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目的:初步探讨三维正电子发射断层显像术(PET)与MRI配准融合技术在儿童药物难治性癫痫术前评估中的应用价值。方法:回顾性分析2019年2月至2021年4月南京医科大学附属儿童医院神经外科收治的32例难治性癫痫患儿的临床资料。患儿术前均行无创性检查[包括头颅MRI、正电子发射断层显像术(PET)、头皮视频脑电图]，然后将PET与MRI数据进行配准融合并以三维立体化呈现，以指导术前评估和手术方案的制定。采用Engel分级标准评估手术疗效。结果:32例患儿中，发作间期癫痫样放电位于病灶同侧9例(28.1%)、双侧23例(71.9%)。其中25例记录到发作期脑电图，24例发作起始较为局限。术前MRI阳性30例(93.7%)、阴性2例(6.3%)；PET均为阳性，经三维PET-MRI配准融合后均为阳性，其中单一病灶29例(90.6%)、多发病灶3例(9.4%)。术中结合皮质脑电图按术前规划顺利完成手术，其中31例行癫痫灶切除术、1例行左侧颞顶枕叶离断术。术后头颅MRI显示手术切除范围均与术前手术规划相吻合。病理学结果：局灶性皮质发育不良23例，软化灶5例，胚胎发育不良性神经上皮肿瘤2例，脑炎后改变1例，血管畸形1例。32例患儿的中位随访时间为15.9个月(4~30个月)。末次随访显示，Engel分级Ⅰ级29例，Ⅱ级1例，Ⅲ级2例。结论:应用三维PET-MRI配准融合技术对儿童药物难治性癫痫致痫灶的检出率高，便于术前评估和进行手术规划，从而提高手术的成功率。“,”Objective:To investigate the preliminary application value of three-dimensional positron emission tomography (PET) and MRI co-registration and fusion in the presurgical evaluation of drug-resistant epilepsy in children.Methods:A retrospective analysis was conducted on the clinical data of 32 children with refractory epilepsy admitted to the Department of Neurosurgery, Children′s Hospital of Nanjing Medical University from February 2019 to April 2021. Preoperative non-invasive examinations [including head MRI, PET, scalp video-EEG (electroencephalography)] were performed, and PET results were co-registered and fused with MRI data and presented in a three-dimensional presentation to guide presurgical evaluation and surgical strategy development. The Engel grading criteria were used to assess surgical efficacy.Results:Among the 32 children, the interictal epileptic discharges were located on the ipsilateral hemisphere of the lesion in 9 cases (28.1%)and on both sides in 23 cases (71.9%). Of those, ictal EEG was recorded in 25 cases, and 24 cases had focal onsets. Preoperative MRI showed positive findings in 30 cases (93.7%), negative in 2 cases (6.3%). PET results were all positive and were all positive after three-dimensional PET-MRI co-registration and fusion, which indicated single lesions in 29 cases (90.6%) and multiple lesions in 3 cases (9.4%). Operations were successfully performed based on intraoperative electrocorticography combined with preoperative plans, which included 31 cases of epileptogenic zonectomy and 1 case of left temporo-parieto-occipital lobe transection. Postoperative head MRI showed that the range of surgical resection was consistent with the preoperative surgical plan. Pathological results included 23 cases of focal cortical dysplasia, 5 cases of encephalomalacia, 2 cases of dysembryoplastic neuroepithelial tumor, 1 case of post-encephalitis change, and 1 case of vascular malformation. The median follow-up time for 32 children was 15.9 months (4 to 30 months). The last follow-up showed that Engel grade I was reported in 29 cases, Grade II in 1 case, and Grade III in 2 cases.Conclusion:The three-dimensional PET-MRI co-registration and fusion technique can improve the detection rate of epileptic foci in children with drug-refractory epilepsy, facilitate preoperative evaluation and surgical planning, and thus improve the success rate of surgery.