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A technique we call SIPCOM (Subtraction Interictal PET Co\u2010registered to MRI) can then be used to compare epilepsy patients' predicted and clinical PET. We assessed the ability of SIPCOM to identify the Resection Zone (RZ) in patients with drug\u2010resistant epilepsy (DRE) with reference to visual and statistical parametric mapping (SPM) analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients with complete presurgical work\u2010up and subsequent SEEG and cortectomy were included. RZ localisation, the reference region, was assigned to one of eighteen anatomical brain regions. SIPCOM was implemented using healthy controls to train a GAN. To compare, the clinical PET coregistered to MRI was visually assessed by two trained readers, and a standard SPM analysis was performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twenty patients aged 17\u201050 (32\u2009\u00b1\u20097.8) years were included, 14 (70%) with temporal lobe epilepsy (TLE). Eight (40%) were MRI\u2010negative. After surgery, 14 patients (70%) had a good outcome (Engel I\u2010II). RZ localisation rate was 60% with SIPCOM vs 35% using SPM (<jats:italic>P<\/jats:italic>\u2009=\u20090.015) and vs 85% using visual analysis (<jats:italic>P<\/jats:italic>\u2009=\u20090.54). Results were similar for Engel I\u2010II patients, the RZ localisation rate was 64% with SIPCOM vs 36% with SPM. With SIPCOM localisation was correct in 67% in MRI\u2010positive vs 50% in MRI\u2010negative patients, and 64% in TLE vs 43% in extra\u2010TLE. The average number of false\u2010positive clusters was 2.2\u2009\u00b1\u20091.3 using SIPCOM vs 2.3\u2009\u00b1\u20093.1 using SPM. All RZs localized with SPM were correctly localized with SIPCOM. In one case, PET and MRI were visually reported as negative, but both SIPCOM and SPM localized the RZ.<\/jats:p><\/jats:sec><jats:sec><jats:title>Significance<\/jats:title><jats:p>SIPCOM performed better than the reference computer\u2010assisted method (SPM) for RZ detection in a group of operated DRE patients. SIPCOM's impact on epilepsy management needs to be prospectively validated.<\/jats:p><\/jats:sec>","DOI":"10.1002\/epi4.12820","type":"journal-article","created":{"date-parts":[[2023,8,21]],"date-time":"2023-08-21T10:55:28Z","timestamp":1692615328000},"page":"1440-1451","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Deep\u2010learning predicted <scp>PET<\/scp> can be subtracted from the true clinical fluorodeoxyglucose <scp>PET<\/scp> co\u2010registered to <scp>MRI<\/scp> to identify the epileptogenic zone in focal epilepsy"],"prefix":"10.1002","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5877-2159","authenticated-orcid":false,"given":"Anthime","family":"Flaus","sequence":"first","affiliation":[{"name":"Department of Nuclear Medicine Hospices Civils de Lyon  Lyon France"},{"name":"Medical Faculty of Lyon Est University Claude Bernard Lyon 1  Lyon France"},{"name":"King's College London &amp; Guy's and St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences King's College London  London UK"},{"name":"Lyon Neuroscience Research Center INSERM U1028\/CNRS UMR5292  Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9274-0086","authenticated-orcid":false,"given":"Julien","family":"Jung","sequence":"additional","affiliation":[{"name":"Lyon Neuroscience Research Center INSERM U1028\/CNRS UMR5292  Lyon France"},{"name":"Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, Member of the ERN EpiCARE Lyon 1 University  Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karine","family":"Ostrowky\u2010Coste","sequence":"additional","affiliation":[{"name":"Lyon Neuroscience Research Center INSERM U1028\/CNRS UMR5292  Lyon France"},{"name":"Department of Pediatric Clinical Epileptology, Sleep Disorders, and Functional Neurology Hospices Civils de Lyon, Member of the ERN EpiCARE  Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4663-8515","authenticated-orcid":false,"given":"Sylvain","family":"Rheims","sequence":"additional","affiliation":[{"name":"Lyon Neuroscience Research Center INSERM U1028\/CNRS UMR5292  Lyon France"},{"name":"Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, Member of the ERN EpiCARE Lyon 1 University  Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Gu\u00e9not","sequence":"additional","affiliation":[{"name":"Lyon Neuroscience Research Center INSERM U1028\/CNRS UMR5292  Lyon France"},{"name":"Department of Functional Neurosurgery, Hospices Civils de Lyon, Member of the ERN EpiCARE Lyon 1 University  Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandrine","family":"Bouvard","sequence":"additional","affiliation":[{"name":"Lyon Neuroscience Research Center INSERM U1028\/CNRS UMR5292  Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Janier","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine Hospices Civils de Lyon  Lyon France"},{"name":"Medical Faculty of Lyon Est University Claude Bernard Lyon 1  Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siti N.","family":"Yaakub","sequence":"additional","affiliation":[{"name":"Brain Research &amp; 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