Purpose Surgery is regarded as a common treatment option for patients with mesial temporal lobe epilepsy (MTLE) as a result of hippocampal sclerosis (HS). However, approximately one-third of patients with intractable epilepsy did not become seizure-free after tailored resection strategies. It would be compelling to identify predictive factors of postoperative seizure outcomes. Our aim was to assess the correlation between HS classification and long-term postoperative seizure outcome in patients with MTLE due to HS. Methods To investigate HS classification, semi-quantitative analysis and immunohistochemical staining of neuronal nuclei (NeuN) were performed on 100 postoperative hippocampal specimens. All patients had a 1–7 year postoperative follow-up. The postoperative seizure outcome was evaluated using International League Against Epilepsy (ILAE) outcome classification. Results Three types of HS were recognized. The highest incidence of initial precipitating injury (IPI) was noted in the HS ILAE type 1 group (53.1%). The most favorable long-term seizure outcome was also noted in the HS ILAE type 1 group. The shortest epilepsy duration was recorded in the HS ILAE type 2 group (mean epilepsy duration = 6.64 ± 5.83 years). The completely seizure free rate of patients in all groups declined with an increase in time. Conclusions Our study for the first time demonstrated a significant correlation between HS ILAE types and long-term postoperative seizure outcome in patients with MTLE due to HS. Therefore, HS ILAE types have predictive value in long-term seizure outcome following epilepsy surgery. [ABSTRACT FROM AUTHOR]

Rationale and Objectives: Magnetic resonance imaging (MRI) studies reveal that atrophy of the corpus callosum (CC) is involved in early Alzheimer’s disease (AD). The aim of this study was to investigate when and how callosal changes occur in the early course of AD. Materials and Methods: The Open Access Series of Imaging Studies data sets were used in this study to investigate callosal change. High-resolution structural MRI was performed in 196 older patients. Subjects were characterized using the Clinical Dementia Rating (CDR); 98 healthy controls were not demented (CDR 0), and 98 patients had clinical diagnosis of AD in the very mild dementia stage (CDR 0.5; n = 70) and the mild dementia stage (CDR 1; n = 28). A semiautomatic segmentation method was used to extract the CC in the midsagittal plane. The total and regional areas of the CC were measured. Results: The results indicated that callosal atrophy occurred in when subjects’ CDRs were 0.5. The area of the genu and rostral body of the CC in the healthy controls (CDR 0) was significantly different from that of the subjects with very mild dementia (CDR 0.5) (P < .05). A significant difference could also be found in the area of the rostral body and midbody of the CC between subjects with very mild dementia (CDR 0.5) and those with mild dementia (CDR 1) (P < .05). Conclusions: Callosal atrophy can be detected in subjects with CDRs of 0.5. The change in the CC in the early stage of AD indicates an anterior-to-posterior atrophic process as the degree of dementia assessed by the CDR (from 0 to 0.5 to 1) increases. [ABSTRACT FROM AUTHOR]

Rationale and Objectives: Anterior/posterior commissure reference system (AC/PC reference system) and the fastigium/ventricular floor plane reference system (FFL/VFL reference system) are two reference systems used in the stereotactic localization of the invisible nuclei of the brainstem in magnetic resonance (MR) images. This study investigated the variation of the midsagittal brainstem in relation to the AC/PC and VFL/FFL reference systems with respect to age and gender. Materials and Methods: High-resolution T1-weighted structural MR images were acquired from 64 adults (age range 21–60 years, 32 males and 32 females). The AC/PC and VFL/FFL reference systems were identified automatically. A set of landmarks of the midsagittal brainstem were defined and localized interactively. Results: Results illustrated that there was significant difference between the variance of the anteroposterior coordinate of the landmarks in relation to the AC/PC reference system and that in relation to the FFL/VFL reference system (P < .05), the former is larger than the latter. The positions of the landmarks in the females are more anterior than those in the males in relation to the AC/PC reference (P < .05); the difference in relation to the FFL/VFL reference system was not found. Conclusion: Either the FFL/VFL reference system or the AC/PC reference system has its own advantage in the stereotactic localization of the structure in the brainstem. [Copyright &y& Elsevier]

Rationale and Objectives: The reference system based on the fourth ventricular landmarks (including the fastigial point and ventricular floor plane) is used in medical image analysis of the brain stem. The objective of this study was to develop a rapid, robust, and accurate method for the automatic identification of this reference system on T1-weighted magnetic resonance images. Materials and Methods: The fully automated method developed in this study consisted of four stages: preprocessing of the data set, expectation-maximization algorithm–based extraction of the fourth ventricle in the region of interest, a coarse-to-fine strategy for identifying the fastigial point, and localization of the base point. The method was evaluated on 27 Brain Web data sets qualitatively and 18 Internet Brain Segmentation Repository data sets and 30 clinical scans quantitatively. Results: The results of qualitative evaluation indicated that the method was robust to rotation, landmark variation, noise, and inhomogeneity. The results of quantitative evaluation indicated that the method was able to identify the reference system with an accuracy of 0.7 ± 0.2 mm for the fastigial point and 1.1 ± 0.3 mm for the base point. It took <6 seconds for the method to identify the related landmarks on a personal computer with an Intel Core 2 6300 processor and 2 GB of random-access memory. Conclusion: The proposed method for the automatic identification of the reference system based on the fourth ventricular landmarks was shown to be rapid, robust, and accurate. The method has potentially utility in image registration and computer-aided surgery. [Copyright &y& Elsevier]