Mapping hippocampal and thalamic atrophy in epilepsy: A 7‐T magnetic resonance imaging study

Abstract Objective Epilepsy patients are often grouped together by clinical variables. Quantitative neuroimaging metrics can provide a data‐driven alternative for grouping of patients. In this work, we leverage ultra‐high‐field 7‐T structural magnetic resonance imaging (MRI) to characterize volumetric atrophy patterns across hippocampal subfields and thalamic nuclei in drug‐resistant focal epilepsy. Methods Forty‐two drug‐resistant epilepsy patients and 13 controls with 7‐T structural neuroimaging were included in this study. We measured hippocampal subfield and thalamic nuclei volumetry, and applied an unsupervised machine learning algorithm, Latent Dirichlet Allocation (LDA), to estimate atrophy patterns across the hippocampal subfields and thalamic nuclei of patients. We studied the association between predefined clinical groups and the estimated atrophy patterns. Additionally, we used hierarchical clustering on the LDA factors to group patients in a data‐driven approach. Results In patients with mesial temporal sclerosis (MTS), we found a significant decrease in volume across all ipsilateral hippocampal subfields (false discovery rate‐corrected p [ p FDR] < .01) as well as in some ipsilateral ( p FDR < .05) and contralateral ( p FDR < .01) thalamic nuclei. In left temporal lobe epilepsy (L‐TLE) we saw ipsilateral hippocampal and some bilateral thalamic atrophy ( p FDR < .05), whereas in right temporal lobe epilepsy (R‐TLE) extensive bilateral hippocampal and thalamic atrophy was observed ( p FDR < .05). Atrophy factors demonstrated that our MTS cohort had two atrophy phenotypes: one that affected the ipsilateral hippocampus and one that affected the ipsilateral hippocampus and bilateral anterior thalamus. Atrophy factors demonstrated posterior thalamic atrophy in R‐TLE, whereas an anterior thalamic atrophy pattern was more common in L‐TLE. Finally, hierarchical clustering of atrophy patterns recapitulated clusters with homogeneous clinical properties. Significance Leveraging 7‐T MRI, we demonstrate widespread hippocampal and thalamic atrophy in epilepsy. Through unsupervised machine learning, we demonstrate patterns of volumetric atrophy that vary depending on disease subtype. Incorporating these atrophy patterns into clinical practice could help better stratify patients to surgical treatments and specific device implantation strategies.