MRI-based classification of the anatomical variants of the hippocampal head

Purpose: The head of the hippocampus (H) is classically described as having two to four digitations both in ex vivo specimens and in vivo MR coronal images. The aim of this study was to develop and evaluate a new MR-based classification of the anatomical variants of the hippocampal head in a large sample population of healthy subjects. Methods: MR images of the brain of 238 young healthy subjects (138 men and 100 women; age range 18–39) were analyzed. The head of the H was identified on coronal reformatted 3D T1 weighted MR images. The frequencies were reported for hemisphere and sex. Inter-rater reliability was assessed. Results: Eight variants of the hippocampal head were described. Class 0 (11.4%) indicated a total absence of sulci. This class was further subdivided as follows: 0A (one digitation, 10.1%) and 0B (no digitations or “null variant”, 1.3%). Class 1 (25.6%) presented a single sulcus and was further subdivided into four types according to the location and the width of the sulcus [1A (8.8%), 1B (12.8%), 1C (1.3%), and 1D (2.7%)]. Class 2 (63.0%, the most frequent and the classical variant) had two symmetrical sulci and three digitations. Statistically significant differences between the two hemispheres were observed only in women and overall. Differences in prevalence between sexes were not observed. Conclusions: The large study population allowed the description of a novel morphological classification of the different anatomical variants of normal H in the coronal plane. This classification could reduce the risk of misinterpreting normal anatomical variants as pathological.