Simulating the Radiological Appearance of Focal Cortical Dysplasia in MRI

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Abstract
Focal cortical dysplasia (FCD) is among the leading causes of drug-resistant focal epilepsy and can be challenging to detect on routine MRI due to the subtle and heterogeneous appearance of lesions. Motivated by the scarcity of clinically representative cohorts, we investigate the feasibility of simulating FCD-like lesions in healthy MRI using a composition of hand-crafted image transformations. We develop Syn-thFCD , a phenomenological FCD simulator, and create 2,164 synthetic examples from healthy controls in the heterogeneous FOMO300k dataset. We then pretrain deep learning (DL) segmentation models on synthetic lesions and fine-tune them on real FCD cases from the University Hospital Bonn (UHB) cohort. Comprehensive evaluations show consistent improvements across simulator presets, with detection-rate gains of up to 18.5 percentage points over training from scratch and 7.4 points over self-supervised pretraining, while achieving state-of-the-art segmentation performance (0.366 DSC) on the challenging held-out UHB benchmark. These findings suggest that simulation-based synthetic data generation can bridge existing radiological knowledge and advances in DL to provide meaningful supervisory signals that could ultimately aid the detection of underrepresented and diagnostically challenging cases.

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