Desynchronization Index: a New Approach for Exploring Complex Epileptogenic Networks in Stereoelectroencephalography

Stereoelectroencephalography (SEEG) is an invasive surgical procedure to record the electrical activities in cortical brain regions, aiming at identifying the Epileptogenic Zone (EZ) in patients with drug-resistant epilepsy. To improve the accuracy of the EZ definition, SEEG analysis can be supported by computational tools, among which the Epileptogenic Index (EI) represents the most common solution. However, the scientific community has still not found an agreement on which quantitative biomarkers can characterize the cortical sites within the EZ. In this work, we design a new algorithm, named Desynchronization Index (DI), to assist neurophysiologists in SEEG interpretation. Our algorithm estimates the effective connectivity between cortical sites and hypothesizes that the EZ is identified by those sites getting abnormally desynchronized from the network during the seizure generation. We test the proposed method over a SEEG dataset of 10 seizures, comparing its accuracy in terms of EZ definition against the EI algorithm and clinical ground truth. Our results indicate that the DI algorithm underscores specific connectivity dynamics that can hardly be identified with a pure visual analysis, increasing sensitivity in detecting epileptogenic cortical sites.

A self-supervised learning strategy for postoperative brain cavity segmentation simulating resections

Accurate segmentation of brain resection cavities (RCs) aids in postoperative analysis and determining follow-up treatment. Convolutional neural networks (CNNs) are the state-of-the-art image segmentation technique, but require large annotated datasets for training. Annotation of 3D medical images is time-consuming, requires highly-trained raters, and may suffer from high inter-rater variability. Self-supervised learning strategies can leverage unlabeled data for training. We developed an algorithm to simulate resections from preoperative magnetic resonance images (MRIs). We performed self-supervised training of a 3D CNN for RC segmentation using our simulation method. We curated EPISURG, a dataset comprising 430 postoperative and 268 preoperative MRIs from 430 refractory epilepsy patients who underwent resective neurosurgery. We fine-tuned our model on three small annotated datasets from different institutions and on the annotated images in EPISURG, comprising 20, 33, 19 and 133 subjects. The model trained on data with simulated resections obtained median (interquartile range) Dice score coefficients (DSCs) of 81.7 (16.4), 82.4 (36.4), 74.9 (24.2) and 80.5 (18.7) for each of the four datasets. After fine-tuning, DSCs were 89.2 (13.3), 84.1 (19.8), 80.2 (20.1) and 85.2 (10.8). For comparison, inter-rater agreement between human annotators from our previous study was 84.0 (9.9). We present a self-supervised learning strategy for 3D CNNs using simulated RCs to accurately segment real RCs on postoperative MRI. Our method generalizes well to data from different institutions, pathologies and modalities. Source code, segmentation models and the EPISURG dataset are available at https://github.com/fepegar/ressegijcars .