Objective To evaluate the value of18F-FDG PET/CT for preoperative localization of epileptogenic foci in refractory epilepsy patients with negative MRI.Methods Clinical data(550 lobes)of 55 epilepsy patients(38 males,17 females,age(20.0±8.1)years)with negative MRI who underwent pre-operative 18F-FDG PET/CT-MRI between January 2014 and June 2020 at the First Affiliated Hospital of Jinan University were retrospectively analyzed.The sensitivity,specificity,accuracy,positive predictive value(PPV)and negative predictive value(NPV)of 18F-FDG PET/CT,video electroencephalogram(VEEG),PET/CT+VEEG and PET/CT-VEEG for localizing epileptogenic foci were calculated using stereoelectroen-cephalography(SEEG)and the outcomes of at least 1 year of postoperative follow-up as reference standards.X2 test was used to compare the efficiencies of different examination modalities for unilobar,multilobar and all patients.Results The correct lateralization rate of epileptogenic foci was 92.6％(25/27)using PET/CT.The sensitivity,specificity,accuracy,PPV and NPV of PET/CT for localization of epileptogenic foci were 65.1％(54/83),77.9％(364/467),76.0％(418/550),34.4％(54/157)and 92.6％(364/393),respectively.The sensitivities of PET/CT-VEEG for localization of epileptogenic foci in all patients and pa-tients with multilobar epilepsy were higher than those of VEEG alone(75.9％(63/83)vs 45.8％(38/83),68.6％(35/51)vs 31.4％(16/51);X2 values:15.80,14.16,both P＜0.001).The specificities of PET/CT+VEEG for localization of epileptogenic foci in all patients and patients with unilobar epilepsy were higher than those of VEEG alone(97.6％(456/467)vs 94.6％(442/467),97.9％(282/288)vs 94.1％(271/288);x2 values:5.66,5.48;P values:0.017,0.019).The sensitivity of PET/CT-VEEG(PET/CT and VEEG concordance)for localization of epileptogenic foci was higher than that of PET/CT+VEEG(PET/CT and VEEG discordance)(8/9 vs 28.4％(21/74);X2=10.40,P=0.001),and its specificity and accuracy were higher than those of PET/CT-VEEG(PET/CT and VEEG discordance)(93.4％(57/61)vs 71.7％(291/406),92.9％(65/70)vs 72.1％(346/480);x2 values:13.23,13.96;both P＜0.001).Conclu-sions 18F-FDG PET/CT can localize and lateralize epileptogenic foci in patients with negative MRI.The combination of 18F-FDG PET/CT and VEEG improves the sensitivity,specificity,and accuracy for epilepto-genic foci detection.18F-FDG PET/CT is more accurate in detecting epileptogenic foci when it is concordant with VEEG.
Drug resistant epilepsyPositron-emission tomographyFluorodeoxyglucose F18Elec-troencephalography
NETL
NSTL
万方数据
