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MR of mesial temporal sclerosis: how much is enough?

In this issue of the AJNR, Mamourian et al (1) assess the relationship between fornix asymmetry and mesial temporal sclerosis. While the authors have justifiably kept their focus narrow, their study raises several broader more important questions: What is mesial temporal sclerosis and why is it important to diagnosis? What imaging findings and techniques are necessary for diagnosing mesial temporal sclerosis and which combination of techniques is the most cost-effective? What is the significance of the secondary MR findings associated with mesial temporal sclerosis? Although there is insufficient information available to answer all aspects of these questions, there are enough data to review the importance of mesial temporal sclerosis, the types of imaging techniques used to diagnosis this entity, and the possible significance of secondary MR findings.