Computer Aided Analysis of Interictal <scp>SPECT</scp> Registered Into <scp>MRI</scp> Helps Detecting Epileptic Lesions and Cognitive Deficits

ABSTRACT Interictal single‐photon emission computed tomography (SPECT) registered into template (ISRT) was developed to enhance the localization of epileptogenic zone (EZ) and predict cognitive deficits in patients with drug‐resistant epilepsy. Eighteen patients (age 26.2 ± 8.1 years) with drug‐resistant focal epilepsy underwent interictal SPECT, MRI, and neuropsychological assessments. ISRT was constructed by spatially normalizing SPECT images to the ICBM 152 MNI template and generating hypoperfusion maps. Regional hypoperfusion and its correlation with Mini‐Mental State Examination (MMSE) scores were analyzed. Fleiss' kappa ( κ ) statistic was used to assess inter‐reader agreement in EZ lateralization. ISRT achieved moderate inter‐reader agreement, with Fleiss' κ improving significantly ( t = 3.13, p = 0.035) in the “perfusion + hypoperfusion” setting ( κ = 0.378 ± 0.148) compared to the “perfusion only” setting ( κ = 0.069 ± 0.118). Hypoperfusion in the Rolandic operculum and lingual gyrus was significantly associated with MMSE scores ( r = −0.742, p = 0.00042, FDR p = 0.028; r = 0.721, p = 0.00074, FDR p = 0.028, respectively). ISRT showed potential to improve the consistency of EZ lateralization among readers and provided preliminary insights into cognitive associations. Further development of age‐adjusted normative rCBF charts could enhance diagnostic precision.