High-resolution pediatric age–specific 18F-FDG PET template: a pilot study in epileptogenic focus localization,European Journal of Nuclear Medicine and Molecular Imaging

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High-resolution pediatric age–specific 18F-FDG PET template: a pilot study in epileptogenic focus localization
European Journal of Nuclear Medicine and Molecular Imaging ( IF 9.1 ) Pub Date : 2021-11-08 , DOI: 10.1007/s00259-021-05611-w
Teng Zhang _{1,

2,

3} , Yuting Li _{1,

2,

3} , Shuilin Zhao _{1,

2,

3} , Yuanfan Xu ₄ , Xiaohui Zhang _{1,

2,

3} , Shuang Wu _{1,

2} , Xiaofeng Dou _{1,

2} , Congcong Yu _{1,

2} , Jianhua Feng ₅ , Yao Ding ₆ , Junming Zhu ₇ , Zexin Chen ₈ , Hong Zhang _{1,

2,

3,

9} , Mei Tian _{1,

2}

Affiliation

Department of Nuclear Medicine and Medical PET Center, The Second Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.
Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.
Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, China.
Hangzhou Universal Medical Imaging Diagnostic Center, Hangzhou, China.
Department of Pediatrics, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China.
Department of Neurology, Epilepsy Center, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China.
Department of Neurosurgery, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China.
Center of Clinical Epidemiology & Biostatistics, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China.
The College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China.

Background

PET imaging has been widely used in diagnosis of neurological disorders; however, its application to pediatric population is limited due to lacking pediatric age–specific PET template. This study aims to develop a pediatric age–specific PET template (PAPT) and conduct a pilot study of epileptogenic focus localization in pediatric epilepsy.

Methods

We recruited 130 pediatric patients with epilepsy and 102 age-matched controls who underwent ¹⁸F-FDG PET examination. High-resolution PAPT was developed by an iterative nonlinear registration-averaging optimization approach for two age ranges: 6–10 years (n = 17) and 11–18 years (n = 50), respectively. Spatial normalization to the PAPT was evaluated by registration similarities of 35 validation controls, followed by estimation of potential registration biases. In a pilot study, epileptogenic focus was localized by PAPT-based voxel-wise statistical analysis, compared with multi-disciplinary team (MDT) diagnosis, and validated by follow-up of patients who underwent epilepsy surgery. Furthermore, epileptogenic focus localization results were compared among three templates (PAPT, conventional adult template, and a previously reported pediatric linear template).

Results

Spatial normalization to the PAPT significantly improved registration similarities (P < 0.001), and nearly eliminated regions of potential biases (< 2% of whole brain volume). The PAPT-based epileptogenic focus localization achieved a substantial agreement with MDT diagnosis (Kappa = 0.757), significantly outperforming localization based on the adult template (Kappa = 0.496) and linear template (Kappa = 0.569) (P < 0.05). The PAPT-based localization achieved the highest detection rate (89.2%) and accuracy (80.0%). In postsurgical seizure-free patients (n = 40), the PAPT-based localization also achieved a substantial agreement with resection areas (Kappa = 0.743), and the highest detection rate (95%) and accuracy (80.0%).

Conclusion

The PAPT can significantly improve spatial normalization and epileptogenic focus localization in pediatric epilepsy. Future pediatric neuroimaging studies can also benefit from the unbiased spatial normalization by PAPT.

Trial registration.

NCT04725162: https://clinicaltrials.gov/ct2/show/NCT04725162

中文翻译：

高分辨率儿科年龄特异性 18F-FDG PET 模板：致癫痫病灶定位的初步研究

背景

PET成像已广泛用于神经系统疾病的诊断；然而，由于缺乏儿科年龄特异性 PET 模板，其在儿科人群中的应用受到限制。本研究旨在开发一种儿童年龄特异性 PET 模板 (PAPT)，并对儿童癫痫的致痫灶定位进行初步研究。

方法

我们招募了 130 名癫痫儿科患者和 102 名年龄匹配的对照组，他们接受了¹⁸ F-FDG PET 检查。高分辨率 PAPT 是通过迭代非线性配准平均优化方法开发的，适用于两个年龄范围：6-10 岁（n = 17）和 11-18 岁（n = 50），分别。PAPT 的空间归一化通过 35 个验证控制的配准相似性进行评估，然后估计潜在的配准偏差。在一项初步研究中，与多学科团队 (MDT) 诊断相比，通过基于 PAPT 的体素统计分析对致癫痫病灶进行了定位，并通过对接受癫痫手术的患者的随访进行了验证。此外，比较了三种模板（PAPT、常规成人模板和先前报道的儿科线性模板）的致癫痫病灶定位结果。

结果

PAPT 的空间归一化显着改善了配准相似性（P < 0.001），并且几乎消除了潜在偏差区域（< 整个脑容量的 2%）。基于 PAPT 的致痫灶定位与 MDT 诊断（Kappa = 0.757）基本一致，显着优于基于成人模板（Kappa = 0.496）和线性模板（Kappa = 0.569）的定位（P < 0.05）。基于 PAPT 的定位实现了最高的检测率 (89.2%) 和准确度 (80.0%)。在术后无癫痫发作的患者（n = 40）中，基于 PAPT 的定位也与切除区域（Kappa = 0.743）取得了显着一致，并且检出率（95％）和准确度（80.0％）最高。