Identifying the epileptogenic zone by four non-invasive imaging techniques versus stereo-EEG in MRI-negative pre-surgery epilepsy patients: Clinical Neurophysiology

D. Rossi Sebastiano, L. Tassi, D. Duran, E. Visani, F. Gozzo, F. Cardinale, L. Nobili, A. Del Sole, A. Rubino, S. Dotta, E. Schiaffi, R. Garbelli, S. Franceschetti, R. Spreafico, F. Panzica

Research output: Contribution to journalArticlepeer-review


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. © 2020 International Federation of Clinical Neurophysiology
Original languageEnglish
Pages (from-to)1815-1823
Number of pages9
JournalClin. Neurophysiol.
Issue number8
Publication statusPublished - 2020


  • EEG-fMRI
  • Epilepsy surgery
  • HR-EEG
  • MEG
  • PET
  • fluorodeoxyglucose f 18
  • adult
  • Article
  • clinical article
  • comparative study
  • controlled study
  • diagnostic accuracy
  • diagnostic value
  • electroencephalogram
  • electroencephalography
  • electroneurology
  • epileptic discharge
  • epileptic focus
  • epileptic patient
  • false negative result
  • false positive result
  • female
  • functional magnetic resonance imaging
  • human
  • image reconstruction
  • magnetoencephalography
  • male
  • neuroimaging
  • neuropathology
  • neurosurgery
  • nuclear magnetic resonance imaging
  • ordered subset expectation maximization
  • positron emission tomography
  • preoperative evaluation
  • priority journal
  • sensitivity and specificity
  • stereoelectroencephalography


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