Work

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

Year: 2026

Type: article

Abstract: • Work based on PET simulations to evaluate the impact of quantification in epilepsy. • Eight nuclear medicine physicians reviewed 125 simulated [¹⁸F]FDG-PET images. • Quantification improved the foci identification and enhanced diagnostic confidence. • Simulation offers a valuable tool to assess and validate quantification methods. • Their use can support better surgical planning in drug-resistant epilepsy patients. Quantitative analysis of [ 18 F]FDG-PET images is expected to improve the location of foci in non-lesional epilepsy. However, the lack of reliable gold standards has prevented a comprehensive evaluation of the potential improvements derived from this approach. Here, we aimed at evaluating these improvements using a novel dataset of realistic simulated studies. 125 realistic simulated [ 18 F]FDG-PET studies were generated (100 with synthetic hypometabolic foci (HF) with different levels of identification complexity and 25 Controls). Eight nuclear physicians performed visual rating (VR) and were given the chance to modify their assessment after reviewing quantitative results (QR). Physicians reported the presence/absence of HF, HF location, and diagnostic confidence (DC) before/after QR. Success Rate (SR) of physician’s assessment was analyzed as well as inter-rater agreement and changes in DC. In 31.3% of the assessments, physicians changed their interpretation after QR, with SR increasing from 16.3% to 61.0% in these cases. Overall SR improved from 49.5% in VR to 63.5% in QR, mostly on Pathologic cases (relative improvement: +34.0%). Improvement was found for each level of HF identification complexity and was higher for challenging cases (relative improvement: +71.8%). Inter-rater agreement also improved significantly (0.273 vs. 0.475, p<0.001). QR also significantly increased DC (‘High’ confidence of 8.1% on VR vs. 38.5% on QR, p<0.001). Quantitative analysis significantly improved diagnostic accuracy, confidence and inter-rater agreement, especially in challenging cases. Furthermore, this work introduces a novel methodological approach of simulated MRI-negative epilepsy [ 18 F]FDG-PET images for realistic quantification research studies.

Source: NeuroImage

DOI: 10.1016/j.neuroimage.2026.121740