Fast fluid-attenuated inversion recovery (FLAIR) compared with T2-weightedspin-echo in the magnetic resonance diagnosis of mesial temporal sclerosis

RATIONALE AND OBJECTIVES. The authors compare coronal fast fluid-attenuated inversion recovery (FLAIR) with coronal T2-weighted spin-echo (SE) magneti c resonance (MR) techniques in the diagnosis of mesial temporal sclerosis ( MTS). METHODS. In this prospective study, the authors assessed MR scans of 30 pat ients with drug-resistant temporal lobe epilepsy (based on clinical symptom atology and electroencephalographic registrations) with MR features suggest ive of MTS. MR scans of age-, sex-, and scanner-matched patients, referred for MR assessment of white matter disease, without a history of epilepsy an d with no visible abnormalities on MR, were used as controls. In 16 patient s the MR diagnosis was confirmed by histologic abnormalities consistent wit h MTS. Coronal T2 SE and FLAIR images of patients and controls were present ed to two experienced radiologists in random order for independent blinded review. Hippocampal and associated extrahippocampal temporal lobe abnormali ties were used for the diagnosis of MTS. RESULTS. The sensitivity of observer A was 97% for the T2 SE sequence and 1 00% for the FLAIR; the specificity of observer A for both techniques was 10 0%. The sensitivity of observer B was 53% for T2 SE and 83% for FLAIR; the specificity for observer B was 93% for the T2 SE and 100% for FLAIR. CONCLUSION. Coronal FLAIR images provide a similar or increased yield in th e detection of MTS compared with T2-weighted SE images.