Diagnostic performance of morphometric analysis program in pediatric epilepsy surgery

Objective: This study assesses the performance of the Morphometric Analysis Program (MAP) in the pre- and post-surgical evaluation of pediatric patients with drug-resistant epilepsy suspected of Focal Cortical Dysplasia (FCD). We evaluated MAP-electroclinical concordance and the diagnostic contribution of individual MAP features to optimize the noninvasive presurgical assessment. Methods: After a Multidisciplinary Surgical Meeting (MSM), patients with strong electroclinical evidence of FCDs underwent MAP analysis, comparing gray/white matter distribution against a non-age-specific database. MAP results were integrated with MRI reevaluation to identify previously undetected lesions. MRI-positive patients, were analyzed for MAP-MRI-electroclinical concordance. For MRI negative patients, we assessed MAP electroclinical concordance and compared with MRI positive patients. A sub-analysis was performed in operated patients. Results: We included in the study 50 pediatric patients (age 1.5-18 y). Twenty-eight patients (56%) were MRI positive after MSM. Two patients originally classified as MRI negative were reevaluated after MAP analysis. In the MRI-positive cohort (60%, 30/50), MAP-MRI concordance was 73.3% for Prob_FCD, 80% for Junction, 63.3% for Extension, and 10% for Thickness, with electroclinical concordance reaching almost 90% for the first three features. In the MRI-negative cohort (40%, 20/50), MAP positivity rates were 10% for Prob_FCD, 40% for Junction, 85% for Extension, and 10% for Thickness. All MAP positivity in the MRI-negative group had discordant data with the electroclinical hypothesis. Significance: In our presurgical cohort, MAP enabled the identification of two previously undetected dysplastic lesions. In case of MRI+, MAP findings were mostly concordant with both MRI and the electroclinical hypothesis, with Junction as the most reliable features. In negative MRI patients, MAP positivity rarely revealed a lesion corresponding to the electroclinical hypothesis, suggesting the need for further complementary diagnostic tools to improve lesion detection and surgical planning in this subgroup.