Cortical surface analysis for focal cortical dysplasia diagnosis by using PET images

Focal cortical dysplasia (FCD) is a neurological disorder distinguished by faulty brain cell structure and development. Repetitive and uncontrollable seizures may be linked to FCD's aberrant cortical thickness, gyrification, and sulcal depth. Quantitative cortical surface analysis is a crucial alternative to ineffective visual inspection. This study recruited 42 subjects including 22 FCD patients who underwent surgery and 20 healthy controls (HC). For the FCD patients, T1-weighted and PET images were obtained by a PET-MRI scanner, and the confirmed epileptogenic zone (EZ) was collected from postsurgical follow-up. For the HCs, CT and PET images were obtained by a PET-CT scanner. Cortical thickness, gyrification index, and sulcal depth were calculated using a computational anatomical toolbox (CAT12). A cluster-based analysis is carried out to determine each FCD patient's aberrant cortical surface. After parcellating the cerebral cortex into 68 regions by the Desikan-Killiany atlas, a region of interest (ROI) analysis was conducted to know whether the feature in the FCD group is significantly different from that in the HC group. Finally, the features of all ROIs were utilised to train a support vector machine classifier (SVM). The classification performance is evaluated by the leave-one-out cross-validation. The cluster-based analysis can localize the EZ cluster with the highest accuracy of 54.5 % (12/22) for cortical thickness, 40.9 % (9/22) and 13.6 % (3/22) for sulcal depth and gyrification, respectively. Moderate concordance (Kappa, 0.6) is observed between the confirmed EZs and identified clusters by using the cortical thickness. Fair concordance (Kappa, 0.3) and no concordance (Kappa, 0.1) is found by using sulcal depth and gyrification. Significant differences are found in 46 of 68 regions (67.7 %) for the three measures. The trained SVM classifier achieved a prediction accuracy of 95.5 % for the cortical thickness, while the sulcal depth and the gyrification obtained 86.0 % and 81.5 %. Cortical thickness, as determined by quantitative cortical surface analysis of PET data, has a greater ability than sulcal depth and gyrification to locate aberrant EZ clusters in FCD. Surface measures might be different in many regions for FCD and HC. By integrating machine learning and cortical morphologies features, individual prediction of FCD seems to be feasible.