Neuronal loss and gliosis of the hippocampus are the histopathological hallmarks of hippocampal sclerosis (HS), the most common cause of intractable medial temporal-lobe epilepsy. Typical MRI features of HS include reduced hippocampal volume and increased T2 signal intensity. Quantitative measurement of hippocampal volume using high-resolution MRI provides histologic and clinical information in medial temporal-lobe epilepsy with HS. Stand-alone offline segmentation software packages such as Freesurfer and SPM are not able to produce structured reports immediately after the scanning, requiring intensive post-processing effort. In this study, we applied an inline morphometry package in temporal-lobe HS epilepsy patients to investigate the degenerative patterns of this patient group.19 subjects with temporal-lobe HS epilepsy (EP) and 19 age- and gender-matched healthy control (NC) subjects were enrolled in this study. The epilepsy focus was confirmed by intracranial EEG, and the HS was confirmed by post-surgical pathology. Each patient was scanned on a 3T scanner (MAGNETOM Trio Tim, Siemens Healthcare, Erlangen, Germany) using a 3D MPRAGE sequence (TR=2300ms; TE=3.01ms; TI=900ms; flip angle=9°; matrix size=256x256x176; voxel size=1×1×1mm3). Prior to this acquisition, a routine MRI exam was performed to screen for obvious abnormalities, e.g., patchy cerebral infarcts or occupying lesions. All MPRAGE scans were then processed using a prototype volume-based morphometry package 1. Volume values for a total of 25 regions were calculated and normalized by the total intracranial volume (TIV), namely: global grey matter, white matter and CSF, thalamus, putamen, caudate, pallidum, deep white matter, hippocampus, ventricles, cingulate gyrus, insula, cerebellum, mesencephalon, pons, medulla oblongata, corpus callosum, grey and white matter in frontal/parietal/occipital/temporal lobe (Fig.1). The prototype package automatically compares each of these volumes to an age-matched reference distribution calibrated on a large-scale Caucasian database and flagged as abnormal. in order to have all lesions located if the left hippocampus, we flipped the volume value from right to left and then did the group analysis of each sub-structure segmented by morphometry package. An FDG-PET exam was also performed on each patient. The clinical evaluation of the PET data was performed by two experienced radiologists.Figure 1 shows the volume (in percentage, normalized by whole-brain volume) of the areas showing group differences between NC and EP. The whole EP group showed brain structure degeneration, and the CSF volume was significantly larger than that in normal control, although the value was still in normal range when compared to the large population database. The bilateral temporal lobes all showed significant decrease of volume in EP group (14/19 in the lesion side and 12/19 in the contralateral side) and the brain structure in the lesion side shows more abnormal value than the health hemisphere. The white matter in frontal lobe, mesancephalon and the deep white matter of the lesion side hemisphere also showed degeneration. The volume of deep white matter in the healthy hemisphere increased significantly (P<0.01). Compared to PET results, most of the areas showing decreased volume also had decreased metabolism on PET.The white matter in the frontal lobe links the frontal lobe to the temporal lobe, which is a main component of the default mode network. A volume decrease might be associated to HS and may reflect restricted connectivity between the frontal and the temporal lobe. The increase of deep white matter volume in the contralateral hemisphere is a sign of brain plasticity could potentially be useful to predict the outcome and rehabilitation of some functions after surgery.The volume measured by the inline segmentation tool could provide accurate information about the brain volume changes of temporal-lobe HS epilepsy patients. It also could provide a whole-brain structure overview and provide evidence for physicians to make the surgery or treatment plan.