{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T16:21:50Z","timestamp":1772468510031,"version":"3.50.1"},"reference-count":50,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T00:00:00Z","timestamp":1772409600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100006117","name":"Dutch epilepsy foundation","doi-asserted-by":"publisher","award":["2020-09"],"award-info":[{"award-number":["2020-09"]}],"id":[{"id":"10.13039\/501100006117","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tomography"],"abstract":"<jats:p>Background: In temporal lobe epilepsy (TLE), locally reduced glucose metabolism (i.e., hypometabolism) is indicative of the epileptogenic onset zone (EZ). Here, we investigate the potential value of resting-state fMRI (rs-fMRI) for localizing the EZ with fluorodeoxyglucose positron emission tomography (FDG-PET) as ground truth. Methods: Twelve PET-positive patients (34.1 \u00b1 13.1 y; 5 females) with unilateral drug-resistant TLE were included. FDG-PET and rs-fMRI were acquired simultaneously at a hybrid 3T PET-MR scanner. Hypometabolic regions were identified on the FDG-PET images by a nuclear medicine expert. The FDG-PET images were compared with a clinical FDG-PET control dataset with normal glucose uptake distribution. The output z-score maps were thresholded at z &lt; \u22122 to produce a binary mask of the significantly hypometabolic regions. The hypometabolism masks were mirrored onto the contralateral hemisphere for the asymmetry comparison. Regional homogeneity (ReHo), amplitude of low-frequency fluctuations (ALFF), and fractional ALFF (fALFF) were calculated from the rs-fMRI in conventional (0.01\u20130.1 Hz) and slow-3 (0.073\u20130.198 Hz) frequency bands. Asymmetry indices (AIs) were calculated using the ipsilateral and contralateral hypometabolic masks in the PET-positive subjects and assessed via the one-sample Wilcoxon test and Spearman correlation coefficients. Results: The AIs of conventional fALFF were significantly lower in the hypometabolic zone (p &lt; 0.05). A significant negative correlation was found between the AIs of FDG-PET and fALFF in the slow-3 band (r = \u22120.62; p &lt; 0.05). Conclusions: Conventional and slow-3 band fALFF showed a potential to mimic the FDG-PET findings in terms of EZ localization. Further research with extended cohorts and histopathological validation is required to determine the clinical value.<\/jats:p>","DOI":"10.3390\/tomography12030030","type":"journal-article","created":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T14:55:01Z","timestamp":1772463301000},"page":"30","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Lateralization of FDG-PET Hypometabolism Using Resting-State fMRI in Temporal Lobe Epilepsy: A Simultaneous PET-MRI Study"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4601-805X","authenticated-orcid":false,"given":"Daniel","family":"Uher","sequence":"first","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands"},{"name":"Mental Health and Neuroscience Research Institute (MHeNs), Maastricht University, 6229 ER Maastricht, The Netherlands"},{"name":"Department of Neurosurgery, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands"},{"name":"Department Biomedical Magnetic Resonance (BMMR), Otto von Guericke University Magdeburg, 39120 Magdeburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7708-8501","authenticated-orcid":false,"given":"Gerhard S.","family":"Drenthen","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands"},{"name":"Mental Health and Neuroscience Research Institute (MHeNs), Maastricht University, 6229 ER Maastricht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3485-7881","authenticated-orcid":false,"given":"Tineke van de","family":"Weijer","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands"},{"name":"Institute of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, 6229 ER Maastricht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5698-3849","authenticated-orcid":false,"given":"Jochem van der","family":"Pol","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christianne M.","family":"Hoeberigs","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands"},{"name":"Academic Center for Epileptology, Kempenhaeghe and Maastricht University Medical Centre, 5591 VE Heeze, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul A. M.","family":"Hofman","sequence":"additional","affiliation":[{"name":"Care and Public Health Research Institute (CAPHRI), Maastricht University, 6229 ER Maastricht, The Netherlands"},{"name":"Department of Radiology, Horatio Oduber Hospital, Oranjestad, Aruba"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8295-2521","authenticated-orcid":false,"given":"Sam","family":"Springer","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0004-1860","authenticated-orcid":false,"given":"Rob P. W.","family":"Rouhl","sequence":"additional","affiliation":[{"name":"Mental Health and Neuroscience Research Institute (MHeNs), Maastricht University, 6229 ER Maastricht, The Netherlands"},{"name":"Department of Neurology, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4321-5912","authenticated-orcid":false,"given":"Albert J.","family":"Colon","sequence":"additional","affiliation":[{"name":"Academic Center for Epileptology, Kempenhaeghe and Maastricht University Medical Centre, 5591 VE Heeze, The Netherlands"},{"name":"Centre d\u2018Etudes et Traitement de l\u2018Epilepsie, CHU-Martinique, 97200 Fort-de-France, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olaf E. M. G.","family":"Schijns","sequence":"additional","affiliation":[{"name":"Mental Health and Neuroscience Research Institute (MHeNs), Maastricht University, 6229 ER Maastricht, The Netherlands"},{"name":"Department of Neurosurgery, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands"},{"name":"Academic Center for Epileptology, Kempenhaeghe and Maastricht University Medical Centre, 5591 VE Heeze, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Walter H.","family":"Backes","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands"},{"name":"Mental Health and Neuroscience Research Institute (MHeNs), Maastricht University, 6229 ER Maastricht, The Netherlands"},{"name":"Academic Center for Epileptology, Kempenhaeghe and Maastricht University Medical Centre, 5591 VE Heeze, The Netherlands"},{"name":"Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, 6229 ER Maastricht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5271-8060","authenticated-orcid":false,"given":"Jacobus F. A.","family":"Jansen","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands"},{"name":"Mental Health and Neuroscience Research Institute (MHeNs), Maastricht University, 6229 ER Maastricht, The Netherlands"},{"name":"Academic Center for Epileptology, Kempenhaeghe and Maastricht University Medical Centre, 5591 VE Heeze, The Netherlands"},{"name":"Department of Electrical Engineering, Eindhoven University of Technology, 5612 AP Eindhoven, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2179","DOI":"10.1111\/epi.14596","article-title":"The epidemiology of drug-resistant epilepsy: A systematic review and meta-analysis","volume":"59","author":"Kalilani","year":"2018","journal-title":"Epilepsia"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1001\/jama.2012.220","article-title":"Early Surgical Therapy for Drug-Resistant Temporal Lobe Epilepsy: A Randomized Trial","volume":"307","author":"Engel","year":"2012","journal-title":"JAMA"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1056\/NEJM200108023450501","article-title":"A Randomized, Controlled Trial of Surgery for Temporal-Lobe Epilepsy","volume":"345","author":"Wiebe","year":"2001","journal-title":"N. 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