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• Clinical Article •
Non-invasive lateralization of refractory temporal lobe epilepsy using combined hippocampal head glutamate excitotoxicity and structural atrophy based on multimodal MRI
DUAN Xiaoling  LIU Zhenye  YANG Chao  WANG Xiaoyang  LIAO Yingyong  LIN Qiao  XU Shangwen  LI Hui 

DOI:10.12015/issn.1674-8034.2025.12.008.


[Abstract] Objective To quantitatively assess metabolic ratios and hippocampal volumetric parameters in patients with drug-refractory temporal lobe epilepsy (TLE) using proton magnetic resonance spectroscopy (¹H-MRS) and artificial intelligence (AI)-based automated brain segmentation, and to evaluate their diagnostic efficacy in lateralizing the epileptogenic focus.Materials and Methods A total of 27 TLE patients and 27 healthy controls underwent three-dimensional T1-weighted imaging (3D-T1WI) and multi-voxel ¹H-MRS on a 3.0 T MRI scanner. Hippocampal volume ratio (defined as the percentage of hippocampal volume relative to total brain volume) was measured bilaterally in both groups using United Imaging Intelligence brain segmentation technology. Glutamate-to-creatine ratio (Glu/Cr) and N-acetylaspartate-to-creatine ratio (NAA/Cr) were measured in the bilateral hippocampal head, bodyand tail.Results ¹H-MRS: The Glu/Cr ratio in the affected hippocampal head of TLE patients was significantly higher than that in the contralateral side (P = 0.012) and the control group (P < 0.001). No significant differences in NAA/Cr ratios were found between the affected and contralateral hippocampal subregions (P > 0.05). Volumetry: The hippocampal volume ratio on the affected side was significantly lower than that on the contralateral side (P = 0.033) and in the control group (P < 0.001). Diagnostic performance [receiver operating characteristic (ROC) analysis, hippocampal head Glu/Cr ratio for lateralization: Sensitivity 88.9%, Specificity 70.4%, area under the curve (AUC) = 0.859]. Hippocampal volume ratio for lateralization: Specificity 88.9%, Sensitivity 70.4% (AUC = 0.808). Combined diagnosis (Glu/Cr + volume ratio): Sensitivity 81.5%, Specificity 96.3% (AUC = 0.941).Conclusions This study confirms the presence of specific glutamate excitotoxicity (↑Glu/Cr) and structural atrophy in the affected hippocampal head of TLE patients. The combined application of hippocampal head Glu/Cr ratio (high sensitivity) and hippocampal volume ratio (high specificity) significantly enhances the efficacy for lateralizing the epileptogenic focus (AUC = 0.941), outperforming either single metric. This multimodal MRI biomarker combination provides a high-value tool for non-invasive pre-surgical localization in drug-refractory TLE.
[Keywords] drug-resistant epilepsy；magnetic resonance imaging；proton magnetic resonance spectroscopy；intelligence brain segmentation technology；hippocampal volume ratio；hippocampus

DUAN Xiaoling1, 2, 3   LIU Zhenye1   YANG Chao2   WANG Xiaoyang2   LIAO Yingyong2   LIN Qiao4   XU Shangwen2   LI Hui1, 2, 3*  

1 Department of Diagnostic Radiology, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou 350025, China

2 Department of Diagnostic Radiology, 900th Hospital of PLA Joint Logistic Support Force, Fuzhou 350025, China

3 Department of Diagnostic Radiology, Fuzong Teaching Hospital of Fujian University of Traditional Chinese Medicine (900th Hospital), Fuzhou 350025, China

4 Department of Neurosurgery, 900th Hospital of PLA Joint Logistic Support Force, Fuzhou 350025, China

Corresponding author: LI H, E-mail: 582788441@qq.com

Conflicts of interest   None.

Received  2025-08-11
Accepted  2025-10-13
DOI: 10.12015/issn.1674-8034.2025.12.008
DOI:10.12015/issn.1674-8034.2025.12.008.

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