To compare the lateralization accuracy and localization accuracy of MRI, interictal ¹⁸F-fluorodeoxyglucose(FDG) and ¹¹C-flumazenil(FMZ) PET/CT imaging for refractory epilepsy(REP) in patients with hippocampal sclerosis(HS).

A total of 41 classical HS patients (25 males, 16 females; age: 15-61 years) with REP from General Hospital of Northern Theater Command of PLA between January 2017 and October 2018 were retrospectively analyzed. All patients underwent MRI, interictal ¹⁸F-FDG and ¹¹C-FMZ PET/CT imaging, followed by the resection of epileptogenic foci. The pathological diagnosis was taken as the gold standard. Visual and semi-quantitative analyses were used to analyze the images. The lateralization accuracy and localization accuracy of the three imaging methods for epileptogenic foci were calculated and compared(χ² test).

The lateral accuracy and localization accuracy of MRI were 70.73%(29/41) and 60.98%(25/41), those of interictal ¹⁸F-FDG PET/CT imaging were 78.05%(32/41) and 70.73%(29/41), and those of interictal ¹¹C-FMZ PET/CT imaging were 100%(41/41) and 100%(41/41), respectively. The interictal ¹¹C-FMZ PET/CT imaging was the best among 3 imaging methods(χ² values: 1.976-12.902, all P<0.01).

All 3 imaging methods have their advantages and limitations. The interictal ¹¹C-FMZ PET/CT imaging has a high value in the localization of classical HSREP, which can significantly improve the diagnostic accuracy of classical HSREP and guide clinical operation.

Epilepsy, temporal lobe; Sclerosis; Hippocampus; Positron-emission tomography; Tomography, X-ray computed; Flumazenil; Carbon radioisotopes; Deoxyglucose; Magnetic resonance imaging