AUTHOR=Mayoral Maria , Niñerola-Baizán Aida , Marti-Fuster Berta , Donaire Antonio , Perissinotti Andrés , Rumià Jordi , Bargalló Núria , Sala-Llonch Roser , Pavia Javier , Ros Domènec , Carreño Mar , Pons Francesca , Setoain Xavier 

TITLE=Epileptogenic Zone Localization With 18FDG PET Using a New Dynamic Parametric Analysis

JOURNAL=Frontiers in Neurology

VOLUME=10

YEAR=2019

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2019.00380

DOI=10.3389/fneur.2019.00380

ISSN=1664-2295

ABSTRACT=<p><bold>Introduction:</bold> [<sup>18</sup>F]fluorodeoxyglucose (<sup>18</sup>F-FDG) positron emission tomography (PET) is part of the regular preoperative work-up in medically refractory epilepsy. As a complement to visual evaluation of PET, statistical parametric maps can help in the detection of the epileptogenic zone (EZ). However, software packages currently available are time-consuming and little intuitive for physicians. We develop a user-friendly software (referred as PET-analysis) for EZ localization in PET studies that allows dynamic real-time statistical parametric analysis. To evaluate its performance, the outcome of PET-analysis was compared with the results obtained by visual assessment and Statistical Parametric Mapping (SPM).</p><p><bold>Methods:</bold> Thirty patients with medically refractory epilepsy who underwent presurgical <sup>18</sup>F-FDG PET with good post-operative outcomes were included. The <sup>18</sup>F-FDG PET studies were evaluated by visual assessment, with SPM8 and PET-analysis. In SPM, parametric T-maps were thresholded at corrected <italic>p</italic> &lt; 0.05 and cluster size k = 50 and at uncorrected <italic>p</italic> &lt; 0.001 and k = 100 (the most used parameters in the literature). Since PET-analysis rapidly processes different threshold combinations, T-maps were thresholded with multiple <italic>p</italic>-value and different clusters sizes. The presurgical EZ identified by visual assessment, SPM and PET-analysis was compared to the confirmed EZ according to post-surgical follow-up.</p><p><bold>Results:</bold> PET-analysis obtained 66.7% (20/30) of correctly localizing studies, comparable to the 70.0% (21/30) achieved by visual assessment and significantly higher (<italic>p</italic> &lt; 0.05) than that obtained with the SPM threshold <italic>p</italic> &lt; 0.001/k = 100, of 36.7% (11/30). Only one study was positive, albeit non-localizing, with the SPM threshold corrected <italic>p</italic> &lt; 0.05/k = 50. Concordance was substantial for PET-analysis (κ = 0.643) and visual interpretation (κ = 0.622), being fair for SPM (κ = 0.242).</p><p><bold>Conclusion:</bold> Compared to SPM with the fixed standard parameters, PET-analysis may be superior in EZ localization with its easy and rapid processing of different threshold combinations. The results of this initial proof-of-concept study validate the clinical use of PET-analysis as a robust objective complementary tool to visual assessment for EZ localization.</p>