Clinical Performance of Analog and Digital 18F-FDG PET/CT in Pediatric Epileptogenic Zone Localization: Preliminary Results

<b>Background</b>: Despite its central role in pediatric pre-surgical evaluation of drug-resistant focal epilepsy, conventional analog ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) PET/CT (aPET) systems often yield modest epileptogenic zone (EZ) detection rates (~50-60%). Silicon photomultiplier-based digital PET/CT (dPET) promises enhanced image quality, but its performance in pediatric epilepsy remains untested. <b>Methods</b>: We retrospectively analyzed 22 children (mean age 11.5 ± 2.6 years) who underwent interictal brain ¹⁸F-FDG PET/CT: 11 on an analog system (Discovery ST, 2018-2019) and 11 on a digital system (Biograph Vision 450, 2020-2021). Three blinded nuclear medicine physicians independently scored EZ localization and image quality (4-point scale); post-surgical histology and ≥1-year clinical follow-up served as reference. <b>Results</b>: The EZ was correctly identified in 8/11 analog scans (72.7%) versus 10/11 digital scans (90.9%). Average image quality was significantly higher with dPET (3.0 ± 0.9 vs. 2.1 ± 0.9; <i>p</i> < 0.05), and inter-reader agreement improved from good (ICC = 0.63) to excellent (ICC = 0.91). <b>Conclusions</b>: Our preliminary findings suggest that dPET enhances image clarity and reader consistency, potentially improving localization accuracy in pediatric epilepsy presurgical workups.