in temporal lobe
epilepsy . The Journal of neuroscience, January 20,
2010. 30 (3):996-1002
[26] Kim.C.H, Chung C.K, Koo B-B, Lee J-M, Kim J.S, Lee
S.K. Changes in Language Pathways in Patients with
Temporal lobe epilepsy: Diffusion Tensor Imaging
Analysis of the Uncinate and Arcuate Fasciculi. World
neurosurgery 75 [¾]: 509 – 516, March/April 2007.
[27] Anthony Wright, Neuroscience online, Chapter 5:
Limbic system: Hippocampus
[28] Harnsberger H.R, Osborn A.G, Ross J.S, Moore K.R,
Salzman K.L, Carrasco C.R et al, Diagnostic and
surgical Imaging anatomy Brain Head & Neck Spine
First edition 2006.
[29] Knake S, Salat D.H, Halgren E, Halko M.A, Greve D.N,
Grant P.E Changes in white matter microstructure in

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