Utility of 18F‐fluorodeoxyglucose positron emission tomography in presurgical evaluation of patients with epilepsy: A multicenter study

Objective 18F‐Fluorodeoxyglucose positron emission tomography (FDG‐PET) is widely used in presurgical assessment in patients with drug‐resistant focal epilepsy (DRE) if magnetic resonance imaging (MRI) and scalp electroencephalography (EEG) do not localize the seizure onset zone or are discordant. Methods In this multicenter, retrospective observational cohort study, we included consecutive patients with DRE who had undergone FDG‐PET as part of their presurgical workup. We assessed the utility of FDG‐PET, which was defined as contributing to the decision‐making process to refer for resection or intracranial EEG (iEEG) or to conclude surgery was not feasible. Results We included 951 patients in this study; 479 had temporal lobe epilepsy (TLE), 219 extratemporal epilepsy (ETLE), and 253 epilepsy of uncertain lobar origin. FDG‐PET showed a distinct hypometabolism in 62% and was concordant with ictal EEG in 74% in TLE and in 56% in ETLE (p