Đặc điểm hình ảnh FDG PET/CT và mức độ phù hợp với MRI/ EEG ở trẻ động kinh cục bộ kháng thuốc

Abstract

This study aimed to describe the cerebral 18F-FDG (18F-Fluorodeoxyglucose) metabolic imaging characteristics using PET/CT (Positron Emission Tomography/Computed Tomography) and to evaluate the concordance of FDG PET/CT with magnetic resonance imaging (MRI) and video electroencephalography (EEG) in children with drug-resistant focal epilepsy (DRE). A retrospective cross-sectional descriptive study was conducted on 42 pediatric DRE patients at the 108 Military Central Hospital from January 2017 to January 2026. The FDG PET/CT scanning, patient preparation, and anesthesia/sedation protocols were strictly performed in accordance with the SNMMI/EANM and the Ministry of Health guidelines. Images were evaluated using visual assessment combined with semi-quantitative indices. The results showed that FDG PET/CT detected metabolic abnormalities in 35/42 cases (83.3%; 95% CI: 69.8 - 92.5%). The lesions were predominantly characterized by hypometabolism (94.3%), focal pattern (80%), and multifocal distribution (51.4%). The frontal lobe was the most common single-lobe location (25.7%). The mean asymmetry index (AI%) at the lesional areas reached 17.66 ± 6.16%. In multimodal comparison, the complete concordance rate of FDG PET/CT with EEG was 62.9% and with MRI was 28.6%. Notably, in the subgroup of pediatric patients with negative brain MRI, FDG PET/CT still identified abnormalities in 25 cases (accounting for 71.4% of all positive PET scans). FDG PET/CT demonstrates the ability to detect areas of cerebral metabolic abnormalities with diverse phenotypes in pediatric patients with DRE. Although it is not the gold standard for defining the epileptogenic zone, FDG PET/CT serves as an important adjunctive diagnostic modality in multimodal presurgical evaluation, being particularly valuable in providing localizing information for the MRI-negative pediatric subgroup.