Automated volumetric brain MRI analysis reveals multiregional morphometric alterations in pediatric epilepsy

Abstract

Objective: To quantitatively evaluate regional brain volume differences between pediatric patients with epilepsy and healthy controls using a fully automated volumetric magnetic resonance imaging (MRI) analysis performed with the Vol2Brain platform. Methods: This retrospective study included 150 children (75 with epilepsy and 75 healthy controls) who underwent 1.5T cranial MRI examinations. High-resolution three-dimensional T1-weighted images were processed using Vol2Brain, a fully automated segmentation tool based on SPM12 and CAT12 frameworks. Absolute and relative volumes of 135 cortical and subcortical structures were computed. Statistical comparisons between groups were performed using the Shapiro–Wilk and Mann–Whitney U tests (p<.05). Results: Patients with epilepsy demonstrated significantly lower volumes in the hippocampus, frontal and temporal gray matter, thalamus, cerebellum, and total brain compared with controls, accompanied by a compensatory increase in cerebrospinal fluid volume. No significant volumetric differences were found in the remaining 128 brain structures, indicating a diffuse morphometric reorganization pattern extending beyond the epileptogenic focus. Significance: Fully automated volumetric MRI analysis using vol2Brain can reliably detect widespread structural brain alterations in pediatric epilepsy. These findings support the concept of epilepsy as a diffuse network disorder extending beyond focal lesions. Quantitative morphometry provides an objective approach to characterize subtle structural reorganization and may serve as a basis for future studies investigating clinical and neurocognitive correlations in pediatric epileptology.