Objective To analyze the application value of18F-FDG PET in the preoperative evalu-ation of patients with extratemporal lobe epilepsy(ETLE)and explore improved methods to enhance its lo-calization accuracy.Methods A total of 41 patients(25 males,16 females,age(22.7±7.5)years)who underwent surgery and ultimately confirmed ETLE in Peking Union Medical College Hospital between Janu-ary 2006 and November 2022 were enrolled.The accuracy of preoperative independent 18 F-FDG PET ima-ging and the combined application of 18 F-FDG PET and MRI in detecting epileptogenic foci and their im-pacts on treatment decisions were retrospectively analyzed by using visual and semi-quantitative methods.Fisher's exact test was used to analyze the data.Results In all 41 patients,40 cases were found metabolic abnormalities in extratemporal lobe by independent 18F-FDG PET based on visual analysis.Among them,26 showed unifocal metabolic abnormalities,which were localized as epileptogenic foci.Fourteen patients showed multifocal metabolic abnormalities,and the epileptogenic foci were further verified in 8 cases through semi-quantitative analysis.In 1 case with negative PET visual analysis,a micro-metabolism focus was found at the abnormal MRI signal area.Among 13 patients with negative independent MRI,9 were found micro-structures abnormalities in brain regions with hypometabolism.18F-FDG PET improved clinical decision-making in 18 patients(43.9％,18/41).There were 30 patients(73.2％,30/41)with seizure-free postsur-gery,and the prognosis was not significantly different between patients with unifocal 18F-FDG PET metabolic pattern and those with multifocal ones(73.1％(19/26)vs 10/14,P=1.000).Conclusions 18F-FDG PET can be a useful diagnostic tool for patients with ETLE.Semi-quantitative analysis helps to detect more epi-leptogenic foci with multifocal metabolic abnormalities.The combined evaluation of 18F-FDG PET and MRI can improve the accuracy in localizing epileptogenic foci outside the temporal lobe.
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