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目的:评价n 11C-胆碱PET/CT动态脑显像对海马硬化难治性颞叶癫n (HS-RTLE)致n 灶的定位诊断价值，并与n 18F-FDG、n 11C-氟马西尼(FMZ) PET/CT进行对比。n 方法:回顾性分析2017年3月至2020年6月间北部战区总医院经病理证实为海马硬化(HS)的62例患者[男39例、女23例，年龄(30.3±11.2)岁]，术前均行多核素(n 18F-FDG、n 11C-FMZ、n 11C-胆碱)PET/CT脑显像。n 11C-胆碱PET显像采用动态连续扫描技术，绘制n 11C-胆碱在双侧海马区域的时间-放射性曲线(TAC)。以术后病理为“金标准”，比较3种显像剂对HS致n 灶的阳性检出率及定位准确率。另对2019年5月至2020年8月间该院46例临床可疑HS-RTLE患者[男27例、女19例，年龄(32.9±11.9)岁]行前瞻性研究，检查方法同回顾性研究，以颅内植入电极或术后病理为“金标准”，验证n 11C-胆碱TAC对致n 灶的定位诊断效能，应用ROC曲线评价3种显像剂定位致n 灶的诊断效能。采用n χ2检验及Fisher确切概率法和Delong检验分析数据。n 结果:回顾性研究示n 18F-FDG PET/CT对致n 灶的阳性检出率高于n 11C-胆碱PET/CT[100%(62/62)与85.48%(53/62)；n P＝0.003]，n 11C-胆碱及n 11C-FMZ PET/CT对致n 灶的定位准确率高于n 18F-FDG PET/CT[100%(53/53)、96.61%(57/59)与33.87%(21/62)；均n P<0.001]。前瞻性研究的46例患者中，25例为HS-RTLE，21例为非HS所致癫n 。n 11C-胆碱PET/CT诊断HS致n 灶的特异性为100%(21/21)，n 11C-FMZ和n 18F-FDG PET/CT分别为90.48%(19/21)和33.33%(7/21)。n 11C-胆碱及n 11C-FMZ PET/CT的AUC高于n 18F-FDG(0.920、0.912与0.627；n z值：4.93、5.16，均n P<0.01)。n 结论:11C-胆碱PET/CT可用于癫n 致n 灶的术前定位。相比于n 18F-FDG、n 11C-FMZ PET/CT，n 11C-胆碱PET/CT特异性高，阴性显像患者更有排除意义。n “,”Objective:To evaluate the diagnostic value of n 11C-choline PET/CT brain imaging for localization of epileptogenic foci in hippocampal sclerosis-refractory temporal lobe epilepsy (HS-RTLE), and compare it with n 18F-FDG and n 11C-flumazeni (FMZ) PET/CT.n Methods:From March 2017 and June 2020, a total of 62 patients (39 males, 23 females, age (30.3±11.2) years) with pathologically confirmed HS-RTLE in General Hospital of Northern Theater Command were retrospectively analyzed. All patients were preoperatively treated with multiple radionuclide (n 18F-FDG, n 11C-FMZ, n 11C-choline) PET/CT brain imaging. n 11C-choline PET imaging was used to acquire dynamic imaging data and time-activity curve (TAC) of n 11C-choline in bilateral hippocampal regions were drawn. With postoperative pathology as the “ gold standard” , the positive detection rates and localization diagnostic efficacies of three radionuclide imaging agents for epileptogenic foci were analyzed. Then a prospective study including 46 patients (27 males, 19 females; age (32.9±11.9) years; between May 2019 and August 2020; General Hospital of Northern Theater Command) with drug-refractory epilepsy caused by clinically suspected hippocampal sclerosis was performed. The examination method was the same as that of retrospective study. Using intracranial electrode implantation or postoperative pathology as “ gold standard” , the diagnostic efficacy of n 11C-choline TAC for localization of epileptogenic foci was verified, and ROC curve was drawn to evaluate the diagnostic value of three imaging agents for HS-RTLE epileptogenic foci. n χ 2 test and Fisher exact probability method, Delong test were used to analyze the data.n Results:In the retrospective study, the positive detection rate of n 18F-FDG PET/CT was higher than that of n 11C-choline PET/CT (100%(62/62) n vs 85.48%(53/62); n P=0.003), and the localization accuracies of n 11C-choline and n 11C-FMZ PET/CT were both higher than that of n 18F-FDG PET/CT (100%(53/53), 96.61%(57/59) n vs 33.87%(21/62); both n P<0.001). In the prospective study, 25 of 46 patients were diagnosed as HS-RTLE and 21 were non-HS induced epilepsy. The specificities ofn 11C-choline, n 11C-FMZ and n 18F-FDG PET/CT were 100%(21/21), 90.48%(19/21), 33.33%(7/21), respectively. The AUCs of n 11C-choline and n 11C-FMZ PET/CT were significantly higher than that of n 18F-FDG PET/CT (0.920, 0.912, 0.627; n z values: 4.93, 5.16, both n P<0.01).n Conclusions:11C-choline PET/CT can be used in the preoperative localization of epileptic foci. Compared with n 18F-FDG and n 11C-FMZ PET/CT, the specificity of n 11C-choline PET/CT is higher, and the negative imaging of n 11C-choline is more significant for exclusion.n