Fast fluid-attenuated inversion recovery (FLAIR) compared with T2-weighted spin-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) magnetic resonance (MR) techniques in the diagnosis of mesial temporal sclerosis (MTS). METHODS. In this prospective study, the authors assessed MR scans of 30 patients with drug-resistant temporal lobe epilepsy (based on clinical symptomatology and electroencephalographic registrations) with MR features suggestive of MTS. MR scans of age-, sex-, and scanner-matched patients, referred for MR assessment of white matter disease, without a history of epilepsy and with no visible abnormalities on MR, were used as controls. In 16 patients the MR diagnosis was confirmed by histologic abnormalities consistent with MTS. Coronal T2 SE and FLAIR images of patients and controls were presented to two experienced radiologists in random order for independent blinded review. Hippocampal and associated extrahippocampal temporal lobe abnormalities were used for the diagnosis of MTS. RESULTS. The sensitivity of observer A was 97% for the T2 SE sequence and 100% for the FLAIR; the specificity of observer A for both techniques was 100%. 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 the detection of MTS compared with T2-weighted SE images.