We read with interest “3T MRI Quantification of Hippocampal Volume and Signal in Mesial Temporal Lobe Epilepsy Improves Detection of Hippocampal Sclerosis,”1 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; http://surfer.nmr.mgh.harvard.edu), 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.2
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