The added value of [18F]-fluoro-D-deoxyglucose positron emission tomography in screening for temporal lobe epilepsy surgery

Epilepsia. 2007 Nov;48(11):2121-9. doi: 10.1111/j.1528-1167.2007.01197.x. Epub 2007 Jul 25.


Purpose: [18F]-Fluoro-d-deoxyglucose positron emission tomography (FDG-PET) is an expensive, invasive, and not widely available technique used in the presurgical evaluation of temporal lobe epilepsy. We assessed its added value to the decision-making process in relation to other commonly used tests.

Methods: In a retrospective study of a large series of consecutive patients referred to the national Dutch epilepsy surgery program between 1996 and 2002, the contribution of FDG-PET, magnetic resonance imaging (MRI), and video-electroencephalogram (video-EEG) monitoring findings, alone or in combination, to the decision whether to perform surgery was investigated. The impact of FDG-PET was quantified by comparing documented decisions concerning surgery before and after FDG-PET results.

Results: Of 469 included patients, 110 (23%) underwent FDG-PET. In 78 of these patients (71%), FDG-PET findings led clinicians to change the decision they had made based on MRI and video-EEG monitoring findings. In 17% of all referred patients, the decision regarding surgical candidacy was based on FDG-PET findings. FDG-PET was most useful when previous MRI results were normal (p < 0.0001) or did not show unilateral temporal abnormalities (p < 0.0001), or when ictal EEG results were not consistent with MRI findings (p < 0.0001) or videotaped seizure semiology (p = 0.027). The positive and negative predictive values for MRI and video-EEG monitoring, which ranged from 0.48 to 0.67, were improved to 0.62 to 0.86 in combination with FDG-PET.

Conclusions: In patients referred for TLE surgery, FDG-PET findings can form the basis for deciding whether a patient is eligible for surgery, and especially when MRI or video-EEG monitoring are nonlocalizing.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Epilepsy, Temporal Lobe / surgery*
  • Fluorodeoxyglucose F18*
  • Positron-Emission Tomography / statistics & numerical data*
  • Retrospective Studies


  • Fluorodeoxyglucose F18