Abstract

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Title:: Role of PET/MRI combined with scalp interictal EEG discharges in presurgical lesion localization in MRI-negative FCD type Ⅱ drug-refractory epilepsy

Author(s):: YANG Xiaoli; ZHOU Feng; GE Liusuo; SANG Lin; Department of Neurosurgery, Beijing Fengtai Hospital, Beijing 100070, China

Keywords:: Keywords: focal cortical dysplasia type II scalp electroencephalogram interictal discharge positron emission tomography presurgical evaluation

Abstract:: Objective To assess the concordance of PET/MRI and scalp interictal EEG discharges (IEDs) in localizing lesions of MRI-negative focal cortical dysplasia (FCD) type Ⅱ drug-refractory epilepsy, and to explore the benefit of combining the two. Methods A retrospective study was carried out on 45 patients who had undergone surgery and pathologically confirmed as MRI-negative FCD type Ⅱ drug-refractory epilepsy. The presurgical IEDs, scalp ictal EEG discharges (IDs), PET, MRI and other clinical data were collected, and the PET and MRI images were coregistered. The result of lesion localization by PET/MRI or IEDs or IDs was analyzed, and the concordance between IEDs or IDs with PET/MRI in localizing FCD type II lesions was compared. Results The lesions were successfully localized in 34, 40 and 35 cases using PET/MRI, IEDs and IDs, respectively, accounting for 75.6%, 88.9% and 77.8% of the enrolled cases. The number of successful lesion localization cases increased to 39 (86.7%) and 37 (82.2%) after combining PET/MRI with IEDs and IDs. There was a high degree of concordance between IEDs and PET/MRI (k=0.90), but a poor concordance between IDs and PET/MRI (k=0.25). Conclusion IEDs and PET/MRI have a high degree of concordance in localizing FCD type II lesions, and the combination of the two which can improve the precise lesion localization is of great significance in presurgical evaluation of MRI negative FCD type II as a noninvasive technique.