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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 24:218-224, February 2003
© 2003 American Society of Neuroradiology

BRAIN

Magnetization Transfer MR Imaging in Patients with Posttraumatic Epilepsy

Rajesh Kumar^a, Rakesh K. Gupta^a, Mazhar Husain^c, Davender K. Vatsal^c, Sanjeev Chawla^a, Ram Kishore S. Rathore^d and Sunil Pradhan^b

^a Department of Radiology, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow, India
^b Department of Neurology, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow, India
^c Department of Neurosurgery, King George’s Medical College, Lucknow
^d Department of Mathematics, Indian Institute of Technology, Kanpur, India

Address reprint requests to Rakesh K. Gupta, MD., MR Section, Department of Radiodiagnosis, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow, UP, India 226014

BACKGROUND AND PURPOSE: Intractable epilepsy is a well-recognized complication following head trauma, and many factors have been implicated in its pathogenesis. This study was performed to determine the severity of tissue damage after severe head injury as assessed with magnetization transfer (MT) MR imaging and the relationship of this damage with seizure intractability.

METHODS: Forty-four patients, 13 without seizures (disease controls) and 31 with seizures, underwent T1-weighted MT MR imaging 1–10 years after head trauma. Phase-corrected gradient-echo (GRE) imaging was also performed in all patients to look for the presence of hemosiderin. All patients were evaluated for the presence of an MT abnormality beyond an abnormality seen on T2-weighted images, an MT abnormality within a T2 abnormality, and hemosiderin deposition.

RESULTS: Patients with an MT abnormality beyond a T2 abnormality had a significantly higher intractability of seizures compared with those with an MT abnormality within a T2 abnormality (P < .05). In addition, the mere presence of hemosiderin deposit was not associated with seizure intractability; however, gliosis around the hemosiderin as seen on T1-weighted MT images was associated with seizure intractability.

CONCLUSIONS: T1-weighted MT imaging may be of value in predicting the intractability of the seizure in delayed posttraumatic epilepsy.