Oxygen-enhanced MRI in temporal lobe epilepsy: Diagnosis and lateralization

We explored the diagnostic value of oxygen-enhanced MRI, a novel technique for measuring regional brain metabolism, in a set of normal adult volunteers and temporal lobe epilepsy patients. Eight right-handed adult normal volunteers and ten right-handed patients with temporal lobe epilepsy were studied. Six patients had lesions concordant with their epilepsy on high-resolution (3T) structural MRI. Four patients were nonlesional. Hyperoxia (oxygen enhancement, OE) was carried out by administering 100% O2 in epochs by mask or cannula interleaved with breathing of normal atmospheric air. The T2* (blood oxygen level dependent, BOLD) signal was recorded in continuously acquired echo-planar images. Data from nine temporal lobe subregions were subjected to spectral analysis and statistical testing. OE resulted in unambiguous concordant positive T2* signal change in all subjects. Analysis of the distribution of spectral power within the temporal lobe revealed a significant (p < 0.025, one-sided) group difference between normals and epilepsy patients, with seven patients exhibiting large deviations from normalcy that lateralized their disease. Two such patients had nonlesional MRIs. Oxygen-enhanced MRI is a promising metabolic imaging modality for the diagnosis and lateralization of oxidative metabolic derangement associated with lesional and nonlesional temporal lobe epilepsy.