Hindawi Publishing Corporation BioMed Research International Volume 2013, Article ID 480524, 9 pages http://dx.doi.org/10.1155/2013/480524 Clinical Study Qualitative and Quantitative Hippocampal MRI Assessments in Intractable Epilepsy Paramdeep Singh, 1 Rupinderjeet Kaur, 2 Kavita Saggar, 3 Gagandeep Singh, 4 and Amarpreet Kaur 5 1 Department of Radiology, Guru Gobind Singh Medical College and Hospital, Baba Farid University of Health Sciences, Faridkot, Punjab 151203, India 2 Department of Medicine, Guru Gobind Singh Medical College and Hospital, Baba Farid University of Health Sciences, Faridkot, Punjab 151203, India 3 Department of Radiology, Dayanand Medical College and Hospital, Ludhiana, Punjab 141001, India 4 Department of Neurology, Dayanand Medical College and Hospital, Ludhiana, Punjab 141001, India 5 Department of Pediatrics, Guru Gobind Singh Medical College and Hospital, Baba Farid University of Health Sciences, Faridkot, Punjab 151203, India Correspondence should be addressed to Paramdeep Singh; paramdeepdoctor@gmail.com Received 24 April 2013; Revised 23 June 2013; Accepted 5 July 2013 Academic Editor: Jinyuan Zhou Copyright © 2013 Paramdeep Singh et al. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Aims. To acquire normative data of hippocampal volumes and T2 relaxation times, to evaluate and compare qualitative and quantitative assessments in evaluating hippocampi in patients with diferent durations of intractable epilepsy, and to propose an imaging protocol based on performance of these techniques. Methods. MRI analysis was done in 50 nonepileptic controls and 30 patients with intractable epilepsy on 1.5T scanner. Visual assessment and hippocampal volumetry were done on oblique coronal IR/T2W and T1W MP-RAGE images, respectively. T2 relaxation times were measured using 16-echo Carr-Purcell-Meiboom-Gill sequence. Volumetric data was normalized for variation in head size between individuals. Patients were divided into temporal ( = 20) and extratemporal ( = 10) groups based on clinical and EEG localization. Results. In controls, right hippocampal volume was slightly more than the let with no efect of age or gender. In TLE patients, hippocampal volumetry provided maximum concordance with EEG. Visual assessment of unilateral pathology concurred well with measured quantitative values but poorly in cases with bilateral pathologies. here were no signiicant diferences of mean values between extratemporal group and controls group. Quantitative techniques detected mild abnormalities, undetected on visual assessment. Conclusions. Quantitative techniques are more sensitive to diagnose bilateral and mild unilateral hippocampal abnormalities. 1. Introduction Epilepsy is a familiar neurological disease characterized by recurrent seizures. Even though epilepsy is presently generally well manageable with modern antiepileptic drugs, there still remain about 30% of patients with epilepsy who do not respond to optimal treatment [1]. hese patients are then understood to have intractable or medically refractory epilepsy. Most of the patients have had good outcomes ater surgery, and this regularly depends on the presurgical evaluation by EEG and magnetic resonance imaging (MRI). Unilateral hippocampal sclerosis (HS) is the most frequent pathological inding in temporal lobe epilepsy (TLE), and up to 65% of cases of TLE can be attributed to pathology arising entirely in the hippocampus [2]. Visual (qualitative) assess- ment of T2-weighted changes (hyperintense signal on T2- weighted images and atrophy) was the earliest method that demonstrated an association among hippocampal pathology and MR-detectable signal abnormality. Hippocampal volume loss is a sensitive and speciic pointer of hippocampal scle- rosis in the clinical setting of epilepsy, and hippocampal volumetric study can quantify atrophy in TLE patients.