In this retrospective study, we aimed to characterize the diagnostic yield of biplanar MRI in patients with TGA. Our findings revealed that the diagnostic yield of biplanar DWI MRI was 70.6%. In comparison, patients who underwent monoplanar MRI during the same period showed a diagnostic yield of only 61.8%, consistent with previous studies [10]. This suggests the potential significance of biplanar MRI as an essential diagnostic tool for patients with TGA.

Contrary to the previously held belief that MRI changes in TGA patients could only be detected at least 24 h after the onset of symptoms, we found that in 2 of the 3 patients who showed changes exclusively in the coronal MRI, the imaging was performed within 24 h of symptom onset [11]. This preliminary observation implies that biplanar MRI might have the potential to detect lesions earlier than previously thought. However, given the limited number of cases in our study and the need for further investigation, cautious interpretation is warranted.

Achieving a high level of diagnostic certainty through MRI in patients with other differential diagnoses, such as those with a psychiatric history, can help prevent further stigmatization. Additionally, by avoiding unnecessary anticonvulsive therapy in patients where seizure is a differential diagnosis, our study may have some clinical impact.

It is important to note that previous studies only included patients using monoplanar MRI, focusing on factors such as the strength of MRI machines (1.5-Tesla and 3-Tesla) and slice thickness, without considering the addition of coronal MRI (biplanar MRI) [10].

Our findings underscore the potential utility of biplanar MRI in diagnosing TGA. By incorporating axial and coronal imaging planes, we may enhance the detection of hippocampal lesions, providing a more comprehensive view of the brain and potentially identifying abnormalities that may be missed with monoplanar MRI. However, given the exploratory nature of our study and the limited sample size, further research with larger cohorts is warranted to validate these findings. We acknowledge that the sample size is a limitation, primarily due to the rarity of this disease and the limited geographic area served by our hospital. Our study was intended as a preliminary investigation to identify potential trends and associations within a specific cohort. Despite this, we believe the data obtained provides valuable insights and highlights the need for larger studies.

In conclusion, although our study provides initial insights into the diagnostic potential of biplanar MRI in TGA, it is essential to interpret these results with caution due to the small number of cases and the exploratory nature of the study. Nevertheless, our findings suggest that biplanar MRI may offer promise as a valuable tool in the early and accurate diagnosis of TGA, emphasizing the necessity of further research to confirm and expand upon these preliminary observations.