• L Bonilha, C-Y Lee, J H Jensen, A Tabesh, M V Spampinato, J C Edwards, J Breedlove, and J A Helpern.
• From the Departments of Neurology and Neurosurgery (L.B., J.C.E.) Comprehensive Epilepsy Center (L.B., J.C.E., J.B.) Center for Biomedical Imaging (L.B., C.-Y.L., J.H.J., A.T., M.V.S.), Medical University of South Carolina, Charleston, South Carolina. bonilha@musc.edu.
• AJNR Am J Neuroradiol. 2015 Apr 1; 36 (4): 719-24.

Background And PurposeTemporal lobe epilepsy is associated with regional abnormalities in tissue microstructure, as demonstrated by DTI. However, the full extent of these abnormalities has not yet been defined because DTI conveys only a fraction of the information potentially accessible with diffusion MR imaging. In this study, we assessed the added value of diffusional kurtosis imaging, an extension of DTI, to evaluate microstructural abnormalities in patients with temporal lobe epilepsy.Materials And MethodsThirty-two patients with left temporal lobe epilepsy and 36 matched healthy subjects underwent diffusion MR imaging. To evaluate abnormalities in patients, we performed voxelwise analyses, assessing DTI-derived mean diffusivity, fractional anisotropy, and diffusional kurtosis imaging-derived mean diffusional kurtosis, as well as diffusional kurtosis imaging and DTI-derived axial and radial components, comparing patients with controls.ResultsWe replicated findings from previous studies demonstrating a reduction in fractional anisotropy and an increase in mean diffusivity preferentially affecting, but not restricted to, the temporal lobe ipsilateral to seizure onset. We also noted a pronounced pattern of diffusional kurtosis imaging abnormalities in gray and white matter tissues, often extending into regions that were not detected as abnormal by DTI measures.ConclusionsDiffusional kurtosis is a sensitive and complementary measure of microstructural compromise in patients with temporal lobe epilepsy. It provides additional information regarding the anatomic distribution and degree of damage in this condition. Diffusional kurtosis imaging may be used as a biomarker for disease severity, clinical phenotypes, and treatment monitoring in epilepsy.© 2015 by American Journal of Neuroradiology.

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