Hybrid PET/MRI Imaging of 18F‐Fluorodeoxyglucose and 18‐kDa Translocator Protein for Presurgical Localization in Refractory Epilepsy

ABSTRACT Purpose Surgery remains the only curative option for a third of refractory epilepsy patients, though success depends on precise localization of the epileptogenic zone (EZ). This study aims to assess the clinical value of hybrid 18 F‐FDG and 18 F‐DPA‐714 PET/MRI for accurate localization and precise boundary delineation. Methods The refractory epilepsy patients who underwent surgery at Xuanwu Hospital from November 2022 to November 2023 were retrospectively recruited. Preoperative simultaneous 18 F‐FDG and 18 F‐DPA‐714 PET/MRI imaging were analyzed using the asymmetry index (AI) and a 4‐point visual score, with the surgical site and pathological findings serving as the gold standard. Results A total of 43 patients (mean age: 26.30 ± 8.37 years, male: 28) were included in this study. Lesion localization accuracy within the EZ was 76.7% for 18 F‐FDG PET/MRI, 69.8% for 18 F‐DPA‐714 PET/MRI, and 60.5% for conventional MRI ( p = 0.26). In 26 MRI‐positive cases, conventional MRI accurately localized all lesions within the EZ, with three cases showing negative findings on 18 F‐FDG images and six on 18 F‐DPA‐714. Among 17 MRI‐negative patients, thirteen demonstrated positive results on hybrid PET/MRI. Additionally, 18 F‐DPA‐714 PET/MRI proved more effective in delineating lesion boundaries. Compared to 18 F‐FDG, the AI score was significantly lower (0.25 ± 0.18 vs. 0.46 ± 0.19, p < 0.001), while the visual score was higher (4.00 ± 2.00 vs. 3.00 ± 0.00, p = 0.01). Conclusion 18 F‐DPA‐714 PET/MRI can effectively complement conventional MRI in the preoperative assessment of refractory epilepsy, with localization accuracy on par with 18 F‐FDG and enhanced capability in delineating lesion boundaries.