This pictorial essay describes the anatomy and pathology of the hippocampus, which—although it is a small but complex structure in the brain—plays an important role in spatial and episodic memory. The article explains the best imaging strategy for the evaluation of the hippocampus and describes the imaging appearance of the most common anatomic variants and pathologic conditions that can affect the hippocampus.
• Knowledge of normal hippocampal anatomy helps recognize anatomic variants and hippocampal pathology.
• Refractory epilepsy and dementia are the main indications requiring dedicated hippocampal imaging.
• Pathologic conditions centered in and around the hippocampus often have similar imaging features.
• Clinical information is often necessary to come to a correct diagnosis or an apt differential.
The hippocampus is a small but complex anatomical structure that plays an important role in spatial and episodic memory. The hippocampus can be affected by a wide range of congenital variants and degenerative, inflammatory, vascular, tumoral and toxic-metabolic pathologies. Magnetic resonance imaging is the preferred imaging technique for evaluating the hippocampus. The main indications requiring tailored imaging sequences of the hippocampus are medically refractory epilepsy and dementia. The purpose of this pictorial review is threefold: (1) to review the normal anatomy of the hippocampus on MRI; (2) to discuss the optimal imaging strategy for the evaluation of the hippocampus; and (3) to present a pictorial overview of the most common anatomic variants and pathologic conditions affecting the hippocampus.