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The objectives of this longitudinal imaging study were to determine the stability of focal hippocampus diffusion changes over time in TLE patients, compare diffusion and quantitative T2 abnormalities of the sclerotic hippocampus, and correlate presurgical mean diffusivity (MD) and T2 maps with postsurgical histology.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Nineteen TLE patients and 19 controls underwent two high\u2010resolution (1\u2009mm isotropic) DTI and 1.1\u2009\u00d7\u20091.1\u2009\u00d7\u20091\u2009mm<jats:sup>3<\/jats:sup>\u00a0T2 relaxometry scans (in a subset of 16 TLE patients and 9 controls) of the hippocampus at 3T, with a 2.6\u2009\u00b1\u20090.8\u2009year inter\u2010scan interval. Within\u2010participant hippocampal volume, MD and T2 were compared between the scans. Contralateral hippocampal changes 2.3\u2009\u00b1\u20091.0\u2009years after surgery and ipsilateral preoperative MD maps versus postoperative subfield histopathology were evaluated in eight patients who underwent surgical resection of the hippocampus.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Reduced volume and elevated MD and T2 of sclerotic hippocampi remained unchanged between longitudinal scans. Focal regions of elevated MD and T2 in bilateral hippocampi of HS TLE were detected consistently at both scans. Regions of high MD and T2 correlated and remained consistent over time. Volume, MD, and T2 remained unchanged in postoperative contralateral hippocampus. Regional elevations of MD identified subfield neuron loss on postsurgical histology with 88% sensitivity and 88% specificity. Focal T2 elevations identified subfield neuron loss with 75% sensitivity and 88% specificity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Significance<\/jats:title><jats:p>Diffusion and T2 abnormalities in ipsilateral and contralateral hippocampi remained unchanged between the scans suggesting permanent microstructural alterations. MD and T2 demonstrated good sensitivity and specificity to detect hippocampal subfield neuron loss on postsurgical histology, supporting the potential that high\u2010resolution hippocampal DTI and T2 could be used to diagnose HS subtype before surgery.<\/jats:p><\/jats:sec>","DOI":"10.1002\/epi4.12679","type":"journal-article","created":{"date-parts":[[2022,12,3]],"date-time":"2022-12-03T06:58:51Z","timestamp":1670050731000},"page":"100-112","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Longitudinal hippocampal diffusion\u2010weighted imaging and T2 relaxometry demonstrate regional abnormalities which are stable and predict subfield pathology in\u00a0temporal\u00a0lobe\u00a0epilepsy"],"prefix":"10.1002","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3596-0362","authenticated-orcid":false,"given":"Seyed Amir Ali","family":"Adel","sequence":"first","affiliation":[{"name":"Department of Biomedical 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