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In this study, we investigate multimodal imaging patterns of brain alterations in TLE<\/jats:styled-content> and evaluate the sensitivity of different imaging measures to verbal memory impairment.<\/jats:p><\/jats:sec>Methods<\/jats:title>Diffusion tensor imaging (DTI<\/jats:styled-content>), volumetric magnetic resonance imaging (vMRI<\/jats:styled-content>), and resting\u2010state functional MRI<\/jats:styled-content> (rs\u2010fMRI<\/jats:styled-content>) were evaluated in 46 patients with TLE<\/jats:styled-content> and 33 healthy controls to measure patterns of microstructural, structural, and functional alterations, respectively. These measurements were obtained within the white matter directly beneath neocortex (ie, superficial white matter [SWM]<\/jats:styled-content>) for DTI<\/jats:styled-content> and across neocortex for vMRI<\/jats:styled-content> and rs\u2010fMRI<\/jats:styled-content>. The degree to which imaging alterations within left medial temporal lobe\/posterior cingulate (LMT<\/jats:styled-content>\/PC<\/jats:styled-content>) and left lateral temporal regions were associated with verbal memory performance was evaluated.<\/jats:p><\/jats:sec>Results<\/jats:title>Patients with left TLE<\/jats:styled-content> and right TLE<\/jats:styled-content> both demonstrated pronounced microstructural alterations (ie, decreased fractional anisotropy [FA<\/jats:styled-content>] and increased mean diffusivity [MD<\/jats:styled-content>]) spanning the entire frontal and temporolimbic SWM<\/jats:styled-content>, which were highly lateralized to the ipsilateral hemisphere. Conversely, reductions in cortical thickness in vMRI<\/jats:styled-content> and alterations in the magnitude of the rs\u2010fMRI<\/jats:styled-content> response were less pronounced and less lateralized than the microstructural changes. Both stepwise regression and mediation analyses further revealed that FA<\/jats:styled-content> and MD<\/jats:styled-content> within SWM<\/jats:styled-content> in LMT<\/jats:styled-content>\/PC<\/jats:styled-content> regions were the most robust predictors of verbal memory, and that these associations were independent of left hippocampal volume.<\/jats:p><\/jats:sec>Significance<\/jats:title>These findings suggest that microstructural loss within the SWM<\/jats:styled-content> is pronounced in patients with TLE<\/jats:styled-content>, and injury to the SWM<\/jats:styled-content> within the LMT<\/jats:styled-content>\/PC<\/jats:styled-content> region plays a critical role in verbal memory impairment.<\/jats:p><\/jats:sec>","DOI":"10.1111\/epi.14736","type":"journal-article","created":{"date-parts":[[2019,4,25]],"date-time":"2019-04-25T09:42:48Z","timestamp":1556185368000},"page":"935-947","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Differential sensitivity of structural, diffusion, and resting\u2010state functional MRI<\/scp> for detecting brain alterations and verbal memory impairment in temporal lobe epilepsy"],"prefix":"10.1111","volume":"60","author":[{"given":"Yu\u2010Hsuan A.","family":"Chang","sequence":"first","affiliation":[{"name":"Department of Psychiatry University of California San Diego California"},{"name":"Center for Multimodal Imaging and Genetics University of California San Diego California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anisa","family":"Marshall","sequence":"additional","affiliation":[{"name":"Center for Multimodal Imaging and Genetics 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