OBJECTIVE We evaluated four imaging techniques, i.e. Electroencephalography (EEG)-functional Magnetic Resonance Imaging (MRI) (EEG-fMRI), High-resolution EEG (HR-EEG), Magnetoencephalography (MEG) and 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography (PET), for the identification of the epileptogenic zone (EZ) in 41 patients with negative MRI, candidate to neurosurgery. METHODS For each technique, results were compared to the Stereo-EEG. Diagnostic measures were calculated with respect to the post-surgical outcome, either for all the patients (39/41, two patients excluded) and for the subgroup of patients with the EZ involving more than one lobe (20/41). RESULTS When considered individually, each functional technique showed accuracy values ranging 54,6%-63,2%, having PET, MEG and HR-EEG higher sensitivity, and EEG-fMRI higher specificity. In patients with multilobar epileptogenic zone, functional techniques achieved the best accuracies (up to 80%) when three techniques, including EEG-fMRI, were considered together. CONCLUSIONS The study highlights the accuracy of a combination of functional imaging techniques in the identification of EZ in MRI negative focal epilepsy. The best diagnostic yield was obtained if the combination of PET, MEG (or HR-EEG as alternative), EEG-fMRI were considered together. SIGNIFICANCE The functional imaging techniques may improve the presurgical workup of MRI negative focal epilepsy, if epileptogenic zone involves more than one lobe.

中文翻译：

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MRI 阴性术前癫痫患者通过四种非侵入性成像技术与立体脑电图识别癫痫区

目的 我们评估了四种成像技术，即脑电图 (EEG)-功能磁共振成像 (MRI) (EEG-fMRI)、高分辨率脑电图 (HR-EEG)、脑磁图 (MEG) 和 2-[18F]fluoro-2-脱氧-D-葡萄糖正电子发射断层扫描 (PET)，用于识别 41 名 MRI 阴性、神经外科候选者的致痫区 (EZ)。方法 对于每种技术，将结果与立体脑电图进行比较。针对所有患者（39/41，排除两名患者）和 EZ 涉及多于一个肺叶的患者亚组 (20/41)，根据手术后结果计算诊断措施。结果 单独考虑时，每种功能技术的准确度值范围为 54.6%-63.2%，PET、MEG 和 HR-EEG 具有更高的灵敏度，而EEG-fMRI的特异性更高。在多叶致癫痫区的患者中，将包括 EEG-fMRI 在内的三种技术结合起来考虑时，功能技术的准确度最高（高达 80%）。结论 该研究强调了功能成像技术组合在 MRI 阴性局灶性癫痫中识别 EZ 的准确性。如果同时考虑 PET、MEG（或 HR-EEG 作为替代）、EEG-fMRI 的组合，则获得最佳诊断率。意义 如果致痫区涉及多个叶，功能成像技术可能会改善 MRI 阴性局灶性癫痫的术前检查。结论 该研究强调了功能成像技术组合在 MRI 阴性局灶性癫痫中识别 EZ 的准确性。如果同时考虑 PET、MEG（或 HR-EEG 作为替代）、EEG-fMRI 的组合，则获得最佳诊断率。意义 如果致痫区涉及多个叶，功能成像技术可能会改善 MRI 阴性局灶性癫痫的术前检查。结论 该研究强调了功能成像技术组合在 MRI 阴性局灶性癫痫中识别 EZ 的准确性。如果同时考虑 PET、MEG（或 HR-EEG 作为替代）、EEG-fMRI 的组合，则获得最佳诊断率。意义 如果致痫区涉及多个叶，功能成像技术可能会改善 MRI 阴性局灶性癫痫的术前检查。