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Introduction: Several methods offer free volumetry services for MR data that adequately quantify volume differences in the hippocampus and its subregions. These methods are frequently used to assist in clinical diagnosis of suspected hippocampal sclerosis in temporal lobe epilepsy. A strong association between severity of histopathological anomalies and hippocampal volumes was reported using MR volumetry with a higher diagnostic yield than visual examination alone. Interpretation of volumetry results is challenging due to inherent methodological differences and to the reported variability of hippocampal volume. Furthermore, normal morphometric differences are recognized in diverse populations that may need consideration. To address this concern, we highlighted procedural discrepancies including atlas definition and computation of total intracranial volume that may impact volumetry results. We aimed to quantify diagnostic performance and to propose reference values for hippocampal volume from two well-established techniques: FreeSurfer v.06 and volBrain-HIPS. Methods: Volumetry measures were calculated using clinical T1 MRI from a local population of 61 healthy controls and 57 epilepsy patients with confirmed unilateral hippocampal sclerosis. We further validated the results by a state-of-the-art machine learning classification algorithm (Random Forest) computing accuracy and feature relevance to distinguish between patients and controls. This validation process was performed using the FreeSurfer dataset alone, considering morphometric values not only from the hippocampus but also from additional non-hippocampal brain regions that could be potentially relevant for group classification. Mean reference values and 95% confidence intervals were calculated for left and right hippocampi along with hippocampal asymmetry degree to test diagnostic accuracy. Results: Both methods showed excellent classification performance (AUC:> 0.914) with noticeable differences in absolute (cm3) and normalized volumes. Hippocampal asymmetry was the most accurate discriminator from all estimates (AUC:1~0.97). Similar results were achieved in the validation test with an automatic classifier (AUC:>0.960), disclosing hippocampal structures as the most relevant features for group differentiation among other brain regions. Conclusion: We calculated reference volumetry values from two commonly used methods to accurately identify patients with temporal epilepsy and hippocampal sclerosis. Validation with an automatic classifier confirmed the principal role of the hippocampus and its subregions for diagnosis.
RESUMO
The main objective of this study was to enhance the performance of sleep stage classification using single-channel electroencephalograms (EEGs), which are highly desirable for many emerging technologies, such as telemedicine and home care. The proposed method consists of decomposing EEGs by a discrete wavelet transform and computing the kurtosis, skewness and variance of its coefficients at selected levels. A random forest predictor is trained to classify each epoch into one of the Rechtschaffen and Kales' stages. By performing a comprehensive set of tests on 106,376 epochs available from the Physionet public database, it is demonstrated that the use of these three statistical moments has enhanced performance when compared to their application in the time domain. Furthermore, the chosen set of features has the advantage of exhibiting a stable classification performance for all scoring systems, i.e., from 2- to 6-state sleep stages. The stability of the feature set is confirmed with ReliefF tests which show a performance reduction when any individual feature is removed, suggesting that this group of feature cannot be further reduced. The accuracies and kappa coefficients yield higher than 90 % and 0.8, respectively, for all of the 2- to 6-state sleep stage classification cases.