Deep-learning predicted PET can be subtracted from the true clinical fluorodeoxyglucose PET co-registered to MRI to identify the epileptogenic zone in focal epilepsy.

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Abstract

Normal interictal [18 F]FDG-PET can be predicted from the corresponding T1w MRI with Generative Adversarial Networks (GANs). A technique we call SIPCOM (Subtraction Interictal PET Co-registered to MRI) can then be used to compare epilepsy patients’ predicted and clinical PET. We assessed the ability of SIPCOM to identify the Resection Zone (RZ) in patients with drug-resistant epilepsy (DRE) with reference to visual and Statistical Parametric Mapping (SPM) analysis.Patients with complete pre-surgical work-up and subsequent SEEG and cortectomy were included. RZ localisation, the reference region, was assigned to one of eighteen anatomical brain regions. SIPCOM was implemented using healthy controls to train a GAN. To compare, the clinical PET coregistered to MRI was visually assessed by two trained readers, and a standard SPM analysis was performed.Twenty patients aged 17 to 50 (32±7.8) years were included, 14 (70%) with temporal lobe epilepsy (TLE). Eight (40%) were MRI-negative. After surgery, fourteen patients (70%) had a good outcome (Engel I-II). RZ localisation rate was 60% with SIPCOM vs. 35% using SPM (p=0.015) and vs. 85% using visual analysis (p=0.54). Results were similar for Engel I-II patients, the RZ localisation rate was 64% with SIPCOM vs 36% with SPM. With SIPCOM localisation was correct in 67% in MRI-positive vs. 50% in MRI-negative patients, and 64% in TLE vs. 43% in extra-TLE. The average number of false-positive clusters was 2.2±1.3 using SIPCOM vs. 2.3±3.1 using SPM. All RZs localised with SPM were correctly localised with SIPCOM. In one case, PET and MRI were visually reported as negative, but both SIPCOM and SPM localised the RZ.SIPCOM performed better than the reference computer-assisted method (SPM) for RZ detection in a group of operated DRE patients. SIPCOM’s impact on epilepsy management needs to be prospectively validated.This article is protected by copyright. All rights reserved.