T2 mapping outperforms normalised FLAIR in identifying hippocampal sclerosis

•T2 mapping has significantly outperforms normalised FLAIR in differentiating sclerotic from healthy hippocampi.•Due to high sensitivity and specificity T2 mapping carries high potential to point out potential bilateral pathology.•The difference of ability to detect the pathology by the two techniques is likely to hold for advanced FLAIR sequences.•T2 mapping should be the technique of choice to differentiate hippocampal sclerosis in clinical setting.

RationaleQualitatively, FLAIR MR imaging is sensitive to the detection of hippocampal sclerosis (HS). Quantitative analysis of T2 maps provides a useful objective measure and increased sensitivity over visual inspection of T2-weighted scans. We aimed to determine whether quantification of normalised FLAIR is as sensitive as T2 mapping in detection of HS.MethodDual echo T2 and FLAIR MR images were retrospectively analysed in 27 patients with histologically confirmed HS and increased T2 signal in ipsilateral hippocampus and 14 healthy controls. Regions of interest were manually segmented in all hippocampi aiming to avoid inclusion of CSF. Hippocampal T2 values and measures of normalised FLAIR Signal Intensity (nFSI) were compared in healthy and sclerotic hippocampi.ResultsHS was identified on T2 values with 100% sensitivity and 100% specificity. HS was identified on nFSI measures with 60% sensitivity and 93% specificity.ConclusionT2 mapping is superior to nFSI for identification of HS.