Magnetization Transfer MR Imaging in Patients with Posttraumatic Epilepsy
Rajesh Kumara,
Rakesh K. Guptaa,
Mazhar Husainc,
Davender K. Vatsalc,
Sanjeev Chawlaa,
Ram Kishore S. Rathored and
Sunil Pradhanb
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
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FIG 1. Patient without seizures after head trauma (disease control).
A and B, Axial T2-weighted image (A) through the lateral ventricles shows a large hyperintensity involving the left frontal region; this area appears hypointense on the T1-weighted image (B).
C, T2*-weighted image does not show any bloom effect to suggest hemosiderin deposit.
D, T1-weighted MT image does not show abnormality beyond the abnormality seen on the T2-weighted (A) and T1-weighted (B) images.
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FIG 2. MT abnormality beyond the abnormality seen on the T2-weighted image, in a patient with intractable PTE.
A, Axial T2-weighted image through the supraventricular region shows mixed hyperintensity in the left frontal region.
B, Corresponding T1-weighted image shows variable hypointensity in the left frontal region.
C, T2*-weighted image shows hypointensity associated with blooming, which confirms hemosiderin deposit in that region.
D, Corresponding phase-corrected GRE image shows negative signal intensity around the lesion, consistent with focal hemosiderin deposit.
E, T1-weighted MT image shows a hypointense cavity surrounded by an area of hyperintensity that extends to the left parietal region (arrows), suggestive of gliosis.
F, Difference of segmentation of the abnormality seen in A and E confirms the extension of hyperintensity beyond the T2 abnormality.
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FIG 3. Gliosis around the hemosiderin deposit in the brain parenchyma of a patient with intractable PTE.
A and B, Axial T2-weighted image (A) through the supraventricular region shows subtle hyperintensity in the white matter involving both sides of the frontal lobe and the left parietal region; this is not visible on the corresponding T1-weighted image (B).
C, T2*-weighted image shows multiple hypointense focal round lesions (large arrow) in the left parieto-occipital region and linear hypointensities (small arrows) in both frontal regions and the left parietal region.
D, In addition, phase-corrected GRE image shows subtle hypointensity (arrows) in the right parasagittal region that was not visible in C. All these hypointensities that are seen as negative signal intensity suggest hemosiderin deposition.
E, Corresponding T1-weighted MT image shows high signal intensity around the linear hemosiderin deposits, which is suggestive of gliosis.
F, Difference of the segmentation of the abnormality seen on the phase-corrected GRE image and T1-weighted MT image in the left frontal region confirms that the MT abnormality is beyond the hemosiderin deposit. The central black region represents the hemosiderin seen on the phase image.
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