Development of an age-specific pediatric 2-[18F]fluoro-2-deoxy-D-glucose PET template aligned with pediatric brain development regularities: enhancing epileptogenic zone localization in drug-resistant epilepsy

This study aims to systematically analyze developmental regularities of brain glucose metabolism in children covering the whole pediatric age-range and establish age-specific pediatric 2-[18F]fluoro-2-deoxy-D-glucose PET brain templates, thereby improving the accuracy of neuroimaging lesion localization in pediatric populations. A retrospective study was conducted, including a pseudo-control group and an epilepsy group. The pseudo-control group data were used to analyze the cerebral glucose metabolism and establish age-specific pediatric Statistical Parametric Mapping templates. Semi-quantitative parameters (Mean Standardized Uptake Value, Maximum Standardized Uptake Value) were calculated for each region, and Standardized Uptake Ratio were compared across different reference regions. Age-related trends of these metabolic parameters were analyzed to derive pediatric cerebral metabolic developmental patterns. 2-[18F]fluoro-2-deoxy-D-glucose PET images of patients with epilepsy were performed using both the established pediatric template and the standard adult template. Taking surgical resection and Electrocorticography results as the gold standard, the accuracy of Epileptogenic Zone localization by the two templates were compared. The mean Standardized Uptake Value and maximum Standardized Uptake Value values in the pseudo-control group showed a significant positive correlation with age, with no significant differences between sex or hemispheres (P>0.05). In the internal and external validation cohorts, the diagnostic accuracy of the pediatric SPM template for Epileptogenic Zone localization was 79.0%, which was significantly higher than 72.5% of the adult template (P=0.033). Stratified analysis showed that the pediatric template had consistent advantages across sex and superior performance in Epileptogenic Zone localization of frontal and temporal lobes. The advantage of the pediatric template was consistent in both internal and external validation cohorts. The age-specific pediatric Statistical Parametric Mapping template has superior overall diagnostic efficacy in Epileptogenic Zone localization of pediatric drug-resistant epilepsy, with stable advantages across sex and unique value in specific brain regions. It can overcome the limitations of adult templates in adapting to pediatric brain development characteristics, providing a more accurate and reliable tool for preoperative Epileptogenic Zone localization in pediatric drug-resistant epilepsy.