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z Scores and Area Under the Curve01:17

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z scores are the standardized values obtained after converting a normal distribution into a standard normal distribution. A z score is measured in units of the standard deviation. The z score tells you how many standard deviations the value x is above (to the right of) or below (to the left of) the mean, μ. Values of x that are larger than the mean have positive z scores, and values of x that are smaller than the mean have negative z scores. If x equals the mean, then x has a z score of...
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Clinical Utility of Z-Score Distribution Mapping in Epileptogenic Zone Localizations.

Jinkun Han1, Penghu Wei1, Sichang Chen1

  • 1Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China.

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|April 25, 2026
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Summary

Positron emission tomography (PET)-based Z-score mapping (Z-map) aids in localizing seizure onset zones (SOZs) in the frontal and parietal lobes. However, its accuracy is limited in temporal and insular regions, requiring further standardization for broader clinical use.

Keywords:
Z‐score distribution mappingepilepsypositron emission tomography (PET)seizure onset zone

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Area of Science:

  • Neuroimaging
  • Epileptology
  • Medical Physics

Background:

  • Accurate localization of seizure onset zones (SOZs) is crucial for epilepsy surgery.
  • Noninvasive methods are sought to reduce reliance on invasive procedures like stereoelectroencephalography (SEEG).
  • Positron emission tomography (PET)-based Z-score distribution mapping (Z-map) is a novel technique for SOZ localization.

Purpose of the Study:

  • To evaluate the clinical utility of PET-based Z-map for noninvasive presurgical SOZ localization.
  • To assess regional performance differences and methodological robustness of Z-map.
  • To compare Z-map performance against SEEG-defined SOZs.

Main Methods:

  • Analysis of 120 drug-resistant epilepsy patients undergoing SEEG implantation.
  • Processing of multimodal imaging data (PET, MRI) using FreeSurfer and 3D Slicer.
  • Generation of Z-maps with hypometabolic regions defined by the bottom 0.5% of Z-scores.

Main Results:

  • Z-map demonstrated high classification performance in frontal (sensitivity: 0.74) and parietal (sensitivity: 0.72) lobes.
  • Reduced effectiveness observed in temporal (sensitivity: 0.41) and insular (sensitivity: 0.65) lobes.
  • High overall specificity (0.94) and negative predictive value (0.91) were noted, with regional disparities linked to anatomical complexity.

Conclusions:

  • Z-map provides valuable support for SOZ localization in frontal and parietal regions, aiding SEEG planning.
  • Limited sensitivity in temporal and insular areas necessitates further research and multimodal integration.
  • Standardization of preprocessing pipelines is crucial for improving Z-map robustness and clinical translation.