Quantitative susceptibility mapping identifies hippocampal and other subcortical grey matter tissue composition changes in temporal lobe epilepsy

Temporal lobe epilepsy (TLE) is associated with widespread brain alterations. Using quantitative susceptibility mapping (QSM) alongside transverse relaxation rate (R2*$$ {R}_2<^>{\ast } $$), we investigated regional brain susceptibility changes in 36 patients with left-sided (LTLE) or right-sided TLE (RTLE) secondary to hippocampal sclerosis, and 27 healthy controls (HC). We compared three susceptibility calculation methods to ensure image quality. Correlations of susceptibility and R2*$$ {R}_2<^>{\ast } $$ with age of epilepsy onset, frequency of focal-to-bilateral tonic-clonic seizures (FBTCS), and neuropsychological test scores were examined. Weak-harmonic QSM (WH-QSM) successfully reduced noise and removed residual background field artefacts. Significant susceptibility increases were identified in the left putamen in the RTLE group compared to the LTLE group, the right putamen and right thalamus in the RTLE group compared to HC, and a significant susceptibility decrease in the left hippocampus in LTLE versus HC. LTLE patients who underwent epilepsy surgery showed significantly lower left-versus-right hippocampal susceptibility. Significant R2*$$ {R}_2<^>{\ast } $$ changes were found between TLE and HC groups in the amygdala, putamen, thalamus, and in the hippocampus. Specifically, decreased R-2* was found in the left and right hippocampus in LTLE and RTLE, respectively, compared to HC. Susceptibility and R2*$$ {R}_2<^>{\ast } $$ were significantly correlated with cognitive test scores in the hippocampus, globus pallidus, and thalamus. FBTCS frequency correlated positively with ipsilateral thalamic and contralateral putamen susceptibility and with R2*$$ {R}_2<^>{\ast } $$ in bilateral globi pallidi. Age of onset was correlated with susceptibility in the hippocampus and putamen, and with R2*$$ {R}_2<^>{\ast } $$ in the caudate. Susceptibility and R2*$$ {R}_2<^>{\ast } $$ changes observed in TLE groups suggest selective loss of low-myelinated neurons alongside iron redistribution in the hippocampi, predominantly ipsilaterally, indicating QSM's sensitivity to local pathology. Increased susceptibility and R2*$$ {R}_2<^>{\ast } $$ in the thalamus and putamen suggest increased iron content and reflect disease severity.