Abstract: Objective To investigate the diagnostic value of hydrogen proton magnetic resonance spectroscopy imaging (1H-MRS) combined with positron emission tomography/magnetic resonance imaging (PET/MRI) in epilepsy. 
Methods Seventy-four epilepsy patients admitted to our hospital were selected as the epilepsy group, while 50 healthy people undergoing physical examination during the same period were selected as the control group. Using stereotactic electroencephalography (SEEG) and surgical and pathological methods as the “gold standard”, the diagnostic value of the 3 modalities, including 1H-MRS examination alone, PET/MRI fusion imaging, 1H-MRS combined with PET/MRI fusion imaging, in detection and lesion localization was evaluated. 
Results Compared with the ratios of N-acetyl aspartate (NAA)/Creatine (Cr), NAA/choline compounds (Cho), NAA/(Cr+Cho) in the affected hippocampus, the ratios of NAA/Cr, NAA/Cho, NAA/(Cr+Cho) in the healthy hippocampus were higher (P＜0.05). The combined detection rate and the coincidence rate of positive lesion localization were higher than those of 1H-MRS and PET/MRI fusion imaging (P＜0.05). With SEEG and surgical and pathological methods as the “gold standard”, the sensitivity of 1H-MRS, PET/MRI fusion and combined detection of the two was 44.59%, 55.41% and 94.59% respectively, the specificity was 54.05%, 59.45% and 78.29% respectively, and the accuracy was 49.32%, 57.43% and 95.39% respectively. The area under the receiver operating characteristic (ROC) curve (AUC) was 0.764, 0.788 and 0.812 respectively. The specificity and AUC of combined detection were the highest. 
Conclusion Diagnosis of epilepsy patients by 1H-MRS combined with PET/MRI can improve the accuracy of epilepsy with good diagnostic efficacy. 

Key words: epilepsy, magnetic resonance spectroscopy, positron emission tomography/magnetic resonance imaging