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Added value of quantitative [18F]FDG-PET analysis in MRI-negative epilepsy: A simulation-based study using realistic

Andrés Perissinotti1, Arnau Farré-Melero2, Francisco J López-González3

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Quantitative analysis of [18F]FDG-PET scans significantly improves the detection of hypometabolic foci in epilepsy. This method enhances diagnostic accuracy and physician confidence, particularly in complex cases, offering a valuable tool for non-lesional epilepsy research.

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Area of Science:

  • Neuroimaging
  • Epilepsy Research
  • Medical Imaging Analysis

Background:

  • Accurate localization of epileptic foci is crucial for non-lesional epilepsy management.
  • Quantitative analysis of [18F]FDG-PET images holds promise for improving focus localization.
  • Lack of gold standards has hindered comprehensive evaluation of quantitative [18F]FDG-PET approaches.

Purpose of the Study:

  • To evaluate the diagnostic improvements offered by quantitative analysis of [18F]FDG-PET images.
  • To assess the impact of quantitative results on physicians' diagnostic confidence and accuracy.
  • To introduce a novel dataset of realistic simulated MRI-negative epilepsy [18F]FDG-PET studies.

Main Methods:

  • Generation of 125 realistic simulated [18F]FDG-PET studies (100 with synthetic hypometabolic foci, 25 controls).
  • Visual rating (VR) and quantitative results (QR) assessment by eight nuclear physicians.
  • Analysis of changes in interpretation, success rate (SR), diagnostic confidence (DC), and inter-rater agreement before and after QR.

Main Results:

  • Physicians modified interpretations in 31.3% of cases after QR, increasing SR from 16.3% to 61.0%.
  • Overall SR improved from 49.5% (VR) to 63.5% (QR), with significant gains in challenging cases (+71.8%).
  • Inter-rater agreement improved (0.273 to 0.475, p<0.001) and diagnostic confidence significantly increased (8.1% to 38.5% 'High', p<0.001).

Conclusions:

  • Quantitative analysis of [18F]FDG-PET images significantly enhances diagnostic accuracy, confidence, and inter-rater agreement in epilepsy.
  • Improvements are particularly notable in challenging cases, aiding the localization of hypometabolic foci.
  • The study presents a valuable methodological approach using simulated PET images for quantification research in epilepsy.