*Result*: Identifying the epileptogenic zone by 18F-FDG PET/MRI in drug-resistant epilepsy with focal cortical dysplasia type IIIa.

Title:
Identifying the epileptogenic zone by 18F-FDG PET/MRI in drug-resistant epilepsy with focal cortical dysplasia type IIIa.
Authors:
Zhang L; Department of Neurology, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou 310006 Zhejiang, China; Department of Nuclear Medicine, PET/CT-MRI Center, Center of Cyclotron and PET Radiopharmaceuticals, The First Affiliated Hospital of Jinan University, 613 West Huangpu Road, Tianhe District, Guangzhou 510630, China., Zhou H; Department of Radiology, Central People's Hospital of Zhanjiang, 236 Yuanzhu Road, Chikan District, Zhanjiang, China., Tang Y; Department of Nuclear Medicine, PET/CT-MRI Center, Center of Cyclotron and PET Radiopharmaceuticals, The First Affiliated Hospital of Jinan University, 613 West Huangpu Road, Tianhe District, Guangzhou 510630, China., Gan J; Department of Nuclear Medicine, PET/CT-MRI Center, Center of Cyclotron and PET Radiopharmaceuticals, The First Affiliated Hospital of Jinan University, 613 West Huangpu Road, Tianhe District, Guangzhou 510630, China., Hu X; Epilepsy Center, Guangdong 999 Brain Hospital, 578 South Shatai Road, Baiyun District, Guangzhou 510510, China., Li H; Department of Pathology, Guangdong 999 Brain Hospital, 578 South Shatai Road, Baiyun District, Guangzhou 510510, China., Ling X; Department of Nuclear Medicine, PET/CT-MRI Center, Center of Cyclotron and PET Radiopharmaceuticals, The First Affiliated Hospital of Jinan University, 613 West Huangpu Road, Tianhe District, Guangzhou 510630, China. Electronic address: lingxuey@163.com., Guo Q; Epilepsy Center, Guangdong 999 Brain Hospital, 578 South Shatai Road, Baiyun District, Guangzhou 510510, China. Electronic address: guoqiang999brain@163.com., Xu H; Department of Nuclear Medicine, PET/CT-MRI Center, Center of Cyclotron and PET Radiopharmaceuticals, The First Affiliated Hospital of Jinan University, 613 West Huangpu Road, Tianhe District, Guangzhou 510630, China. Electronic address: txh@jnu.edu.cn.
Source:
Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology [Clin Neurophysiol] 2026 Jan; Vol. 181, pp. 2111412. Date of Electronic Publication: 2025 Nov 08.
Publication Type:
Journal Article
Language:
English
Journal Info:
Publisher: Elsevier Country of Publication: Netherlands NLM ID: 100883319 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1872-8952 (Electronic) Linking ISSN: 13882457 NLM ISO Abbreviation: Clin Neurophysiol Subsets: MEDLINE
Imprint Name(s):
Original Publication: Amsterdam : Elsevier, c1999-
MeSH Terms:
Drug Resistant Epilepsy*/diagnostic imaging , Drug Resistant Epilepsy*/physiopathology , Drug Resistant Epilepsy*/surgery , Magnetic Resonance Imaging*/methods , Positron-Emission Tomography*/methods , Malformations of Cortical Development, Group I*/diagnostic imaging , Malformations of Cortical Development*/diagnostic imaging , Fluorodeoxyglucose F18*, Humans ; Male ; Female ; Adult ; Retrospective Studies ; Young Adult ; Adolescent ; Middle Aged ; Child ; Electroencephalography ; Focal Cortical Dysplasia ; Epilepsy
Contributed Indexing:
Keywords: (18)F-FDG PET/MRI; Drug-resistant epilepsy; Epileptogenic zone; Focal cortical dysplasia type IIIa
Substance Nomenclature:
0Z5B2CJX4D (Fluorodeoxyglucose F18)
SCR Disease Name:
Focal cortical dysplasia of Taylor
Entry Date(s):
Date Created: 20251113 Date Completed: 20251213 Latest Revision: 20251213
Update Code:
20260130
DOI:
10.1016/j.clinph.2025.2111412
PMID:
41232484
Database:
MEDLINE

*Further Information*

*Objective: Focal cortical dysplasia (FCD) type IIIa, distinct from isolated FCD in drug-resistant epilepsy, is typically confirmed via postoperative histopathology. This study aimed to evaluate the diagnostic utility of preoperative noninvasive <sup>18</sup>F-fludeoxyglucose (FDG) PET/MRI co-registration in localizing the epileptogenic zone (EZ) in FCD type IIIa.
Methods: We performed a retrospective study that included 60 patients with FCD type IIIa who underwent resection for drug-resistant epilepsy. The sensitivity of each modality for localizing the EZ was calculated, with invasive stereoelectroencephalography (SEEG) as a reference. Diagnostic accuracy and value of each modality were further assessed with respect to SEEG and postoperative outcomes for all patients and MRI negative/doubtful patients.
Results: We analyzed the diagnostic value of the different non-invasive diagnostic techniques with respect to concordance with SEEG findings and postsurgical seizure outcomes. For all included patients, <sup>18</sup>F-FDG PET/MRI showed the highest sensitivity (75.7 %) for localizing the EZ across all modalities. We also found that <sup>18</sup>F-FDG PET/MRI demonstrated the best accuracy and diagnostic value for localizing the EZ (60.0 %). Among MRI-doubtful/negative patients, <sup>18</sup>F-FDG PET/MRI not only showed the highest sensitivity (79.3 %) but also achieved most promising accuracy and diagnostic value for identifying the EZ (61.7 % accuracy) across all modalities.
Significance: <sup>18</sup>F-FDG PET/MRI coregistration appears to be overwhelmingly rewarding in affording localization of EZ for patients with FCD type IIIa. This technique is potentially valuable as a noninvasive method to identify the EZ in patients with drug-resistant epilepsy due to FCD type IIIa, especially for MRI-negative/doubtful patients.
(Copyright © 2025 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.)*

*Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.*