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      <h1 class="highwire-cite-title" id="page-title">Manual Hippocampal Volumetry Is a Better Detector of Hippocampal Sclerosis than Current Automated Hippocampal Volumetric Methods</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">H.R. Pardoe</span> and <span class="highwire-citation-author" data-delta="1">G.D. Jackson</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">October 2013,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">34 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(10) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">E114-E115; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A3750 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-12661--6729349890" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">H.R. Pardoe </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>New York University School of Medicine
New York, New York</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=H.R.%2BPardoe%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Pardoe%20H&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AH.R.%2BPardoe%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">G.D. Jackson </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>The Florey Institute of Neuroscience and Mental Health
Heidelberg, Victoria, Australia</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=G.D.%2BJackson%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Jackson%20G&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AG.D.%2BJackson%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article fulltext-view "><span class="highwire-journal-article-marker-start"></span><p id="p-1">We read with interest “3T MRI Quantification of Hippocampal Volume and Signal in Mesial Temporal Lobe Epilepsy Improves Detection of Hippocampal Sclerosis,”<sup><a id="xref-ref-1-1" class="xref-bibr" href="#ref-1">1</a></sup> in which Coan et al presented convincing evidence that quantitative assessment of hippocampal volume and T2 improves detection of hippocampal sclerosis vs visual inspection. Although we agree with the principal findings of the study, we disagree with the statement “whether manual or automatic analysis [of hippocampal volume] has higher sensitivity and specificity is still debatable” (text in square brackets added for clarity). We assert that current methods of automated hippocampal segmentation have poorer sensitivity and specificity than manual hippocampal segmentation for the detection of hippocampal sclerosis. To provide evidence supporting this assertion, we measured left hippocampal volumes in 22 patients with epilepsy with left-lateralized hippocampal sclerosis and 22 age-matched healthy control participants 1) manually and 2) automatically (using FreeSurfer version 5.0; <a href="http://surfer.nmr.mgh.harvard.edu">http://surfer.nmr.mgh.harvard.edu</a>), and compared the sensitivity and specificity of the 2 techniques. A subset of the MR imaging scans used for this analysis were used in a prior study.<sup><a id="xref-ref-2-1" class="xref-bibr" href="#ref-2">2</a></sup></p><p id="p-2">The sensitivity and specificity are both dependent on the hippocampal volume threshold used to classify participants. The commonly used method of measuring the area under the receiver operating characteristic (ROC) curve was used to assess which method (manual or automated) is a superior detector of hippocampal sclerosis. The ROC curves for manual and automated hippocampal segmentation are provided in the <a id="xref-fig-1-1" class="xref-fig" href="#F1">Figure</a>. The area under the ROC curve for manual hippocampal segmentation is higher than automated hippocampal segmentation, indicating that manual segmentation is a superior method for the discrimination of hippocampal sclerosis (<a id="xref-table-wrap-1-1" class="xref-table" href="#T1">Table</a>). Sensitivity and specificity are greater for manual segmentation than automated when each other's measure is set at 0.95. In our opinion, the superiority of manual segmentation vs current automated methods, particularly in pathologic conditions such as hippocampal sclerosis, is widely accepted by the image-processing community and is not particularly controversial.</p><div id="F1" class="fig pos-anchor  odd"><div class="highwire-figure"><div class="fig-inline-img-wrapper"><div class="fig-inline-img"><span class="hw-responsive-img"><img class="highwire-fragment fragment-image lazyload" alt="Figure." src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" data-src="http://ajnr-stage2.stage.highwire.org/content/ajnr/34/10/E114/F1.medium.gif" width="436" height="440"/><noscript><img class="highwire-fragment fragment-image" alt="Figure." src="http://ajnr-stage2.stage.highwire.org/content/ajnr/34/10/E114/F1.medium.gif" width="436" height="440"/></noscript></span></div></div></div><div class="fig-caption" xmlns:xhtml="http://www.w3.org/1999/xhtml"><span class="fig-label">Figure.</span> <p id="p-3" class="first-child">ROC curves for manual segmentation (<em>green line</em>) and automated segmentation (<em>red line</em>) in hippocampal sclerosis. The area under the ROC curve is higher for manual segmentation, indicating that it is a superior method to classify hippocampal sclerosis. The vertical dashed line indicates a specificity of 0.95 and shows that the sensitivity is higher for manual segmentation; in a likewise fashion, the horizontal dashed line indicates a sensitivity of 0.95 and shows that the specificity is higher for manual segmentation.</p><div class="sb-div caption-clear"></div></div></div><div class="table pos-float" id="T1"><div class="table-inline table-callout-links"><div class="callout"><span>View this table:</span><ul class="callout-links"><li class="view-inline first"><a href="" class="table-expand-inline" data-table-url="/highwire/markup/41003/expansion?postprocessors=highwire_tables%2Chighwire_reclass%2Chighwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed&amp;table-expand-inline=1" data-icon-position="" data-hide-link-title="0">View inline</a></li><li class="view-popup last"><a href="/highwire/markup/41003/expansion?width=1000&amp;height=500&amp;iframe=true&amp;postprocessors=highwire_tables%2Chighwire_reclass%2Chighwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed" class="colorbox colorbox-load table-expand-popup" rel="gallery-fragment-tables" data-icon-position="" data-hide-link-title="0">View popup</a></li></ul></div></div><div class="table-caption"><p id="p-4" class="first-child">Manual and automated hippocampal volume as a classifier of hippocampal sclerosis</p><div class="sb-div caption-clear"></div></div></div><p id="p-6">The most important caveat to attach to this analysis is that the discriminative ability of automated, manual, and visual-based methods is likely to improve as MR imaging acquisitions improve. Nevertheless, we believe that manual hippocampal segmentation would likely improve the ability of quantitative methods to detect hippocampal sclerosis above the 28% improvement presented by Coan et al.<sup><a id="xref-ref-1-2" class="xref-bibr" href="#ref-1">1</a></sup></p><p id="p-7">In summary, we have presented evidence that manual hippocampal segmentation has higher sensitivity and specificity and is a better detector of hippocampal sclerosis than current automated hippocampal segmentation methods.</p><div class="section ref-list" id="ref-list-1"><h2>REFERENCES</h2><ol class="cit-list ref-use-labels"><li><span class="ref-label">1.</span><a class="rev-xref-ref" href="#xref-ref-1-1" title="View reference 1. in text" id="ref-1">↵</a>

<div class="cit ref-cit ref-journal" id="cit-34.10.E114.1"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Coan</span>  <span class="cit-name-given-names">AC</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Kubota</span>  <span class="cit-name-given-names">B</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Bergo</span>  <span class="cit-name-given-names">FP</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">3T MRI quantification of hippocampal volume and signal in mesial temporal lobe epilepsy improves detection of hippocampal sclerosis</span>. <abbr class="cit-jnl-abbrev">AJNR Am J Neuroradiol</abbr> <span class="cit-pub-date">2013</span> <span class="cit-month">Jul</span> <span class="cit-day">18</span>. <span class="cit-comment">[Epub ahead of print]</span></cite></div><div class="cit-extra"></div></div></li><li><span class="ref-label">2.</span><a class="rev-xref-ref" href="#xref-ref-2-1" title="View reference 2. in text" id="ref-2">↵</a>

<div class="cit ref-cit ref-journal" id="cit-34.10.E114.2" data-doi="10.1111/j.1528-1167.2009.02243.x"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Pardoe</span>  <span class="cit-name-given-names">HR</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Pell</span>  <span class="cit-name-given-names">GS</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Abbott</span>  <span class="cit-name-given-names">DF</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Hippocampal volume assessment in temporal lobe epilepsy: How good is automated segmentation?</span> <abbr class="cit-jnl-abbrev">Epilepsia</abbr> <span class="cit-pub-date">2009</span>;<span class="cit-vol">50</span>:<span class="cit-fpage">2586</span>–<span class="cit-lpage">92</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1111/j.1528-1167.2009.02243.x&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=19682030&amp;link_type=MED&amp;atom=%2Fajnr%2F34%2F10%2FE114.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li></ol></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">© 2013 by American Journal of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div></div>  </div>

  
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