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The authors determined the additive value of a new clustering mapping method in which average direct-flip distance (ADFD) reclassifies the outliers of original DWI-MAP streamlines by referring to their minimum distances to the exemplar streamlines (i.e., medoids).<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>The authors studied 40 children with drug-resistant focal epilepsy (mean age 8.7 \u00b1 4.8 years) who had undergone resection of the presumed epileptogenic zone and had five categories of postoperative deficits (i.e., hemiparesis involving the face, hand, and\/or leg; dysphasia requiring speech therapy; and\/or visual field cut). In pre- and postoperative images of the resected hemisphere, DWI-MAP identified a total of nine streamline pathways: C<jats:sub>1<\/jats:sub> = face motor area, C<jats:sub>2<\/jats:sub> = hand motor area, C<jats:sub>3<\/jats:sub> = leg motor area, C<jats:sub>4<\/jats:sub> = Broca\u2019s area\u2013Wernicke\u2019s area, C<jats:sub>5<\/jats:sub> = premotor area\u2013Broca\u2019s area, C<jats:sub>6<\/jats:sub> = premotor area\u2013Wernicke\u2019s area, C<jats:sub>7<\/jats:sub> = parietal area\u2013Wernicke\u2019s area, C<jats:sub>8<\/jats:sub> = premotor area\u2013parietal area, and C<jats:sub>9<\/jats:sub> = occipital lobe\u2013lateral geniculate nucleus. For each streamline of the identified pathway, the minimal ADFD to the nine exemplars corrected the pathway membership. Binary logistic regression analysis was employed to determine how accurately two fractional predictors, \u0394<jats:sub>1\u20139<\/jats:sub> (postoperative volume change of C<jats:sub>1\u20139<\/jats:sub>) and \u03b3<jats:sub>1\u20139<\/jats:sub> (preoperatively planned volume of C<jats:sub>1\u20139<\/jats:sub> resected), predicted postoperative motor, language, and visual deficits.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>The addition of ADFD to DWI-MAP analysis improved the sensitivity and specificity of regression models for predicting postoperative motor, language, and visual deficits by 28% for \u0394<jats:sub>1\u20133<\/jats:sub> (from 0.62 to 0.79), 13% for \u0394<jats:sub>4\u20138<\/jats:sub> (from 0.69 to 0.78), 13% for \u0394<jats:sub>9<\/jats:sub> (from 0.77 to 0.87), 7% for \u03b3<jats:sub>1\u20133<\/jats:sub> (from 0.81 to 0.87), 1% for \u03b3<jats:sub>4\u20138<\/jats:sub> (from 0.86 to 0.87), and 24% for \u03b3<jats:sub>9<\/jats:sub> (from 0.75 to 0.93). Preservation of the eloquent pathways defined by preoperative DWI-MAP analysis with ADFD (up to 97% of C<jats:sub>1\u20134,9<\/jats:sub>) prevented postoperative motor, language, and visual deficits with sensitivity and specificity ranging from 88% to 100%.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>The present study suggests that postoperative functional outcome substantially differs according to the extent of resected white matter encompassing eloquent cortex as determined by preoperative DWI-MAP analysis. The preservation of preoperative DWI-MAP\u2013defined pathways may be crucial to prevent postoperative deficits. The improved DWI-MAP analysis may provide a complementary noninvasive tool capable of guiding the surgical margin to minimize the risk of postoperative deficits for children.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2018.11.peds18601","type":"journal-article","created":{"date-parts":[[2019,2,27]],"date-time":"2019-02-27T00:52:05Z","timestamp":1551228725000},"page":"648-659","source":"Crossref","is-referenced-by-count":4,"title":["Prediction of postoperative deficits using an improved diffusion-weighted imaging maximum a posteriori probability analysis in pediatric epilepsy surgery"],"prefix":"10.3171","volume":"23","author":[{"given":"Min-Hee","family":"Lee","sequence":"first","affiliation":[{"name":"Departments of Pediatrics,"},{"name":"Translational Imaging Laboratory, Children\u2019s Hospital of Michigan, Detroit, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nolan B.","family":"O\u2019Hara","sequence":"additional","affiliation":[{"name":"Translational Neuroscience Program, Wayne State University School of Medicine; and"},{"name":"Translational Imaging Laboratory, Children\u2019s Hospital of Michigan, Detroit, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuo","family":"Nakai","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aimee F.","family":"Luat","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics,"},{"name":"Neurology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Csaba","family":"Juhasz","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics,"},{"name":"Neurology, and"},{"name":"Neurosurgery;"},{"name":"Translational Neuroscience Program, Wayne State University School of Medicine; and"},{"name":"Translational Imaging Laboratory, Children\u2019s Hospital of Michigan, Detroit, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandeep","family":"Sood","sequence":"additional","affiliation":[{"name":"Neurosurgery;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eishi","family":"Asano","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics,"},{"name":"Neurology, and"},{"name":"Translational Neuroscience Program, Wayne State University School of Medicine; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeong-Won","family":"Jeong","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics,"},{"name":"Neurology, and"},{"name":"Translational Neuroscience Program, Wayne State University School of Medicine; and"},{"name":"Translational Imaging Laboratory, Children\u2019s Hospital of Michigan, Detroit, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Stat Sci","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1214\/ss\/1177011454","article-title":"A survey of exact inference for contingency tables","volume":"7","author":"Agresti A","year":"1992","unstructured":"Agresti A: A survey of exact inference for contingency tables. 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