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Lateralisation with magnetic resonance spectroscopic imaging in temporal lobe epilepsy: an evaluation of visual and region-of-interest analysis of metabolite concentration images.

Journal article
Authors Barbro Vikhoff-Baaz
Kristina Malmgren
Lars Jönsson
Göran Starck
Maria Ljungberg
Eva Forssell-Aronsson
Paul Uvebrant
Sven Ekholm
Published in Neuroradiology
Volume 43
Issue 9
Pages 721-7
ISSN 0028-3940
Publication year 2001
Published at Institute of Selected Clinical Sciences, Department of Radiation Physics
Institute of Clinical Neurosciences
Institute for the Health of Women and Children, Dept of Paediatrics
Institute of Selected Clinical Sciences, Department of Radiology
Pages 721-7
Language en
Keywords Adolescent, Adult, Aspartic Acid, analogs & derivatives, metabolism, Brain Stem, physiopathology, Choline, metabolism, Creatine, metabolism, Electroencephalography, Epilepsy, Temporal Lobe, diagnosis, metabolism, pathology, Female, Humans, Image Enhancement, Magnetic Resonance Spectroscopy, diagnostic use, Male, Middle Aged, Observer Variation, Phosphocreatine, metabolism
Subject categories Radiology, Diagnostic radiology, Radiological physics, Medical and Health Sciences


We carried out spectroscopic imaging (MRSI) on nine consecutive patients with temporal lobe epilepsy being assessed for epilepsy surgery, and nine neurologically healthy, age-matched volunteers. A volume of interest (VOI) was angled along the temporal horns on axial and sagittal images, and symmetrically over the temporal lobes on coronal images. Images showing the concentrations of N-acetylaspartate (NAA) and of choline-containing compounds plus creatine and phosphocreatine (Cho + Cr) were used for lateralisation. We compared assessment by visual inspection and by signal analysis from regions of interest (ROI) in different positions, where side-to-side differences in NAA/(Cho + Cr) ratio were used for lateralisation. The NAA/ (Cho + Cr) ratio from the different ROI was also compared with that in the brain stem to assess if the latter could be used as an internal reference, e. g., for identification of bilateral changes. The metabolite concentration images were found useful for lateralisation of temporal lobe abnormalities related to epilepsy. Visual analysis can, with high accuracy, be used routinely. ROI analysis is useful for quantifying changes, giving more quantitative information about spatial distribution and the degree of signal loss. There was a large variation in NAA/ (Cho + Cr) values in both patients and volunteers. The brain stem may be used as a reference for identification of bilateral changes.

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