DeepEZ: A Graph Convolutional Network for Automated Epileptogenic Zone Localization From Resting-State fMRI Connectivity

<italic>Objective:</italic> Epileptogenic zone (EZ) localization is a crucial step during diagnostic work up and therapeutic planning in medication refractory epilepsy. In this paper, we present the first deep learning approach to localize the EZ based on resting-state fMRI (rs-fMRI) data. <italic>Methods:</italic> Our network, called DeepEZ, uses a cascade of graph convolutions that emphasize signal propagation along expected anatomical pathways. We also integrate domain-specific information, such as an asymmetry term on the predicted EZ and a learned subject-specific bias to mitigate environmental confounds. <italic>Results:</italic> We validate DeepEZ on rs-fMRI collected from 14 patients with focal epilepsy at the University of Wisconsin Madison. Using cross validation, we demonstrate that DeepEZ achieves consistently high EZ localization performance (Accuracy: 0.88 <inline-formula><tex-math notation="LaTeX">$\pm$</tex-math></inline-formula> 0.03; AUC: 0.73 <inline-formula><tex-math notation="LaTeX">$\pm$</tex-math></inline-formula> 0.03) that far outstripped any of the baseline methods. This performance is notable given the variability in EZ locations and scanner type across the cohort. <italic>Conclusion:</italic> Our results highlight the promise of using DeepEZ as an accurate and noninvasive therapeutic planning tool for medication refractory epilepsy. <italic>Significance:</italic> While prior work in EZ localization focused on identifying localized aberrant signatures, there is growing evidence that epileptic seizures affect inter-regional connectivity in the brain. DeepEZ allows clinicians to harness this information from noninvasive imaging that can easily be integrated into the existing clinical workflow.