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

Lingling Zhang,Hailing Zhou,Yongjin Tang,Jiefeng Gan,Xiangshu Hu,Hainan Li,Xueying Ling,Qiang Guo,Hao Xu

Published 2025 in Clinical Neurophysiology

ABSTRACT

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 18F-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, 18F-FDG PET/MRI showed the highest sensitivity (75.7 %) for localizing the EZ across all modalities. We also found that 18F-FDG PET/MRI demonstrated the best accuracy and diagnostic value for localizing the EZ (60.0 %). Among MRI-doubtful/negative patients, 18F-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 18F-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.

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