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Activation volume vs BOLD signal change as measures of fMRI activation - Its impact on GABA - fMRI activation correlation. Magn Reson Imaging 2017. [PMID: 28634048 DOI: 10.1016/j.mri.2017.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE To explore the relative robustness of functional MRI (fMRI) activation volume and blood oxygen level-dependent (BOLD) signal change as fMRI metric, and to study the effect of relative robustness on the correlation between fMRI activation and cortical gamma amino butyric acid (GABA) in healthy controls and patients with multiple sclerosis (MS). METHODS fMRI data were acquired from healthy controls and patients with MS, with the subjects peforming self paced bilateral finger tapping in block design. GABA spectroscopy was performed with voxel placed on the area of maximum activation during fMRI. Activation volume and BOLD signal changes at primary motor cortex (M1), as well as GABA concentration were calculated for each patient. RESULTS Activation volume correlated with BOLD signal change in healthy controls, but no such correlation was observed in patients with MS. This difference was likely the result of higher intersubject noise variance in the patient population. GABA concentration correlated with M1 activation volume in patients but not in controls, and did not correlate with any fMRI metric in patients or controls. CONCLUSION Our data suggest that activation volume is a more robust measure than BOLD signal change in a group with high intersubject noise variance as in patients with MS. Additionally, this study demonstrated difference in correlation behavior between GABA concentration and the 2 fMRI metrics in patients with MS, suggesting that GABA - activation volume correlation is more appropriate measure in the patient group.
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Lima Cardoso P, Fischmeister FPS, Dymerska B, Geißler A, Wurnig M, Trattnig S, Beisteiner R, Robinson SD. Robust presurgical functional MRI at 7 T using response consistency. Hum Brain Mapp 2017; 38:3163-3174. [PMID: 28321965 PMCID: PMC5434844 DOI: 10.1002/hbm.23582] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 03/07/2017] [Accepted: 03/11/2017] [Indexed: 12/31/2022] Open
Abstract
Functional MRI is valuable in presurgical planning due to its non-invasive nature, repeatability, and broad availability. Using ultra-high field MRI increases the specificity and sensitivity, increasing the localization reliability and reducing scan time. Ideally, fMRI analysis for this application should identify unreliable runs and work even if the patient deviates from the prescribed task timing or if there are changes to the hemodynamic response due to pathology. In this study, a model-free analysis method-UNBIASED-based on the consistency of fMRI responses over runs was applied, to ultra-high field fMRI localizations of the hand area. Ten patients with brain tumors and epilepsy underwent 7 Tesla fMRI with multiple runs of a hand motor task in a block design. FMRI data were analyzed with the proposed approach (UNBIASED) and the conventional General Linear Model (GLM) approach. UNBIASED correctly identified and excluded fMRI runs that contained little or no activation. Generally, less motion artifact contamination was present in UNBIASED than in GLM results. Some cortical regions were identified as activated in UNBIASED but not GLM results. These were confirmed to show reproducible delayed or transient activation, which was time-locked to the task. UNBIASED is a robust approach to generating activation maps without the need for assumptions about response timing or shape. In presurgical planning, UNBIASED can complement model-based methods to aid surgeons in making prudent choices about optimal surgical access and resection margins for each patient, even if the hemodynamic response is modified by pathology. Hum Brain Mapp 38:3163-3174, 2017. © 2017 The Authors Human Brain Mapping Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Pedro Lima Cardoso
- High Field Magnetic Resonance Centre, Department of Biomedical Imaging and Image‐guided TherapyMedical University of ViennaLazarettgasse 14, A‐1090ViennaAustria
| | - Florian Ph. S. Fischmeister
- Study Group Clinical fMRI, Department of NeurologyMedical University of ViennaWähringer Gürtel 18‐20, A‐1090ViennaAustria
| | - Barbara Dymerska
- High Field Magnetic Resonance Centre, Department of Biomedical Imaging and Image‐guided TherapyMedical University of ViennaLazarettgasse 14, A‐1090ViennaAustria
| | - Alexander Geißler
- Study Group Clinical fMRI, Department of NeurologyMedical University of ViennaWähringer Gürtel 18‐20, A‐1090ViennaAustria
| | - Moritz Wurnig
- Study Group Clinical fMRI, Department of NeurologyMedical University of ViennaWähringer Gürtel 18‐20, A‐1090ViennaAustria
| | - Siegfried Trattnig
- High Field Magnetic Resonance Centre, Department of Biomedical Imaging and Image‐guided TherapyMedical University of ViennaLazarettgasse 14, A‐1090ViennaAustria
| | - Roland Beisteiner
- Study Group Clinical fMRI, Department of NeurologyMedical University of ViennaWähringer Gürtel 18‐20, A‐1090ViennaAustria
| | - Simon Daniel Robinson
- High Field Magnetic Resonance Centre, Department of Biomedical Imaging and Image‐guided TherapyMedical University of ViennaLazarettgasse 14, A‐1090ViennaAustria
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Mellerio C, Charron S, Lion S, Roca P, Kuchcinski G, Legrand L, Edjlali M, Naggara O, Meder JF, Pallud J, Oppenheim C. Perioperative functional neuroimaging of gliomas in eloquent brain areas. Neurochirurgie 2017; 63:129-134. [DOI: 10.1016/j.neuchi.2016.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 10/10/2016] [Accepted: 10/31/2016] [Indexed: 11/25/2022]
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Połczyńska M, Japardi K, Curtiss S, Moody T, Benjamin C, Cho A, Vigil C, Kuhn T, Jones M, Bookheimer S. Improving language mapping in clinical fMRI through assessment of grammar. NEUROIMAGE-CLINICAL 2017; 15:415-427. [PMID: 28616382 PMCID: PMC5458087 DOI: 10.1016/j.nicl.2017.05.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 05/03/2017] [Accepted: 05/25/2017] [Indexed: 11/27/2022]
Abstract
Introduction Brain surgery in the language dominant hemisphere remains challenging due to unintended post-surgical language deficits, despite using pre-surgical functional magnetic resonance (fMRI) and intraoperative cortical stimulation. Moreover, patients are often recommended not to undergo surgery if the accompanying risk to language appears to be too high. While standard fMRI language mapping protocols may have relatively good predictive value at the group level, they remain sub-optimal on an individual level. The standard tests used typically assess lexico-semantic aspects of language, and they do not accurately reflect the complexity of language either in comprehension or production at the sentence level. Among patients who had left hemisphere language dominance we assessed which tests are best at activating language areas in the brain. Method We compared grammar tests (items testing word order in actives and passives, wh-subject and object questions, relativized subject and object clauses and past tense marking) with standard tests (object naming, auditory and visual responsive naming), using pre-operative fMRI. Twenty-five surgical candidates (13 females) participated in this study. Sixteen patients presented with a brain tumor, and nine with epilepsy. All participants underwent two pre-operative fMRI protocols: one including CYCLE-N grammar tests (items testing word order in actives and passives, wh-subject and object questions, relativized subject and object clauses and past tense marking); and a second one with standard fMRI tests (object naming, auditory and visual responsive naming). fMRI activations during performance in both protocols were compared at the group level, as well as in individual candidates. Results The grammar tests generated more volume of activation in the left hemisphere (left/right angular gyrus, right anterior/posterior superior temporal gyrus) and identified additional language regions not shown by the standard tests (e.g., left anterior/posterior supramarginal gyrus). The standard tests produced more activation in left BA 47. Ten participants had more robust activations in the left hemisphere in the grammar tests and two in the standard tests. The grammar tests also elicited substantial activations in the right hemisphere and thus turned out to be superior at identifying both right and left hemisphere contribution to language processing. Conclusion The grammar tests may be an important addition to the standard pre-operative fMRI testing. We added comprehensive grammar tests to standard presurgical fMRI of language. The grammar tests generated more volume of activation bilaterally. The tests identified additional language regions not shown by the standard tests. The grammar tests may be an important addition to standard pre-operative fMRI.
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Affiliation(s)
- Monika Połczyńska
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA 90095, USA; Faculty of English, Adam Mickiewicz University, Poznań, Poland.
| | - Kevin Japardi
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA 90095, USA
| | | | - Teena Moody
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA 90095, USA.
| | | | - Andrew Cho
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA 90095, USA
| | - Celia Vigil
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA 90095, USA
| | - Taylor Kuhn
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA 90095, USA.
| | - Michael Jones
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA 90095, USA
| | - Susan Bookheimer
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA 90095, USA.
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Prevention of radiotherapy-induced neurocognitive dysfunction in survivors of paediatric brain tumours: the potential role of modern imaging and radiotherapy techniques. Lancet Oncol 2017; 18:e91-e100. [DOI: 10.1016/s1470-2045(17)30030-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 10/24/2016] [Accepted: 10/26/2016] [Indexed: 02/06/2023]
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Functional Magnetic Resonance Imaging for Preoperative Planning in Brain Tumour Surgery. Can J Neurol Sci 2016; 44:59-68. [PMID: 28004630 DOI: 10.1017/cjn.2016.306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Functional magnetic resonance imaging (fMRI) is being increasingly used for the preoperative evaluation of patients with brain tumours. METHODS The study is a retrospective chart review investigating the use of clinical fMRI from 2002 through 2013 in the preoperative evaluation of brain tumour patients. Baseline demographic and clinical data were collected. The specific fMRI protocols used for each patient were recorded. RESULTS Sixty patients were identified over the 12-year period. The tumour types most commonly investigated were high-grade glioma (World Health Organization grade III or IV), low-grade glioma (World Health Organization grade II), and meningioma. Most common presenting symptoms were seizures (69.6%), language deficits (23.2%), and headache (19.6%). There was a predominance of left hemispheric lesions investigated with fMRI (76.8% vs 23.2% for right). The most commonly involved lobes were frontal (64.3%), temporal (33.9%), parietal (21.4%), and insular (7.1%). The most common fMRI paradigms were language (83.9%), motor (75.0%), sensory (16.1%), and memory (10.7%). The majority of patients ultimately underwent a craniotomy (75.0%), whereas smaller groups underwent stereotactic biopsy (8.9%) and nonsurgical management (16.1%). Time from request for fMRI to actual fMRI acquisition was 3.1±2.3 weeks. Time from fMRI acquisition to intervention was 4.9±5.5 weeks. CONCLUSIONS We have characterized patient demographics in a retrospective single-surgeon cohort undergoing preoperative clinical fMRI at a Canadian centre. Our experience suggests an acceptable wait time from scan request to scan completion/analysis and from scan to intervention.
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Krieg SM, Picht T, Sollmann N, Bährend I, Ringel F, Nagarajan SS, Meyer B, Tarapore PE. Resection of Motor Eloquent Metastases Aided by Preoperative nTMS-Based Motor Maps-Comparison of Two Observational Cohorts. Front Oncol 2016; 6:261. [PMID: 28066717 PMCID: PMC5174728 DOI: 10.3389/fonc.2016.00261] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 12/08/2016] [Indexed: 11/13/2022] Open
Abstract
Introduction Preoperative mapping of motor areas with navigated transcranial magnetic stimulation (nTMS) has been shown to improve surgical outcomes for peri-Rolandic lesions and, in particular, for gliomas. However, the impact of this technique on surgical outcomes for peri-Rolandic metastatic lesions is yet unknown. Objective To investigate the impact of nTMS on surgical outcomes for peri-Rolandic metastatic lesions, various clinical parameters were analyzed in our international study group. Methods Two prospectively enrolled cohorts were compared by investigating patients receiving preoperative nTMS (2010–2015; 120 patients) and patients who did not receive preoperative nTMS (2006–2015; 130 patients). Tumor location, pathology, size, and preoperative deficits were comparable. Results The nTMS group showed a lower rate of residual tumor on postoperative magnetic resonance imaging (odds ratio 0.3025; 95% confidence interval 0.1356–0.6749). On long-term follow-up, surgery-related paresis was decreased in the nTMS group (nTMS vs. non-nTMS; improved: 30.8 vs. 13.1%, unchanged: 65.8 vs. 73.8%, worse: 3.4 vs. 13.1% of patients; p = 0.0002). Moreover, the nTMS group received smaller craniotomies (nTMS: 16.7 ± 8.6 cm2 vs. non-nTMS: 25.0 ± 17.1 cm2; p < 0.0001). Surgical time differed significantly between the two groups (nTMS: 128.8 ± 49.4 min vs. non-nTMS: 158.0 ± 65.8 min; p = 0.0002). Conclusion This non-randomized study suggests that preoperative motor mapping by nTMS may improve the treatment of patients undergoing surgical resection of metastases in peri-Rolandic regions. These findings suggest that further evaluation with a prospective, randomized trial may be warranted.
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Affiliation(s)
- Sandro M Krieg
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München , Munich , Germany
| | - Thomas Picht
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin , Berlin , Germany
| | - Nico Sollmann
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München , Munich , Germany
| | - Ina Bährend
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin , Berlin , Germany
| | - Florian Ringel
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München , Munich , Germany
| | - Srikantan S Nagarajan
- Biomagnetic Imaging Laboratory, Department of Radiology, University of California San Francisco , San Francisco, CA , USA
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München , Munich , Germany
| | - Phiroz E Tarapore
- Department of Neurological Surgery, University of California San Francisco , San Francisco, CA , USA
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Abstract
Cortical reorganization of function due to the growth of an adjacent brain tumor has clearly been demonstrated in a number of surgically proven cases. Such cases demonstrate the unmistakable implications for the neurosurgical treatment of brain tumors, as the cortical function may not reside where one may initially suspect based solely on the anatomical magnetic resonance imaging (MRI). Consequently, preoperative localization of eloquent areas adjacent to a brain tumor is necessary, as this may demonstrate unexpected organization, which may affect the neurosurgical approach to the lesion. However, in interpreting functional MRI studies, the interpreting physician must be cognizant of artifacts, which may limit the accuracy of functional MRI in the setting of brain tumors.
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Morrison MA, Tam F, Garavaglia MM, Hare GMT, Cusimano MD, Schweizer TA, Das S, Graham SJ. Sources of Variation Influencing Concordance between Functional MRI and Direct Cortical Stimulation in Brain Tumor Surgery. Front Neurosci 2016; 10:461. [PMID: 27803645 PMCID: PMC5067437 DOI: 10.3389/fnins.2016.00461] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 09/26/2016] [Indexed: 11/13/2022] Open
Abstract
Object: Preoperative functional magnetic resonance imaging (fMRI) remains a promising method to aid in the surgical management of patients diagnosed with brain tumors. For patients that are candidates for awake craniotomies, surgical decisions can potentially be improved by fMRI but this depends on the level of concordance between preoperative brain maps and the maps provided by the gold standard intraoperative method, direct cortical stimulation (DCS). There have been numerous studies of the concordance between fMRI and DCS using sensitivity and specificity measures, however the results are variable across studies and the key factors influencing variability are not well understood. Thus, the present work addresses the influence of technical factors on fMRI and DCS concordance. Methods: Motor and language mapping data were collected for a group of glioma patients (n = 14) who underwent both preoperative fMRI and intraoperative DCS in an awake craniotomy procedure for tumor removal. Normative fMRI data were also acquired in a healthy control group (n = 12). The fMRI and DCS mapping data were co-registered; true positive (TP), true negative (TN), false positive (FP), and false negative (FN) occurrences were tabulated over the exposed brain surface. Sensitivity and specificity were measured for the total group, and for the motor and language sub-groups. The influence of grid placement, fMRI statistical thresholding, and task standardization were assessed. Correlations between proportions of agreement and error were also carefully scrutinized to evaluate concordance in more detail. Results: Concordance was significantly better for motor vs. language mapping. There was an inverse relationship between TP and TN with increasing statistical threshold, and FP dominated the total error. Sensitivity and specificity were reduced when tasks were not standardized across fMRI and DCS. Conclusions: Although the agreement between fMRI and DCS is good, variability is introduced by technical factors that can diminish the quality of patient data. Neurosurgeons should evaluate the usefulness of fMRI data while considering that (a) discordance arises primarily from FP fMRI results; (b) there is an inherent trade-off between sensitivity and specificity with fMRI statistical threshold; and
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Affiliation(s)
- Melanie A. Morrison
- Physical Sciences Platform, Sunnybrook Research InstituteToronto, ON, Canada
- Department of Medical Biophysics, University of TorontoToronto, ON, Canada
| | - Fred Tam
- Physical Sciences Platform, Sunnybrook Research InstituteToronto, ON, Canada
| | - Marco M. Garavaglia
- Department of Anaesthesia, University of TorontoToronto, ON, Canada
- Department of Anaesthesia, Toronto Western HospitalToronto, ON, Canada
| | - Gregory M. T. Hare
- Department of Anaesthesia, University of TorontoToronto, ON, Canada
- Keenan Research Centre, St. Michael's HospitalToronto, ON, Canada
- Department of Anaesthesia, St. Michael's HospitalToronto, ON, Canada
| | - Michael D. Cusimano
- Keenan Research Centre, St. Michael's HospitalToronto, ON, Canada
- Division of Neurosurgery, St. Michael's HospitalToronto, ON, Canada
- Department of Surgery, University of TorontoToronto, ON, Canada
| | - Tom A. Schweizer
- Keenan Research Centre, St. Michael's HospitalToronto, ON, Canada
- Department of Surgery, University of TorontoToronto, ON, Canada
| | - Sunit Das
- Keenan Research Centre, St. Michael's HospitalToronto, ON, Canada
- Division of Neurosurgery, St. Michael's HospitalToronto, ON, Canada
- Department of Surgery, University of TorontoToronto, ON, Canada
| | - Simon J. Graham
- Physical Sciences Platform, Sunnybrook Research InstituteToronto, ON, Canada
- Department of Medical Biophysics, University of TorontoToronto, ON, Canada
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Fraga de Abreu VH, Peck KK, Petrovich-Brennan NM, Woo KM, Holodny AI. Brain Tumors: The Influence of Tumor Type and Routine MR Imaging Characteristics at BOLD Functional MR Imaging in the Primary Motor Gyrus. Radiology 2016; 281:876-883. [PMID: 27383533 DOI: 10.1148/radiol.2016151951] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To evaluate the effects of histologic features and anatomic magnetic resonance (MR) imaging characteristics of brain tumors on the functional MR imaging signal in the primary motor cortex (PMC), as false-negative blood oxygen level-dependent (BOLD) functional MR imaging activation can limit the accurate localization of eloquent cortices. Materials and Methods Institutional review board approval was obtained, and informed consent was waived for this HIPAA-compliant retrospective study. It comprised 63 patients referred between 2006 and 2014 for preoperative functional MR imaging localization of the Rolandic cortex. The patients had glioblastoma multiforme (GBM) (n = 20), metastasis (n = 21), or meningioma (n = 22). The volumes of functional MR imaging activation were measured during performance of a bilateral hand motor task. Ratios of functional MR imaging activation were normalized to PMC volume. Statistical analysis was performed for the following: (a) differences between hemispheres within each histologic tumor type (paired Wilcoxon test), (b) differences across tumor types (Kruskal-Wallis and Fisher tests), (c) pairwise tests between tumor types (Mann-Whitney U test), (d) relationships between fast fluid-attenuated inversion recovery (FLAIR) data and enhancement volume with activation (Spearman rank correlation coefficient), and (e) differences in activation volumes by tumor location (Mann-Whitney U test). Results A significant interhemispheric difference was found between the activation volumes in GBMs (mean, 511.43 voxels ± 307.73 [standard deviation] and 330.78 voxels ± 278.95; P < .01) but not in metastases (504.68 voxels ± 220.98 and 460.22 voxels ± 276.83; P = .15) or meningiomas (424.07 voxels ± 247.58 and 415.18 voxels ± 222.36; P = .85). GBMs showed significantly lower activation ratios (median, 0.49; range, 0.04-1.15) than metastases (median, 0.79; range, 0.28-1.66; P = .043) and meningiomas (median, 0.91; range, 0.52-2.05; P < .01). There was a moderate correlation with the volumes of FLAIR abnormality in metastases (ρ = -0.50) and meningiomas (ρ = -0.55). Enhancement volume (ρ = -0.11) and tumor distance from the PMC (median, 0.73 and range, 0.04-2.05 for near and median, 0.82 and range, 0.39-1.66 for far; P = .14) did not influence activation. Conclusion BOLD functional MR imaging activation in the ipsilateral PMC is influenced by tumor type and is significantly reduced in GBMs. FLAIR abnormality correlates moderately with the activation ratios in metastases and meningiomas. © RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Vitor Hugo Fraga de Abreu
- From the Functional MRI Laboratory, Department of Radiology (V.H.F.d.A., K.K.P., N.M.P., A.I.H.), the Department of Medical Physics (K.K.P.), the Department of Epidemiology-Biostatistics (K.M.W.), and the Brain Tumor Center (A.I.H.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and the Department of Radiology, Vestfold Hospital Trust, Tønsberg, Norway (V.H.F.d.A.)
| | - Kyung K Peck
- From the Functional MRI Laboratory, Department of Radiology (V.H.F.d.A., K.K.P., N.M.P., A.I.H.), the Department of Medical Physics (K.K.P.), the Department of Epidemiology-Biostatistics (K.M.W.), and the Brain Tumor Center (A.I.H.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and the Department of Radiology, Vestfold Hospital Trust, Tønsberg, Norway (V.H.F.d.A.)
| | - Nicole M Petrovich-Brennan
- From the Functional MRI Laboratory, Department of Radiology (V.H.F.d.A., K.K.P., N.M.P., A.I.H.), the Department of Medical Physics (K.K.P.), the Department of Epidemiology-Biostatistics (K.M.W.), and the Brain Tumor Center (A.I.H.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and the Department of Radiology, Vestfold Hospital Trust, Tønsberg, Norway (V.H.F.d.A.)
| | - Kaitlin M Woo
- From the Functional MRI Laboratory, Department of Radiology (V.H.F.d.A., K.K.P., N.M.P., A.I.H.), the Department of Medical Physics (K.K.P.), the Department of Epidemiology-Biostatistics (K.M.W.), and the Brain Tumor Center (A.I.H.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and the Department of Radiology, Vestfold Hospital Trust, Tønsberg, Norway (V.H.F.d.A.)
| | - Andrei I Holodny
- From the Functional MRI Laboratory, Department of Radiology (V.H.F.d.A., K.K.P., N.M.P., A.I.H.), the Department of Medical Physics (K.K.P.), the Department of Epidemiology-Biostatistics (K.M.W.), and the Brain Tumor Center (A.I.H.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and the Department of Radiology, Vestfold Hospital Trust, Tønsberg, Norway (V.H.F.d.A.)
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Hypercapnic evaluation of vascular reactivity in healthy aging and acute stroke via functional MRI. NEUROIMAGE-CLINICAL 2016; 12:173-9. [PMID: 27437178 PMCID: PMC4939388 DOI: 10.1016/j.nicl.2016.06.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 05/26/2016] [Accepted: 06/22/2016] [Indexed: 11/23/2022]
Abstract
Functional MRI (fMRI) is well-established for the study of brain function in healthy populations, although its clinical application has proven more challenging. Specifically, cerebrovascular reactivity (CVR), which allows the assessment of the vascular response that serves as the basis for fMRI, has been shown to be reduced in healthy aging as well as in a range of diseases, including chronic stroke. However, the timing of when this occurs relative to the stroke event is unclear. We used a breath-hold fMRI task to evaluate CVR across gray matter in a group of acute stroke patients (< 10 days from stroke; N = 22) to address this question. These estimates were compared with those from both age-matched (N = 22) and younger (N = 22) healthy controls. As expected, young controls had the greatest mean CVR, as indicated by magnitude and extent of fMRI activation; however, stroke patients did not differ from age-matched controls. Moreover, the ipsilesional and contralesional hemispheres of stroke patients did not differ with respect to any of these measures. These findings suggest that fMRI remains a valid tool within the first few days of a stroke, particularly for group fMRI studies in which findings are compared with healthy subjects of similar age. However, given the relatively high variability in CVR observed in our stroke sample, caution is warranted when interpreting fMRI data from individual patients or a small cohort. We conclude that a breath-hold task can be a useful addition to functional imaging protocols for stroke patients. Breath-holding can be used to assess the validity of fMRI in stroke patients. Vascular reactivity, estimated by breath-hold fMRI, was greatest in young controls. Acute stroke patients and age-matched controls had similar vascular reactivity. Modeling the breath-hold response on an individual basis can improve results.
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Glioblastoma Induces Vascular Dysregulation in Nonenhancing Peritumoral Regions in Humans. AJR Am J Roentgenol 2016; 206:1073-81. [PMID: 27007449 DOI: 10.2214/ajr.15.14529] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Glioblastoma is an invasive primary brain malignancy that typically infiltrates the surrounding tissue with malignant cells. It disrupts cerebral blood flow through a variety of biomechanical and biochemical mechanisms. Thus, neuroimaging focused on identifying regions of vascular dysregulation may reveal a marker of tumor spread. The purpose of this study was to use blood oxygenation level-dependent (BOLD) functional MRI (fMRI) to compare the temporal dynamics of the enhancing portion of a tumor with those of brain regions without apparent tumors. MATERIALS AND METHODS Patients with pathologically proven glioblastoma underwent preoperative resting-state BOLD fMRI, T1-weighted contrast-enhanced MRI, and FLAIR MRI. The contralesional control hemisphere, contrast-enhancing tumor, and peritu-moral edema were segmented by use of structural images and were used to extract the time series of these respective regions. The parameter estimates (beta values) for the two regressors and resulting z-statistic images were used as a metric to compare the similarity of the tumor dynamics to those of other brain regions. RESULTS The time course of the contrast-enhancing tumor was significantly different from that of the rest of the brain (p < 0.05). Similarly, the control signal intensity was significantly different from the tumor signal intensity (p < 0.05). Notably, the temporal dynamics in the peritumoral edema, which did not contain enhancing tumor, were most similar to the those of enhancing tumor than to those of control regions. CONCLUSION The findings show that the disruption in vascular regulation induced by a glioblastoma can be detected with BOLD fMRI and that the spatial distribution of these disruptions is localized to the immediate vicinity of the tumor and peritumoral edema.
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Cardoso PL, Fischmeister FPS, Dymerska B, Geißler A, Wurnig M, Trattnig S, Beisteiner R, Robinson SD. Improving the clinical potential of ultra-high field fMRI using a model-free analysis method based on response consistency. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2016; 29:435-49. [PMID: 26965512 PMCID: PMC4891377 DOI: 10.1007/s10334-016-0533-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 01/19/2016] [Accepted: 02/06/2016] [Indexed: 12/16/2022]
Abstract
Objective To develop an analysis method that is sensitive to non-model-conform responses often encountered in ultra-high field presurgical planning fMRI. Using the consistency of time courses over a number of experiment repetitions, it should exclude low quality runs and generate activation maps that reflect the reliability of responses. Materials and methods 7 T fMRI data were acquired from six healthy volunteers: three performing purely motor tasks and three a visuomotor task. These were analysed with the proposed approach (UNBIASED) and the GLM. Results UNBIASED results were generally less affected by false positive results than the GLM. Runs that were identified as being of low quality were confirmed to contain little or no activation. In two cases, regions were identified as activated in UNBIASED but not GLM results. Signal changes in these areas were time-locked to the task, but were delayed or transient. Conclusion UNBIASED is shown to be a reliable means of identifying consistent task-related signal changes regardless of response timing. In presurgical planning, UNBIASED could be used to rapidly generate reliable maps of the consistency with which eloquent brain regions are activated without recourse to task timing and despite modified hemodynamics. Electronic supplementary material The online version of this article (doi:10.1007/s10334-016-0533-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pedro Lima Cardoso
- />Department of Biomedical Imaging and Image-guided Therapy, High Field Magnetic Resonance Centre, Medical University of Vienna, Lazarettgasse 14/BT32, 1090 Vienna, Austria
| | - Florian Ph. S. Fischmeister
- />Study Group Clinical fMRI, Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Barbara Dymerska
- />Department of Biomedical Imaging and Image-guided Therapy, High Field Magnetic Resonance Centre, Medical University of Vienna, Lazarettgasse 14/BT32, 1090 Vienna, Austria
| | - Alexander Geißler
- />Study Group Clinical fMRI, Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Moritz Wurnig
- />Study Group Clinical fMRI, Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Siegfried Trattnig
- />Department of Biomedical Imaging and Image-guided Therapy, High Field Magnetic Resonance Centre, Medical University of Vienna, Lazarettgasse 14/BT32, 1090 Vienna, Austria
| | - Roland Beisteiner
- />Study Group Clinical fMRI, Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Simon Daniel Robinson
- />Department of Biomedical Imaging and Image-guided Therapy, High Field Magnetic Resonance Centre, Medical University of Vienna, Lazarettgasse 14/BT32, 1090 Vienna, Austria
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Hou BL, Bhatia S, Carpenter JS. Quantitative comparisons on hand motor functional areas determined by resting state and task BOLD fMRI and anatomical MRI for pre-surgical planning of patients with brain tumors. NEUROIMAGE-CLINICAL 2016; 11:378-387. [PMID: 27069871 PMCID: PMC4810013 DOI: 10.1016/j.nicl.2016.03.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 02/17/2016] [Accepted: 03/01/2016] [Indexed: 11/24/2022]
Abstract
For pre-surgical planning we present quantitative comparison of the location of the hand motor functional area determined by right hand finger tapping BOLD fMRI, resting state BOLD fMRI, and anatomically using high resolution T1 weighted images. Data were obtained on 10 healthy subjects and 25 patients with left sided brain tumors. Our results show that there are important differences in the locations (i.e., > 20 mm) of the determined hand motor voxels by these three MR imaging methods. This can have significant effect on the pre-surgical planning of these patients depending on the modality used. In 13 of the 25 cases (i.e., 52%) the distances between the task-determined and the rs-fMRI determined hand areas were more than 20 mm; in 13 of 25 cases (i.e., 52%) the distances between the task-determined and anatomically determined hand areas were > 20 mm; and in 16 of 25 cases (i.e., 64%) the distances between the rs-fMRI determined and anatomically determined hand areas were more than 20 mm. In just three cases, the distances determined by all three modalities were within 20 mm of each other. The differences in the location or fingerprint of the hand motor areas, as determined by these three MR methods result from the different underlying mechanisms of these three modalities and possibly the effects of tumors on these modalities.
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Affiliation(s)
- Bob L Hou
- Department of Radiology, WVU, Morgantown, WV 26506, USA.
| | - Sanjay Bhatia
- Department of Neurosurgery, WVU, Morgantown, WV 26506, USA
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Agarwal S, Sair HI, Airan R, Hua J, Jones CK, Heo HY, Olivi A, Lindquist MA, Pekar JJ, Pillai JJ. Demonstration of Brain Tumor-Induced Neurovascular Uncoupling in Resting-State fMRI at Ultrahigh Field. Brain Connect 2016; 6:267-72. [PMID: 26918887 DOI: 10.1089/brain.2015.0402] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
To demonstrate in a small case series for the first time the phenomenon of brain tumor-related neurovascular uncoupling (NVU) in resting-state blood oxygen level-dependent (BOLD) functional magnetic resonance imaging (fMRI) at ultrahigh field (7T). Two de novo (i.e., untreated) brain tumor patients underwent both BOLD resting-state fMRI (rsfMRI) on a 7T MRI system and motor task-based BOLD fMRI at 3T. Ipsilesional (i.e., ipsilateral to tumor or IL) and contralesional (i.e., contralateral to tumor or CL) region of interest (ROI) analysis was performed on both 3T motor task-related general linear model-derived activation maps and on 7T rsfMRI independent component analysis (ICA)-derived sensorimotor network maps for each case. Asymmetry scores (ASs) were computed based on numbers of suprathreshold voxels in the IL and CL ROIs. In each patient, ASs derived from ROI analysis of suprathreshold voxels in IL and CL ROIs in task-related activation maps and rsfMRI ICA-derived sensorimotor component maps indicate greater number of suprathreshold voxels in contralesional than ipsilesional sensorimotor cortex in both maps. In patient 1, an AS of 0.2 was obtained from the suprathreshold Z-score spectrum (voxels with Z-scores >5.0) of the task-based activation map and AS of 1.0 was obtained from the suprathreshold Z-score spectrum (Z-scores >5.0) of the ICA-derived sensorimotor component map. Similarly, in patient 2, an AS of 1.0 was obtained from the suprathreshold Z-score spectrum (Z-scores >5.0) of the task-based activation map and an AS of 1.0 was obtained from the suprathreshold Z-score spectrum (Z-scores >5.0) of the ICA-derived sensorimotor component map. Overall, decreased BOLD signal was noted in IL compared with CL ROIs on both task-based activation maps and ultrahigh field resting-state maps, indicating the presence of NVU. We have demonstrated evidence of NVU on ultrahigh field 7T rsfMRI comparable with the findings on standard 3T motor task-based fMRI in both cases.
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Affiliation(s)
- Shruti Agarwal
- 1 Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Haris I Sair
- 1 Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Raag Airan
- 1 Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Jun Hua
- 2 Division of MR Research, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine , Baltimore, Maryland
- 3 F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute , Baltimore, Maryland
| | - Craig K Jones
- 2 Division of MR Research, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine , Baltimore, Maryland
- 3 F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute , Baltimore, Maryland
| | - Hye-Young Heo
- 2 Division of MR Research, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine , Baltimore, Maryland
- 3 F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute , Baltimore, Maryland
| | - Alessandro Olivi
- 4 Department of Neurosurgery, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Martin A Lindquist
- 5 Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health , Baltimore, Maryland
| | - James J Pekar
- 2 Division of MR Research, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine , Baltimore, Maryland
- 3 F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute , Baltimore, Maryland
| | - Jay J Pillai
- 1 Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine , Baltimore, Maryland
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Morrison MA, Churchill NW, Cusimano MD, Schweizer TA, Das S, Graham SJ. Reliability of Task-Based fMRI for Preoperative Planning: A Test-Retest Study in Brain Tumor Patients and Healthy Controls. PLoS One 2016; 11:e0149547. [PMID: 26894279 PMCID: PMC4760755 DOI: 10.1371/journal.pone.0149547] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 02/02/2016] [Indexed: 11/25/2022] Open
Abstract
Background Functional magnetic resonance imaging (fMRI) continues to develop as a clinical tool for patients with brain cancer, offering data that may directly influence surgical decisions. Unfortunately, routine integration of preoperative fMRI has been limited by concerns about reliability. Many pertinent studies have been undertaken involving healthy controls, but work involving brain tumor patients has been limited. To develop fMRI fully as a clinical tool, it will be critical to examine these reliability issues among patients with brain tumors. The present work is the first to extensively characterize differences in activation map quality between brain tumor patients and healthy controls, including the effects of tumor grade and the chosen behavioral testing paradigm on reliability outcomes. Method Test-retest data were collected for a group of low-grade (n = 6) and high-grade glioma (n = 6) patients, and for matched healthy controls (n = 12), who performed motor and language tasks during a single fMRI session. Reliability was characterized by the spatial overlap and displacement of brain activity clusters, BOLD signal stability, and the laterality index. Significance testing was performed to assess differences in reliability between the patients and controls, and low-grade and high-grade patients; as well as between different fMRI testing paradigms. Results There were few significant differences in fMRI reliability measures between patients and controls. Reliability was significantly lower when comparing high-grade tumor patients to controls, or to low-grade tumor patients. The motor task produced more reliable activation patterns than the language tasks, as did the rhyming task in comparison to the phonemic fluency task. Conclusion In low-grade glioma patients, fMRI data are as reliable as healthy control subjects. For high-grade glioma patients, further investigation is required to determine the underlying causes of reduced reliability. To maximize reliability outcomes, testing paradigms should be carefully selected to generate robust activation patterns.
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Affiliation(s)
- Melanie A. Morrison
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- * E-mail:
| | | | - Michael D. Cusimano
- Keenan Research Centre, St. Michael's Hospital, Toronto, ON, Canada
- Division of Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Tom A. Schweizer
- Keenan Research Centre, St. Michael's Hospital, Toronto, ON, Canada
- Division of Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Sunit Das
- Keenan Research Centre, St. Michael's Hospital, Toronto, ON, Canada
- Division of Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Simon J. Graham
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
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Dong JW, Brennan NMP, Izzo G, Peck KK, Holodny AI. fMRI activation in the middle frontal gyrus as an indicator of hemispheric dominance for language in brain tumor patients: a comparison with Broca's area. Neuroradiology 2016; 58:513-20. [PMID: 26847705 DOI: 10.1007/s00234-016-1655-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 01/29/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Functional MRI (fMRI) can assess language lateralization in brain tumor patients; however, this can be limited if the primary language area-Broca's area (BA)-is affected by the tumor. We hypothesized that the middle frontal gyrus (MFG) can be used as a clinical indicator of hemispheric dominance for language during presurgical workup. METHODS Fifty-two right-handed subjects with solitary left-hemispheric primary brain tumors were retrospectively studied. Subjects performed a verbal fluency task during fMRI. The MFG was compared to BA for fMRI voxel activation, language laterality index (LI), and the effect of tumor grade on the LI. RESULTS Language fMRI (verbal fluency) activated more voxels in MFG than in BA (MFG = 315, BA = 216, p < 0.001). Voxel activations in the left-hemispheric MFG and BA were positively correlated (r = 0.69, p < 0.001). Mean LI in the MFG was comparable to that in BA (MFG = 0.48, BA = 0.39, p = 0.06). LIs in MFG and BA were positively correlated (r = 0.62, p < 0.001). Subjects with high-grade tumors demonstrate lower language lateralization than those with low-grade tumors in both BA and MFG (p = 0.02, p = 0.02, respectively). CONCLUSION MFG is comparable to BA in its ability to indicate hemispheric dominance for language using a measure of verbal fluency and may be an adjunct measure in the clinical determination of language laterality for presurgical planning.
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Affiliation(s)
- Jian W Dong
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
- New York University School of Medicine, New York, NY, USA
| | - Nicole M Petrovich Brennan
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Giana Izzo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
- Department of Bioimaging and Radiological Sciences, Catholic University of Rome, A. Gemelli Hospital, Rome, Italy
| | - Kyung K Peck
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
- Department of Medical Physics and the Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrei I Holodny
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA.
- Department of Medical Physics and the Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Sollmann N, Ille S, Tussis L, Maurer S, Hauck T, Negwer C, Bauer JS, Ringel F, Meyer B, Krieg SM. Correlating subcortical interhemispheric connectivity and cortical hemispheric dominance in brain tumor patients: A repetitive navigated transcranial magnetic stimulation study. Clin Neurol Neurosurg 2016; 141:56-64. [DOI: 10.1016/j.clineuro.2015.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 12/14/2015] [Indexed: 12/31/2022]
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Bisdas S, Charyasz-Leks E, Roder C, Tatagiba MS, Ernemann U, Klose U. Evidence of Resting-state Activity in Propofol-anesthetized Patients with Intracranial Tumors. Acad Radiol 2016; 23:192-9. [PMID: 26625707 DOI: 10.1016/j.acra.2015.10.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 10/11/2015] [Accepted: 10/13/2015] [Indexed: 10/22/2022]
Abstract
RATIONALE AND OBJECTIVES Resting-state (RS) networks, revealed by functional magnetic resonance imaging (fMRI) studies in healthy volunteers, have never been evaluated in anesthetized patients with brain tumors. Our purpose was to examine the presence of residual brain activity on the auditory network during propofol-induced loss of consciousness in patients with brain tumors. MATERIALS AND METHODS Twenty subjects with intracranial masses were prospectively studied by means of intraoperative RS-fMRI acquisitions before any craniectomy. After performing single-subject independent component analysis, spatial maps and time courses were assigned to an auditory RS network template from the literature and compared via spatial regression coefficients. RESULTS All fMRI data were of sufficient quality for further postprocessing. In all but two patients, the RS functional activity of the auditory network could be successfully mapped. In almost all patients, contralateral activation of the auditory network was present. No significant difference was found between the mean distance of the RS activity clusters and the lesion periphery for tumors located in the temporal gyri vs. those in other brain regions. The spatial deviation between the activated cluster in our experiment and the template was significantly (P = 0.04) higher in patients with tumors located in the temporal gyri than in patients with tumors located in other regions. CONCLUSIONS Propofol-induced anesthesia in patients with intracranial lesions does not alter the blood-oxygenation level-depended signal, and independent component analysis of intraoperative RS-fMRI may allow assessment of the auditory network in a clinical setting.
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Alteration of long-distance functional connectivity and network topology in patients with supratentorial gliomas. Neuroradiology 2015; 58:311-20. [DOI: 10.1007/s00234-015-1621-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 11/17/2015] [Indexed: 10/22/2022]
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de Oliveira ÉA, Faintuch BL, Targino RC, Moro AM, Martinez RCR, Pagano RL, Fonoff ET, Carneiro CDG, Garcez AT, Faria DDP, Buchpiguel CA. Evaluation of GX1 and RGD-GX1 peptides as new radiotracers for angiogenesis evaluation in experimental glioma models. Amino Acids 2015; 48:821-831. [PMID: 26592499 DOI: 10.1007/s00726-015-2130-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 11/04/2015] [Indexed: 01/31/2023]
Abstract
Gliomas are the most common type among all central nervous system tumors. The aggressiveness of gliomas is correlated with the level of angiogenesis and is often associated with prognosis. The aim of this study is to evaluate the novel GX1 peptide and the heterodimer RGD-GX1 radiolabeled with technetium-99m, for angiogenesis detection in glioma models. Radiolabeling and radiochemical controls were assessed for both radioconjugates. In vitro binding studies in glioma tumor cells were performed, as well as biodistribution in SCID mice bearing tumor cells, in order to evaluate the biological behavior and tumor uptake of the radiocomplexes. Blocking and imaging studies were also conducted. MicroSPECT/CT images were acquired in animals with experimentally implanted intracranial tumor. Open field activity was performed to evaluate behavior, as well as perfusion and histology analysis. The radiochemical purity of both radiotracers was greater than 96 %. In vitro binding studies revealed rather similar binding profi le for each molecule. The highest binding was for RGD-GX1 peptide at 120 min in U87MG cells (1.14 ± 0.35 %). Tumor uptake was also favorable for RGD-GX1 peptide in U87MG cells, reaching 2.96 ± 0.70 % at 1 h p.i. with 47 % of blocking. Imaging studies also indicated better visualization for RGD-GX1 peptide in U87MG cells. Behavior evaluation pointed brain damage and histology studies confirmed actual tumor in the uptake site. The results with the angiogenesis seeking molecule (99m)Tc-HYNIC-E-[c(RGDfk)-c(GX1)] were successful, and better than with (99m)Tc-HYNIC-PEG4-c(GX1). Future studies targeting angiogenesis in other glioma and nonglioma tumor models are recommended.
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Affiliation(s)
- Érica Aparecida de Oliveira
- Radiopharmacy Center, Institute of Energy and Nuclear Research, Av. Prof. Lineu Prestes, 2242, São Paulo, 05508-000, Brazil. .,School of Pharmaceutical Sciences, University of Sao Paulo, Av. Prof. Lineu Prestes, 580 Bloco 17, São Paulo, 05508-900, Brazil.
| | - Bluma Linkowski Faintuch
- Radiopharmacy Center, Institute of Energy and Nuclear Research, Av. Prof. Lineu Prestes, 2242, São Paulo, 05508-000, Brazil
| | - Roselaine Campos Targino
- Laboratory of Biopharmacology in Animal Cells, Butantan Institute, Av. Vital Brasil, 1500, Sao Paulo, 05503-900, Brazil
| | - Ana Maria Moro
- Laboratory of Biopharmacology in Animal Cells, Butantan Institute, Av. Vital Brasil, 1500, Sao Paulo, 05503-900, Brazil
| | - Raquel Chacon Ruiz Martinez
- Laboratory of Neuromodulation and Experimental Pain, Teaching and Research Institute, Hospital Sírio-Libanês, Rua Professor Daher Cutait, 69, Sao Paulo, 01308-060, Brazil
| | - Rosana Lima Pagano
- Laboratory of Neuromodulation and Experimental Pain, Teaching and Research Institute, Hospital Sírio-Libanês, Rua Professor Daher Cutait, 69, Sao Paulo, 01308-060, Brazil
| | - Erich Talamoni Fonoff
- Laboratory of Neuromodulation and Experimental Pain, Teaching and Research Institute, Hospital Sírio-Libanês, Rua Professor Daher Cutait, 69, Sao Paulo, 01308-060, Brazil.,Division of Functional Neurosurgery, Institute of Psychiatry of Hospital das Clinicas and Department of Neurology, School of Medicine, University of São Paulo, R. Dr. Ovídio Pires de Campos, 785, São Paulo, 01060-970, Brazil
| | - Camila de Godoi Carneiro
- Nuclear Medicine Laboratory (LIM 43), Medical School, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, s/nº-Rua 1, Sao Paulo, 05403-900, Brazil
| | - Alexandre Teles Garcez
- Nuclear Medicine Laboratory (LIM 43), Medical School, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, s/nº-Rua 1, Sao Paulo, 05403-900, Brazil
| | - Daniele de Paula Faria
- Nuclear Medicine Laboratory (LIM 43), Medical School, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, s/nº-Rua 1, Sao Paulo, 05403-900, Brazil
| | - Carlos Alberto Buchpiguel
- Nuclear Medicine Laboratory (LIM 43), Medical School, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, s/nº-Rua 1, Sao Paulo, 05403-900, Brazil
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Chamberland M, Bernier M, Fortin D, Whittingstall K, Descoteaux M. 3D interactive tractography-informed resting-state fMRI connectivity. Front Neurosci 2015; 9:275. [PMID: 26321901 PMCID: PMC4531323 DOI: 10.3389/fnins.2015.00275] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 07/22/2015] [Indexed: 01/01/2023] Open
Abstract
In the past decade, the fusion between diffusion magnetic resonance imaging (dMRI) and functional magnetic resonance imaging (fMRI) has opened the way for exploring structure-function relationships in vivo. As it stands, the common approach usually consists of analysing fMRI and dMRI datasets separately or using one to inform the other, such as using fMRI activation sites to reconstruct dMRI streamlines that interconnect them. Moreover, given the large inter-individual variability of the healthy human brain, it is possible that valuable information is lost when a fixed set of dMRI/fMRI analysis parameters such as threshold values are assumed constant across subjects. By allowing one to modify such parameters while viewing the results in real-time, one can begin to fully explore the sensitivity of structure-function relations and how they differ across brain areas and individuals. This is especially important when interpreting how structure-function relationships are altered in patients with neurological disorders, such as the presence of a tumor. In this study, we present and validate a novel approach to achieve this: First, we present an interactive method to generate and visualize tractography-driven resting-state functional connectivity, which reduces the bias introduced by seed size, shape and position. Next, we demonstrate that structural and functional reconstruction parameters explain a significant portion of intra- and inter-subject variability. Finally, we demonstrate how our proposed approach can be used in a neurosurgical planning context. We believe this approach will promote the exploration of structure-function relationships in a subject-specific aspect and will open new opportunities for connectomics.
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Affiliation(s)
- Maxime Chamberland
- Centre de Recherche CHUS, University of Sherbrooke Sherbrooke, QC, Canada ; Sherbrooke Connectivity Imaging Lab, Computer Science Department, Faculty of Science, University of Sherbrooke Sherbrooke, QC, Canada ; Department of Nuclear Medicine and Radiobiology, Faculty of Medicine and Health Science, University of Sherbrooke Sherbrooke, QC, Canada
| | - Michaël Bernier
- Centre de Recherche CHUS, University of Sherbrooke Sherbrooke, QC, Canada ; Department of Nuclear Medicine and Radiobiology, Faculty of Medicine and Health Science, University of Sherbrooke Sherbrooke, QC, Canada
| | - David Fortin
- Centre de Recherche CHUS, University of Sherbrooke Sherbrooke, QC, Canada ; Division of Neurosurgery and Neuro-Oncology, Faculty of Medicine and Health Science, University of Sherbrooke Sherbrooke, QC, Canada
| | - Kevin Whittingstall
- Centre de Recherche CHUS, University of Sherbrooke Sherbrooke, QC, Canada ; Department of Nuclear Medicine and Radiobiology, Faculty of Medicine and Health Science, University of Sherbrooke Sherbrooke, QC, Canada ; Department of Diagnostic Radiology, Faculty of Medicine and Health Science, University of Sherbrooke Sherbrooke, QC, Canada
| | - Maxime Descoteaux
- Centre de Recherche CHUS, University of Sherbrooke Sherbrooke, QC, Canada ; Sherbrooke Connectivity Imaging Lab, Computer Science Department, Faculty of Science, University of Sherbrooke Sherbrooke, QC, Canada
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Agarwal S, Sair HI, Yahyavi-Firouz-Abadi N, Airan R, Pillai JJ. Neurovascular uncoupling in resting state fMRI demonstrated in patients with primary brain gliomas. J Magn Reson Imaging 2015. [PMID: 26201672 DOI: 10.1002/jmri.25012] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND To demonstrate that the problem of brain tumor-related neurovascular uncoupling (NVU) is a significant issue with respect to resting state blood oxygen level dependent (BOLD) functional MRI (rsfMRI) similar to task-based BOLD fMRI, in which signal detectability can be compromised by breakdown of normal neurovascular coupling. METHODS We evaluated seven de novo brain tumor patients who underwent resting state fMRI as part of comprehensive clinical fMRI exams at 3 Tesla. For each of the seven patients who demonstrated evidence of NVU on task-based motor fMRI, we performed both an independent component analysis (ICA) and an atlas-based parcellation-based seed correlation analysis (SCA) of the resting state fMRI data. For each patient, ipsilesional (IL) and contralesional (CL) regions of interest (ROIs) comprising primary motor and somatosensory cortices were used to evaluate BOLD signal changes on Z score maps derived from both ICA and SCA analysis for evidence of NVU. A subsequent two-tailed t-test was performed to determine whether statistically significant differences between the two sides were present that were consistent with NVU. RESULTS In seven patients, overall decreased BOLD signal (based on suprathreshold voxels in ICA and SCA-derived Z-score maps) was noted in IL compared with CL ROIs (P < 0.01), consistent with NVU. CONCLUSION We have demonstrated that NVU can result in false negative BOLD signal changes on rsfMRI comparable to previously published findings on standard motor task-based fMRI.
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Affiliation(s)
- Shruti Agarwal
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Haris I Sair
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Noushin Yahyavi-Firouz-Abadi
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Raag Airan
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jay J Pillai
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Krieg SM, Sollmann N, Obermueller T, Sabih J, Bulubas L, Negwer C, Moser T, Droese D, Boeckh-Behrens T, Ringel F, Meyer B. Changing the clinical course of glioma patients by preoperative motor mapping with navigated transcranial magnetic brain stimulation. BMC Cancer 2015; 15:231. [PMID: 25884404 PMCID: PMC4423137 DOI: 10.1186/s12885-015-1258-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 03/25/2015] [Indexed: 01/21/2023] Open
Abstract
Background Mapping of the motor cortex by navigated transcranial magnetic stimulation (nTMS) can be used for preoperative planning in brain tumor patients. Just recently, it has been proven to actually change outcomes by increasing the rate of gross total resection (GTR) and by reducing the surgery-related rate of paresis significantly in cohorts of patients suffering from different entities of intracranial lesions. Yet, we also need data that shows whether these changes also lead to a changed clinical course, and can also be achieved specifically in high-grade glioma (HGG) patients. Methods We prospectively enrolled 70 patients with supratentorial motor eloquently located HGG undergoing preoperative nTMS (2010–2014) and matched these patients with 70 HGG patients who did not undergo preoperative nTMS (2007–2010). Results On average, the overall size of the craniotomy was significantly smaller for nTMS patients when compared to the non-nTMS group (nTMS: 25.3 ± 9.7 cm2; non-nTMS: 30.8 ± 13.2 cm2; p = 0.0058). Furthermore, residual tumor tissue (nTMS: 34.3%; non-nTMS: 54.3%; p = 0.0172) and unexpected tumor residuals (nTMS: 15.7%; non-nTMS: 32.9%; p = 0.0180) were less frequent in nTMS patients. Regarding the further clinical course, median inpatient stay was 12 days for the nTMS and 14 days for the non-nTMS group (nTMS: CI 10.5 – 13.5 days; non-nTMS: CI 11.6 – 16.4 days; p = 0.0446). 60.0% of patients of the nTMS group and 54.3% of patients of the non-nTMS group were eligible for postoperative chemotherapy (OR 1.2630, CI 0.6458 – 2.4710, p = 0.4945), while 67.1% of nTMS patients and 48.6% of non-nTMS patients received radiotherapy (OR 2.1640, CI 1.0910 – 4.2910, p = 0.0261). Moreover, 3, 6, and 9 months survival was significantly better in the nTMS group (p = 0.0298, p = 0.0015, and p = 0.0167). Conclusions With the limitations of this study in mind, our data show that HGG patients might benefit from preoperative nTMS mapping.
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Affiliation(s)
- Sandro M Krieg
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany. .,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Nico Sollmann
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany. .,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany. .,Section of Neuroradiology, Department of Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Thomas Obermueller
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany. .,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Jamil Sabih
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany. .,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Lucia Bulubas
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany. .,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Chiara Negwer
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Tobias Moser
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany. .,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Doris Droese
- Department of Anesthesiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, München, 81675, Germany.
| | - Tobias Boeckh-Behrens
- Section of Neuroradiology, Department of Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Florian Ringel
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
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Stippich C, Blatow M, Garcia M. Task-Based Presurgical Functional MRI in Patients with Brain Tumors. CLINICAL FUNCTIONAL MRI 2015. [DOI: 10.1007/978-3-662-45123-6_4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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76
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Niu C, Zhang M, Min Z, Rana N, Zhang Q, Liu X, Li M, Lin P. Motor network plasticity and low-frequency oscillations abnormalities in patients with brain gliomas: a functional MRI study. PLoS One 2014; 9:e96850. [PMID: 24806463 PMCID: PMC4013133 DOI: 10.1371/journal.pone.0096850] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 04/09/2014] [Indexed: 11/18/2022] Open
Abstract
Brain plasticity is often associated with the process of slow-growing tumor formation, which remodels neural organization and optimizes brain network function. In this study, we aimed to investigate whether motor function plasticity would display deficits in patients with slow-growing brain tumors located in or near motor areas, but who were without motor neurological deficits. We used resting-state functional magnetic resonance imaging to probe motor networks in 15 patients with histopathologically confirmed brain gliomas and 15 age-matched healthy controls. All subjects performed a motor task to help identify individual motor activity in the bilateral primary motor cortex (PMC) and supplementary motor area (SMA). Frequency-based analysis at three different frequencies was then used to investigate possible alterations in the power spectral density (PSD) of low-frequency oscillations. For each group, the average PSD was determined for each brain region and a nonparametric test was performed to determine the difference in power between the two groups. Significantly reduced inter-hemispheric functional connectivity between the left and right PMC was observed in patients compared with controls (P<0.05). We also found significantly decreased PSD in patients compared to that in controls, in all three frequency bands (low: 0.01-0.02 Hz; middle: 0.02-0.06 Hz; and high: 0.06-0.1 Hz), at three key motor regions. These findings suggest that in asymptomatic patients with brain tumors located in eloquent regions, inter-hemispheric connection may be more vulnerable. A comparison of the two approaches indicated that power spectral analysis is more sensitive than functional connectivity analysis for identifying the neurological abnormalities underlying motor function plasticity induced by slow-growing tumors.
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Affiliation(s)
- Chen Niu
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi-Province, P. R. China
| | - Ming Zhang
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi-Province, P. R. China
| | - Zhigang Min
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi-Province, P. R. China
| | - Netra Rana
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi-Province, P. R. China
| | - Qiuli Zhang
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi-Province, P. R. China
| | - Xin Liu
- Institute of Biomedical Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi-Province, P.R. China
| | - Min Li
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi-Province, P. R. China
| | - Pan Lin
- Institute of Biomedical Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi-Province, P.R. China
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77
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Pillai JJ, Mikulis DJ. Cerebrovascular reactivity mapping: an evolving standard for clinical functional imaging. AJNR Am J Neuroradiol 2014; 36:7-13. [PMID: 24788129 DOI: 10.3174/ajnr.a3941] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
SUMMARY This review article explains the methodology of breath-hold cerebrovascular reactivity mapping, both in terms of acquisition and analysis, and reviews applications of this method to presurgical mapping, particularly with respect to blood oxygen level-dependent fMRI. Its main application in clinical fMRI is for the assessment of neurovascular uncoupling potential. Neurovascular uncoupling is potentially a major limitation of clinical fMRI, particularly in the setting of mass lesions in the brain such as brain tumors and intracranial vascular malformations that are associated with alterations in regional hemodynamics on either an acquired or congenital basis. As such, breath-hold cerebrovascular reactivity mapping constitutes an essential component of quality control analysis in clinical fMRI, particularly when performed for presurgical mapping of eloquent cortex. Exogenous carbon dioxide challenges used for cerebrovascular reactivity mapping will also be discussed, and their applications to the evaluation of cerebrovascular reserve and cerebrovascular disease will be described.
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Affiliation(s)
- J J Pillai
- From the Division of Neuroradiology (J.J.P.), Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - D J Mikulis
- Department of Medical Imaging (D.J.M.), The University of Toronto, The University Health Network, The Toronto Western Hospital, Toronto, Ontario, Canada
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Hayashi Y, Nakada M, Kinoshita M, Hamada JI. Surgical strategies for nonenhancing slow-growing gliomas with special reference to functional reorganization: review with own experience. Neurol Med Chir (Tokyo) 2014; 53:438-46. [PMID: 23883554 DOI: 10.2176/nmc.53.438] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Nonenhancing intrinsic brain tumors have been empirically treated with a strategy that has been adopted for World Health Organization (WHO) grade II gliomas (low-grade gliomas: LGGs), even though small parts of the tumors might have been diagnosed as WHO grade III gliomas after surgery. However, the best surgical strategy for nonenhancing gliomas, including LGGs, is still debatable. LGGs have the following features: slow growth, high possibility of histologically malignant transformation, and no clear border between the tumor and adjacent normal brain. We retrospectively examined 26 consecutive patients with nonenhancing gliomas who were surgically treated at Kanazawa University Hospital between January 2006 and May 2012, with special reference to functional reorganization, extent of resection (EOR), and functional mapping during awake surgery. These categories are closely related with the features of LGG, i.e. functional reorganization due to slow-growing nature, EOR with related malignant transformation, and functional mapping for delineating the unclear tumor border. Finally, we discuss surgical strategies for slow-growing gliomas that are represented by LGGs and nonenhancing gliomas. In conclusion, slow-growing gliomas tend to undergo functional reorganization, and the functional reorganization affects the presurgical evaluation for resectability based on tumor location related to eloquence. In the clinical setting, to definitely identify the reorganized functional regions, awake surgery is recommended. Therefore, awake surgery could increase the extent of the resection of the tumor without deficits, resulting in the delay of malignant transformation and increase in overall survival.
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Affiliation(s)
- Yutaka Hayashi
- Department of Neurosurgery, Kanazawa University, Kanazama, Ishikawa, Japan.
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Serres S, Martin CJ, Sarmiento Soto M, Bristow C, O'Brien ER, Connell JJ, Khrapitchev AA, Sibson NR. Structural and functional effects of metastases in rat brain determined by multimodal MRI. Int J Cancer 2014; 134:885-96. [PMID: 23913394 DOI: 10.1002/ijc.28406] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 07/10/2013] [Accepted: 07/18/2013] [Indexed: 01/04/2023]
Abstract
Metastasis to the brain results in significant impairment of brain function and poor patient survival. Currently, magnetic resonance imaging (MRI) is under-utilised in monitoring brain metastases and their effects on brain function. Here, we sought to establish a model of focal brain metastasis in the rat that enables serial multimodal structural and functional MRI studies, and to assess the sensitivity of these approaches to metastatic growth. Female Berlin-Druckrey-IX rats were injected intracerebrally with metastatic ENU1564 cells in the ventroposterior medial nucleus (VPM) of the thalamus, a relay node of the whisker-to-barrel cortex pathway. Animals underwent multimodal structural and vascular MRI, as well as functional MRI of the cortical blood oxygenation level dependent (BOLD) responses to whisker pad stimulation. T2 , diffusion, magnetisation transfer and perfusion weighted MRI enabled differentiation between a central area of more advanced metastatic growth and penumbral regions of co-optive perivascular micrometastatic growth, with magnetisation transfer MRI being the most sensitive to micrometastatic growth. Areas of cortical BOLD activation in response to whisker pad stimulation were significantly reduced in the hemisphere containing metastases in the VPM. The reduction in BOLD response correlated with metastatic burden in the thalamus, and was sensitive to the presence of smaller metastases than currently detectable clinically. Our findings suggest that multimodal MRI provides greater sensitivity to tumour heterogeneity and micrometastatic growth than single modality contrast-enhanced MRI. Understanding the relationships between these MRI parameters and the underlying pathology may greatly enhance the utility of MRI in diagnosis, staging and monitoring of brain metastasis.
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Affiliation(s)
- Sébastien Serres
- CR-UK/MRC Gray Institute for Radiation Oncology and Biology, Department of Oncology, University of Oxford, Churchill Hospital, Oxford, OX3 7LJ, United Kingdom
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80
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Krieg SM, Sabih J, Bulubasova L, Obermueller T, Negwer C, Janssen I, Shiban E, Meyer B, Ringel F. Preoperative motor mapping by navigated transcranial magnetic brain stimulation improves outcome for motor eloquent lesions. Neuro Oncol 2014; 16:1274-82. [PMID: 24516237 DOI: 10.1093/neuonc/nou007] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Navigated transcranial magnetic stimulation (nTMS) has been proven to influence surgical indication and planning. Yet there is still no clear evidence how these additional preoperative functional data influence the clinical course and outcome. Thus, this study aimed to compare patients with motor eloquently located supratentorial lesions investigated with or without preoperative nTMS in terms of clinical outcome parameters. METHODS A prospectively enrolled cohort of 100 patients with supratentorial lesions located in motor eloquent areas was investigated by preoperative nTMS (2010-2013) and matched with a control of 100 patients who were operated on without nTMS data (2006-2010) by a matched pair analysis. RESULTS Patients in the nTMS group showed a significantly lower rate of residual tumor on postoperative MRI (OR 0.3828; 95% CI 0.2062-0.7107). Twelve percent of patients in the nTMS and 1% of patients in the non-nTMS group improved while 75% and 81% of the nTMS and non-nTMS groups, respectively, remained unchanged and 13% and 18% of patients in the nTMS and non-nTMS groups, respectively, deteriorated in postoperative motor function on long-term follow-up (P = .0057). Moreover, the nTMS group showed smaller craniotomies (nTMS 22.4 ± 8.3 cm(2); non-nTMS 26.7 ± 11.3 cm(2); P = .0023). CONCLUSIONS This work increases the level of evidence for preoperative motor mapping by nTMS for rolandic lesions in a group comparison study. We therefore strongly advocate nTMS to become increasingly used for these lesions. However, a randomized trial on the comparison with the gold standard of intraoperative mapping seems mandatory.
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Affiliation(s)
- Sandro M Krieg
- Department of Neurosurgery (S.M.K., J.S., L.B., T.O., C.N., I.J., E.S., B.M., F.R.); TUM-Neuroimaging Center, Klinikum rechts der Isar, TU München, Germany (S.M.K., J.S., L.B., T.O.)
| | - Jamil Sabih
- Department of Neurosurgery (S.M.K., J.S., L.B., T.O., C.N., I.J., E.S., B.M., F.R.); TUM-Neuroimaging Center, Klinikum rechts der Isar, TU München, Germany (S.M.K., J.S., L.B., T.O.)
| | - Lucia Bulubasova
- Department of Neurosurgery (S.M.K., J.S., L.B., T.O., C.N., I.J., E.S., B.M., F.R.); TUM-Neuroimaging Center, Klinikum rechts der Isar, TU München, Germany (S.M.K., J.S., L.B., T.O.)
| | - Thomas Obermueller
- Department of Neurosurgery (S.M.K., J.S., L.B., T.O., C.N., I.J., E.S., B.M., F.R.); TUM-Neuroimaging Center, Klinikum rechts der Isar, TU München, Germany (S.M.K., J.S., L.B., T.O.)
| | - Chiara Negwer
- Department of Neurosurgery (S.M.K., J.S., L.B., T.O., C.N., I.J., E.S., B.M., F.R.); TUM-Neuroimaging Center, Klinikum rechts der Isar, TU München, Germany (S.M.K., J.S., L.B., T.O.)
| | - Insa Janssen
- Department of Neurosurgery (S.M.K., J.S., L.B., T.O., C.N., I.J., E.S., B.M., F.R.); TUM-Neuroimaging Center, Klinikum rechts der Isar, TU München, Germany (S.M.K., J.S., L.B., T.O.)
| | - Ehab Shiban
- Department of Neurosurgery (S.M.K., J.S., L.B., T.O., C.N., I.J., E.S., B.M., F.R.); TUM-Neuroimaging Center, Klinikum rechts der Isar, TU München, Germany (S.M.K., J.S., L.B., T.O.)
| | - Bernhard Meyer
- Department of Neurosurgery (S.M.K., J.S., L.B., T.O., C.N., I.J., E.S., B.M., F.R.); TUM-Neuroimaging Center, Klinikum rechts der Isar, TU München, Germany (S.M.K., J.S., L.B., T.O.)
| | - Florian Ringel
- Department of Neurosurgery (S.M.K., J.S., L.B., T.O., C.N., I.J., E.S., B.M., F.R.); TUM-Neuroimaging Center, Klinikum rechts der Isar, TU München, Germany (S.M.K., J.S., L.B., T.O.)
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Affiliation(s)
- Tim Wehner
- Department of Clinical Neurophysiology; National Hospital for Neurology and Neurosurgery; London United Kingdom
- Department of Clinical and Experimental Epilepsy; Institute of Neurology; University College of London; London United Kingdom
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Zacà D, Jovicich J, Nadar SR, Voyvodic JT, Pillai JJ. Cerebrovascular reactivity mapping in patients with low grade gliomas undergoing presurgical sensorimotor mapping with BOLD fMRI. J Magn Reson Imaging 2013; 40:383-90. [PMID: 24338845 DOI: 10.1002/jmri.24406] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 08/05/2013] [Indexed: 11/11/2022] Open
Abstract
PURPOSE (i) to validate blood oxygenation level dependent (BOLD) breathhold cerebrovascular reactivity (BH CVR) mapping as an effective technique for potential detection of neurovascular uncoupling (NVU) in a cohort of patients with perirolandic low grade gliomas undergoing presurgical functional MRI (fMRI) for sensorimotor mapping, and (ii) to determine whether NVU potential, as assessed by BH CVR mapping, is prevalent in this tumor group. MATERIALS AND METHODS We retrospectively evaluated 12 patients, with histological diagnosis of grade II glioma, who performed multiple motor tasks and a BH task. Sensorimotor activation maps and BH CVR maps were compared in two automatically defined regions of interest (ROIs), ipsilateral to the lesion (i.e., ipsilesional) and contralateral to the lesion (i.e., contralesional). RESULTS Motor task mean T-value was significantly higher in the contralesional ROIs (6.00 ± 1.74 versus 4.34 ± 1.68; P = 0.00004) as well as the BH mean T-value (4.74 ± 2.30 versus 4.09 ± 2.50; P = 0.009). The number of active voxels was significantly higher in the contralesional ROIs (Z = 2.99; P = 0.03). Actual NVU prevalence was 75%. CONCLUSION Presurgical sensorimotor fMRI mapping can be affected by NVU-related false negative activation in low grade gliomas (76% of analyzed tasks).
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Affiliation(s)
- Domenico Zacà
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Center for Mind/Brain Sciences, University of Trento, Italy
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83
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Posse S, Ackley E, Mutihac R, Zhang T, Hummatov R, Akhtari M, Chohan M, Fisch B, Yonas H. High-speed real-time resting-state FMRI using multi-slab echo-volumar imaging. Front Hum Neurosci 2013; 7:479. [PMID: 23986677 PMCID: PMC3752525 DOI: 10.3389/fnhum.2013.00479] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 07/29/2013] [Indexed: 11/21/2022] Open
Abstract
We recently demonstrated that ultra-high-speed real-time fMRI using multi-slab echo-volumar imaging (MEVI) significantly increases sensitivity for mapping task-related activation and resting-state networks (RSNs) compared to echo-planar imaging (Posse et al., 2012). In the present study we characterize the sensitivity of MEVI for mapping RSN connectivity dynamics, comparing independent component analysis (ICA) and a novel seed-based connectivity analysis (SBCA) that combines sliding-window correlation analysis with meta-statistics. This SBCA approach is shown to minimize the effects of confounds, such as movement, and CSF and white matter signal changes, and enables real-time monitoring of RSN dynamics at time scales of tens of seconds. We demonstrate highly sensitive mapping of eloquent cortex in the vicinity of brain tumors and arterio-venous malformations, and detection of abnormal resting-state connectivity in epilepsy. In patients with motor impairment, resting-state fMRI provided focal localization of sensorimotor cortex compared with more diffuse activation in task-based fMRI. The fast acquisition speed of MEVI enabled segregation of cardiac-related signal pulsation using ICA, which revealed distinct regional differences in pulsation amplitude and waveform, elevated signal pulsation in patients with arterio-venous malformations and a trend toward reduced pulsatility in gray matter of patients compared with healthy controls. Mapping cardiac pulsation in cortical gray matter may carry important functional information that distinguishes healthy from diseased tissue vasculature. This novel fMRI methodology is particularly promising for mapping eloquent cortex in patients with neurological disease, having variable degree of cooperation in task-based fMRI. In conclusion, ultra-high-real-time speed fMRI enhances the sensitivity of mapping the dynamics of resting-state connectivity and cerebro-vascular pulsatility for clinical and neuroscience research applications.
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Affiliation(s)
- Stefan Posse
- Department of Neurology, School of Medicine, The University of New Mexico, Albuquerque, NM, USA
- Department of Electrical and Computer Engineering, The University of New Mexico, Albuquerque, NM, USA
- Department of Physics and Astronomy, The University of New Mexico, Albuquerque, NM, USA
| | - Elena Ackley
- Department of Neurology, School of Medicine, The University of New Mexico, Albuquerque, NM, USA
| | - Radu Mutihac
- Department of Physics, University of Bucharest, Bucharest, Romania
- Division of Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Tongsheng Zhang
- Department of Neurology, School of Medicine, The University of New Mexico, Albuquerque, NM, USA
| | - Ruslan Hummatov
- Department of Physics and Astronomy, The University of New Mexico, Albuquerque, NM, USA
| | - Massoud Akhtari
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
| | - Muhammad Chohan
- Department of Neurosurgery, School of Medicine, The University of New Mexico, Albuquerque, NM, USA
| | - Bruce Fisch
- Department of Neurology, School of Medicine, The University of New Mexico, Albuquerque, NM, USA
| | - Howard Yonas
- Department of Neurosurgery, School of Medicine, The University of New Mexico, Albuquerque, NM, USA
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Wang L, Chen D, Yang X, Olson JJ, Gopinath K, Fan T, Mao H. Group independent component analysis and functional MRI examination of changes in language areas associated with brain tumors at different locations. PLoS One 2013; 8:e59657. [PMID: 23555736 PMCID: PMC3608667 DOI: 10.1371/journal.pone.0059657] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 02/19/2013] [Indexed: 01/07/2023] Open
Abstract
Object This study investigates the effect of tumor location on alterations of language network by brain tumors at different locations using blood oxygenation level dependent (BOLD) fMRI and group independent component analysis (ICA). Subjects and Methods BOLD fMRI data were obtained from 43 right handed brain tumor patients. Presurgical mapping of language areas was performed on all 43 patients with a picture naming task. All data were retrospectively analyzed using group ICA. Patents were divided into three groups based on tumor locations, i.e., left frontal region, left temporal region or right hemisphere. Laterality index (LI) was used to assess language lateralization in each group. Results The results from BOLD fMRI and ICA revealed the different language activation patterns in patients with brain tumors located in different brain regions. Language areas, such as Broca’s and Wernicke’s areas, were intact in patients with tumors in the right hemisphere. Significant functional changes were observed in patients with tumor in the left frontal and temporal areas. More specifically, the tumors in the left frontal region affect both Broca’s and Wernicke’s areas, while tumors in the left temporal lobe affect mainly Wernicke’s area. The compensated activation increase was observed in the right frontal areas in patients with left hemisphere tumors. Conclusion Group ICA provides a model free alternative approach for mapping functional networks in brain tumor patients. Altered language activation by different tumor locations suggested reorganization of language functions in brain tumor patients and may help better understanding of the language plasticity.
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Affiliation(s)
- Liya Wang
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Center for Systems Imaging, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Department of Radiology, Baoan Hospital, Shenzhen, Guangdong, China
| | - Dandan Chen
- Department of Physics, Emory University, Atlanta, Georgia, United States of America
| | - Xiaofeng Yang
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Center for Systems Imaging, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Jeffrey J. Olson
- Department of Neurosurgery, Emory University School of Medicine, Georgia, United States of America
| | - Kaundinya Gopinath
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Center for Systems Imaging, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Tianning Fan
- Center for Systems Imaging, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Hui Mao
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Center for Systems Imaging, Emory University School of Medicine, Atlanta, Georgia, United States of America
- * E-mail:
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Belyaev AS, Peck KK, Brennan NMP, Holodny AI. Clinical applications of functional MR imaging. Magn Reson Imaging Clin N Am 2013; 21:269-78. [PMID: 23642553 DOI: 10.1016/j.mric.2012.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Functional magnetic resonance (fMR) imaging for neurosurgical planning has become the standard of care in centers where it is available. Although paradigms to measure eloquent cortices are not yet standardized, simple tasks elicit reliable maps for planning neurosurgical procedures. A patient-specific paradigm design will refine the usability of fMR imaging for prognostication and recovery of function. Certain pathologic conditions and technical issues limit the interpretation of fMR imaging maps in clinical use and should be considered carefully. However, fMR imaging for neurosurgical planning continues to provide insights into how the brain works and how it responds to pathologic insults.
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Affiliation(s)
- Artem S Belyaev
- Functional MRI Laboratory, Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
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86
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Krieg SM, Shiban E, Buchmann N, Meyer B, Ringel F. Presurgical navigated transcranial magnetic brain stimulation for recurrent gliomas in motor eloquent areas. Clin Neurophysiol 2013; 124:522-7. [DOI: 10.1016/j.clinph.2012.08.011] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 08/05/2012] [Accepted: 08/09/2012] [Indexed: 11/26/2022]
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Tozakidou M, Wenz H, Reinhardt J, Nennig E, Riffel K, Blatow M, Stippich C. Primary motor cortex activation and lateralization in patients with tumors of the central region. NEUROIMAGE-CLINICAL 2013; 2:221-8. [PMID: 24179775 PMCID: PMC3777836 DOI: 10.1016/j.nicl.2013.01.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 12/23/2012] [Accepted: 01/08/2013] [Indexed: 11/25/2022]
Abstract
Hemispheric lateralization is a frequently encountered phenomenon of cortical function. It describes the functional specialization of a region on one side of the brain for a given task. It is well characterized in motor and sensory, as well as language systems and becomes more and more known for various cognitive domains. While in the adult healthy brain hemispheric lateralization is mostly set, pathological processes may lead to cortical reorganization. In these cases neuroplasticity of the corresponding region in the non-dominant hemisphere seems to play an important role. In a previous study we investigated language associated regions in right-handed patients with frontal and temporal tumors of the left hemisphere. We observed a marked change of language lateralization in these patients towards the non-dominant hemisphere as measured by functional MRI (Partovi et al., 2012). In the present study we evaluated activation and lateralization of cortical motor areas in patients with tumors of the central region. BOLD fMRI was performed during unilateral voluntary movements of the contralesional hand in 87 patients. Individual correlations of measured BOLD-signals with the model hemodynamic reference function were determined on a ROI basis in single subjects and compared to those of 16 healthy volunteers. In volunteers the strongest activation is usually found in the M1 hand representation contralateral to the movement, while a weaker homotopic co-activation is observed in ipsilateral M1 (Stippich et al., 2007a). In the patient group our results show significant changes of motor activations, ranging from a reduction of M1 lateralization to equalization of M1 activations or even inversion of M1 lateralization during contralesional movements. This study corroborates in a large patient group the idea that lesions affecting M1 may lead to functional reorganization of cortical motor systems and in particular equalize hemispheric lateralization. However, it is not yet clear whether these changes are only an epiphenomenon or indeed reflect an attempt of recovery of brain function.
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Affiliation(s)
- Magdalini Tozakidou
- Division of Diagnostic and Interventional Neuroradiology, Department of Radiology and Nuclear Medicine, University Hospital of Basel, Basel, Switzerland
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Mangraviti A, Casali C, Cordella R, Legnani FG, Mattei L, Prada F, Saladino A, Contarino VE, Perin A, DiMeco F. Practical assessment of preoperative functional mapping techniques: navigated transcranial magnetic stimulation and functional magnetic resonance imaging. Neurol Sci 2012; 34:1551-7. [PMID: 23266868 DOI: 10.1007/s10072-012-1283-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Accepted: 12/17/2012] [Indexed: 11/30/2022]
Abstract
Preoperative brain mapping is vital to improve the outcome of patients with tumors located in eloquent areas. While functional magnetic resonance imaging (fMRI) remains the most commonly used preoperative mapping technique, navigated transcranial magnetic stimulation (nTMS) has recently been proposed as a new preoperative method for the clinical and surgical management of such patients. This study aims at evaluating the impact of nTMS as a routine examination and its ultimate contribution to patient outcome. We performed a preliminary prospective study on eight patients harboring a cerebral lesion in eloquent motor areas. Each patient underwent preoperative cortical brain mapping via both fMRI and nTMS; then, we assessed the reliability of both methods by comparing them with intraoperative mapping by direct cortical stimulation (DCS). This study suggests that nTMS was more accurate than fMRI in detecting the true cortical motor area when compared with DCS data, with a mean of deviation ± confidence interval (CI) of 8.47 ± 4.6 mm between nTMS and DCS and of 12.9 ± 5.7 mm between fMRI and DCS (p < 0.05). The results indicated that within the limits of our statistical sample, nTMS was found to be a useful, reliable, and non-invasive option for preoperative planning as well as for the identification of the motor strip; in addition, it usually has short processing times and is very well tolerated by patients, thereby increasing their compliance and possibly improving surgical outcome.
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89
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Dimou S, Battisti RA, Hermens DF, Lagopoulos J. A systematic review of functional magnetic resonance imaging and diffusion tensor imaging modalities used in presurgical planning of brain tumour resection. Neurosurg Rev 2012. [PMID: 23187966 DOI: 10.1007/s10143-012-0436-8] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Historically, brain tumour resection has relied upon standardised anatomical atlases and classical mapping techniques for successful resection. While these have provided adequate results in the past, the emergence of new technologies has heralded a wave of less invasive, patient-specific techniques for the mapping of brain function. Functional magnetic resonance imaging (fMRI) and, more recently, diffusion tensor imaging (DTI) are two such techniques. While fMRI is able to highlight localisation of function within the cortex, DTI represents the only technique able to elucidate white matter structures in vivo. Used in conjunction, both of these techniques provide important presurgical information for thorough preoperative planning, as well as intraoperatively via integration into frameless stereotactic neuronavigational systems. Together, these techniques show great promise for improved neurosurgical outcomes. While further research is required for more widespread clinical validity and acceptance, results from the literature provide a clear road map for future research and development to cement these techniques into the clinical setup of neurosurgical departments globally.
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Affiliation(s)
- S Dimou
- The Brain and Mind Research Institute, The University of Sydney, 94 Mallet Street, Camperdown, NSW, Australia
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Wang L, Chen D, Olson J, Ali S, Fan T, Mao H. Re-examine tumor-induced alterations in hemodynamic responses of BOLD fMRI: implications in presurgical brain mapping. Acta Radiol 2012; 53:802-11. [PMID: 22850572 DOI: 10.1258/ar.2012.120118] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Blood oxygenation level dependent (BOLD) fMRI is used for presurgical functional mapping of brain tumor patients. Abnormal tumor blood supply may affect hemodynamic responses and BOLD fMRI signals. PURPOSE To perform a multivariate and quantitative investigation of the effect of brain tumors on the hemodynamic responses and its impact on BOLD MRI signal time course, data analysis in order to better understand tumor-induced alterations in hemodynamic responses, and accurately mapping cortical regions in brain tumor patients. MATERIAL AND METHODS BOLD fMRI data from 42 glioma patients who underwent presurgical mapping of the primary motor cortex (PMC) with a block designed finger tapping paradigm were analyzed, retrospectively. Cases were divided into high grade (n = 24) and low grade (n = 18) groups based on pathology. The tumor volume and distance to the activated PMCs were measured. BOLD signal time courses from selected regions of interest (ROIs) in the PMCs of tumor affected and contralateral unaffected hemispheres were obtained from each patient. Tumor-induced changes of BOLD signal intensity and time to peak (TTP) of BOLD signal time courses were analyzed statistically. RESULTS The BOLD signal intensity and TTP in the tumor-affected PMCs are altered when compared to that of the unaffected hemisphere. The average BOLD signal level is statistically significant lower in the affected PMCs. The average TTP in the affected PMCs is shorter in the high grade group, but longer in the low grade tumor group compared to the contralateral unaffected hemisphere. Degrees of alterations in BOLD signal time courses are related to both the distance to activated foci and tumor volume with the stronger effect in tumor distance to activated PMC. CONCLUSION Alterations in BOLD signal time courses are strongly related to the tumor grade, the tumor volume, and the distance to the activated foci. Such alterations may impair accurate mapping of tumor-affected functional areas when using conventional fixed models.
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Affiliation(s)
- Liya Wang
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Radiology, Baoan Hospital, Shenzhen, Guangdong, China
| | - Dandan Chen
- Department of Physics, Emory University, Atlanta, Georgia, USA
- School of Radiation Medicine & Protection, Soochow University, Suzhou, China
| | - Jeffrey Olson
- Department of Neurosurgery, Emory University School of Medicine, Georgia, USA
| | - Shazia Ali
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Tianning Fan
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Hui Mao
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
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Abstract
First described for use in mapping the human visual cortex in 1991, functional magnetic resonance imaging (fMRI) is based on blood-oxygen level dependent (BOLD) changes in cortical regions that occur during specific tasks. Typically, an overabundance of oxygenated (arterial) blood is supplied during activation of brain areas. Consequently, the venous outflow from the activated areas contains a higher concentration of oxyhemoglobin, which changes the paramagnetic properties of the tissue that can be detected during a T2-star acquisition. fMRI data can be acquired in response to specific tasks or in the resting state. fMRI has been widely applied to studying physiologic and pathophysiologic diseases of the brain. This review will discuss the most common current clinical applications of fMRI as well as emerging directions.
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Affiliation(s)
- Daniel A Orringer
- Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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93
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Zacà D, Nickerson JP, Deib G, Pillai JJ. Effectiveness of four different clinical fMRI paradigms for preoperative regional determination of language lateralization in patients with brain tumors. Neuroradiology 2012; 54:1015-25. [PMID: 22744798 DOI: 10.1007/s00234-012-1056-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Accepted: 06/12/2012] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Blood oxygen level-dependent functional magnetic resonance imaging (fMRI) has demonstrated its capability to provide comparable results to gold standard intracarotid sodium amobarbital (Wada) testing for preoperative determination of language hemispheric dominance. However, thus far, no consensus has been established regarding which fMRI paradigms are the most effective for the determination of hemispheric language lateralization in specific categories of patients and specific regions of interest (ROIs). METHODS Forty-one brain tumor patients who performed four different language tasks-rhyming (R), silent word generation (SWG) sentence completion, and sentence listening comprehension (LC)-for presurgical language mapping by fMRI were included in this study. A statistical threshold-independent lateralization index (LI) was calculated and compared among the paradigms in four different ROIs for language activation: functional Broca's (BA) and Wernicke's areas (WA) as well as larger anatomically defined expressive (EA) and receptive (RA) areas. RESULTS The two expressive paradigms evaluated in this study are very good lateralizing tasks in expressive language areas; specifically, a significantly higher mean LI value was noted for SWG (0.36 ± 0.25) compared to LC (0.16 ± 0.24, p = 0.009) and for R (0.40 ± 0.22) compared to LC (0.16 ± 0.24, p = 0.001) in BA. SWG LI (0.28 ± 0.19) was higher than LC LI (0.12 ± 0.16, p = 0.01) also in EA. No significant differences in LI were found among these paradigms in WA or RA. CONCLUSIONS SWG and R are sufficient for the determination of lateralization in expressive language areas, whereas new semantic or receptive paradigms need to be designed for an improved assessment of lateralization in receptive language areas.
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Affiliation(s)
- Domenico Zacà
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine & The Johns Hopkins Hospital, 600 N. Wolfe Street, Phipps B-100, Baltimore, MD 21287, USA
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Krieg SM, Shiban E, Buchmann N, Gempt J, Foerschler A, Meyer B, Ringel F. Utility of presurgical navigated transcranial magnetic brain stimulation for the resection of tumors in eloquent motor areas. J Neurosurg 2012; 116:994-1001. [DOI: 10.3171/2011.12.jns111524] [Citation(s) in RCA: 164] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Navigated transcranial magnetic stimulation (nTMS) is a newly evolving technique. Despite its supposed purpose (for example, preoperative central region mapping), little is known about its accuracy compared with established modalities like direct cortical stimulation (DCS) and functional MR (fMR) imaging. Against this background, the authors performed the current study to compare the accuracy of nTMS with DCS and fMR imaging.
Methods
Fourteen patients with tumors in or close to the precentral gyrus were examined using nTMS for motor cortex mapping, as were 12 patients with lesions in the subcortical white matter motor tract. Moreover, preoperative fMR imaging and intraoperative mapping of the motor cortex were performed via DCS, and the outlining of the motor cortex was compared.
Results
In the 14 cases of lesions affecting the precentral gyrus, the primary motor cortex as outlined by nTMS correlated well with that delineated by intraoperative DCS mapping, with a deviation of 4.4 ± 3.4 mm between the two methods. In comparing nTMS with fMR imaging, the deviation between the two methods was much larger: 9.8 ± 8.5 mm for the upper extremity and 14.7 ± 12.4 mm for the lower extremity. In 13 of 14 cases, the surgeon admitted easier identification of the central region because of nTMS. The procedure had a subjectively positive influence on the operative results in 5 cases and was responsible for a changed resection strategy in 2 cases. One of 26 patients experienced nTMS as unpleasant; none found it painful.
Conclusions
Navigated TMS correlates well with DCS as a gold standard despite factors that are supposed to contribute to the inaccuracy of nTMS. Moreover, surgeons have found nTMS to be an additional and helpful modality during the resection of tumors affecting eloquent motor areas, as well as during preoperative planning.
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Affiliation(s)
| | | | | | | | - Annette Foerschler
- 2Section of Neuroradiology, Department of Radiology, Klinikum rechts der Isar, Technische Universität München, Germany
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Pillai JJ, Zacà D. Comparison of BOLD cerebrovascular reactivity mapping and DSC MR perfusion imaging for prediction of neurovascular uncoupling potential in brain tumors. Technol Cancer Res Treat 2012; 11:361-74. [PMID: 22376130 DOI: 10.7785/tcrt.2012.500284] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The coupling mechanism between neuronal firing and cerebrovascular dilatation can be significantly compromised in cerebral diseases, making it difficult to identify eloquent cortical areas near or within resectable lesions by using Blood Oxygen Level Dependent (BOLD) fMRI. Several metabolic and vascular factors have been considered to account for this lesion-induced neurovascular uncoupling (NVU), but no imaging gold standard exists currently for the detection of NVU. However, it is critical in clinical fMRI studies to evaluate the risk of NVU because the presence of NVU may result in false negative activation that may result in inadvertent resection of eloquent cortex, resulting in permanent postoperative neurologic deficits. Although NVU results from a disruption of one or more components of a complex cellular and chemical neurovascular coupling cascade (NCC) MR imaging is only able to evaluate the final step in this NCC involving the ultimate cerebrovascular response. Since anything that impairs cerebrovascular reactivity (CVR) will necessarily result in NVU, regardless of its effect more proximally along the NCC, we can consider mapping of CVR as a surrogate marker of NVU potential. We hypothesized that BOLD breath-hold (BH) CVR mapping can serve as a better marker of NVU potential than T2* Dynamic Susceptibility Contrast gadolinium perfusion MR imaging, because the latter is known to only reflect NVU risk associated with high grade gliomas by determining elevated relative cerebral blood volume (rCBV) and relative cerebral blood flow (rCBF) related to tumor angiogenesis. However, since low and intermediate grade gliomas are not associated with such tumoral hyperperfusion, BOLD BH CVR mapping may be able to detect such NVU potential even in lower grade gliomas without angiogenesis, which is the hallmark of glioblastomas. However, it is also known that glioblastomas are associated with variable NVU, since angiogenesis may not always result in NVU. Perfusion metrics obtained by T2* gadolinium perfusion MR imaging were compared to BOLD percentage signal change on BH CVR maps in a group of 19 patients with intracranial brain tumors of different nature and grade. Single pixel maximum rCBV and rCBF within holotumoral regions of interest (i.e., "ipsilesional" ROIs) were normalized to contralateral hemispheric homologous (i.e., "contralesional") normal tissue. Furthermore, percentage signal change on BH CVR maps within ipsilesional ROIs were normalized to the percentage signal change within contralesional homologous ROIs. Inverse linear correlation was found between normalized rCBF (r(flow)) or rCBV (r(vol)) and normalized CVR percentage signal change (r(CVR)) in grade IV lesions. In the grade III lesions a less steep inverse linear trend was seen that did not reach statistical significance, whereas no correlation at all was seen in the grade II group. Statistically significant difference was present for r(flow) and r(vol) between the grade II and IV groups and between the grade III and IV groups but not for r(CVR). The r(CVR) was significantly lower than 1 in every group. Our results demonstrate that while T2*MR perfusion maps and CVR maps are both adequate to map tumoral regions at risk of NVU in high grade gliomas, CVR maps can detect areas of decreased CVR also in low and intermediate grade gliomas where NVU may be caused by factors other than tumor neovascularity alone. Comparison of areas of abnormally decreased regional CVR with areas of absent BOLD task-based activation in expected eloquent cortical regions infiltrated by or adjacent to the tumors revealed overall 95% concordance, thus confirming the capability of BH CVR mapping to effectively demonstrate areas of NVU. ed by factors other than tumor neovascularity alone. Comparison of areas of abnormally decreased regional CVR with areas of absent BOLD task-based activation in expected eloquent cortical regions infiltrated by or adjacent to the tumors revealed overall 95% concordance, thus confirming the capability of BH CVR mapping to effectively demonstrate areas of NVU.
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Affiliation(s)
- Jay J Pillai
- Neuroradiology Division, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine and The Johns Hopkins Hospital, Baltimore, MD, USA.
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Appel S, Duke ES, Martinez AR, Khan OI, Dustin IM, Reeves-Tyer P, Berl MB, Sato S, Gaillard WD, Theodore WH. Cerebral blood flow and fMRI BOLD auditory language activation in temporal lobe epilepsy. Epilepsia 2012; 53:631-8. [PMID: 22332720 DOI: 10.1111/j.1528-1167.2012.03403.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Blood oxygen level-dependent (BOLD) functional magnetic resonance imaging (fMRI), an important research and clinical tool, depends on relatively greater transient increases in (regional cerebral blood flow) rCBF than cerebral metabolic rate for oxygen during neural activity. We investigated whether reduced resting rCBF in patients with temporal lobe epilepsy affects BOLD signal during fMRI language mapping. METHODS We used [(15)O] water positron emission tomography (PET) to measure rCBF, and 3 Tesla echo planar imaging (EPI) BOLD fMRI with an auditory description decision task in 33 patients with temporal lobe epilepsy (16 men; mean age 33.6 ± standard deviation [SD] 10.6 years; epilepsy onset 14.8 ± 10.6 years; mean duration 18.8 ± 13.2 years; 23 left focus, 10 right focus). Anatomic regions drawn on structural MRI, based on the Wake Forest Pick Atlas, included Wernicke's area (WA), inferior frontal gyrus (IFG), middle frontal gyrus (MFG), and hippocampus (HC). Laterality indices (LIs), and asymmetry indices (AIs), were calculated on coregistered fMRI and PET. KEY FINDINGS Twelve patients had mesial temporal sclerosis (seven on the left), two patients had a tumor or malformation of cortical development (both left), one patient a right temporal cyst, and 18 patients had normal MRI (14 left). Decreasing relative left WA CBF correlated with decreased left IFG voxel activation and decreasing left IFG LI. However, CBF WA AI was not related to left WA voxel activation itself or WA LI. There was a weak positive correlation between absolute CBF and fMRI activation in left IFG, right IFG, and left WA. Patients with normal and abnormal MRI did not differ in fMRI activation or rCBF AIs. SIGNIFICANCE Reduced WA rCBF is associated with reduced fMRI activation in IFG but not WA itself, suggesting distributed network effects, but not impairment of underlying BOLD response. Hypoperfusion in TLE does not affect fMRI clinical value.
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Affiliation(s)
- Shmuel Appel
- Clinical Epilepsy Section, NINDS NIH, Bethesda, Maryland 20892, USA
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The role of susceptibility weighted imaging in functional MRI. Neuroimage 2012; 62:923-9. [PMID: 22245649 DOI: 10.1016/j.neuroimage.2012.01.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 11/15/2011] [Accepted: 01/01/2012] [Indexed: 11/21/2022] Open
Abstract
The development of functional brain magnetic resonance imaging (fMRI) has been a boon for neuroscientists and radiologists alike. It provides for fundamental information on brain function and better diagnostic tools to study disease. In this paper, we will review some of the early concepts in high resolution gradient echo imaging with a particular emphasis on susceptibility weighted imaging (SWI) and MR angiography (MRA). We begin with the history of our own experience in this area, followed by a discussion of the role of high resolution in studying the vasculature of the brain and how this relates to the BOLD (blood oxygenation level dependent) signal. We introduce the role of SWI and susceptibility mapping (SWIM) in fMRI and close with recommendations for future high resolution experiments.
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Pillai JJ, Zacá D. Clinical utility of cerebrovascular reactivity mapping in patients with low grade gliomas. World J Clin Oncol 2011; 2:397-403. [PMID: 22171282 PMCID: PMC3235658 DOI: 10.5306/wjco.v2.i12.397] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Revised: 11/24/2011] [Accepted: 12/01/2011] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate neurovascular uncoupling (NVU) associated with low grade gliomas (LGG) using blood oxygen level dependent (BOLD) cerebrovascular reactivity mapping.
METHODS: Seven patients with low grade gliomas referred by neurosurgeons for presurgical mapping were included in this pilot study. Cerebrovascular reactivity (CVR) mapping was performed by acquiring BOLD images while patients performed a block-design breath-hold (BH) hypercapnia task. CVR mapping was expressed as BOLD percentage signal change (PSC) from baseline associated with performance of the BH hypercapnia task. Standard T2* Dynamic Susceptibility Contrast perfusion imaging was performed and relative cerebral blood volume (rCBV) and relative cerebral blood flow (rCBF) maps were generated. Structural T1 weighted MR images were also acquired. A correlation analysis between intratumoral normalized (via ratio with contralateral homologous regions) BOLD BH PSC [referred to as (nCVR)] and intratumoral normalized resting state rCBV (rCBF) values (i.e., nCBV and nCBF, respectively) was performed.
RESULTS: No significant correlation was seen between the normalized BOLD BH PSC (i.e., nCBV) and nCBV or nCBF. However, the average nCVR (median = 0.50, z = -2.28, P = 0.01) was significantly less than 1.0, indicating abnormally reduced vascular responses in the tumor regions relative to normal contralesional homologous regions, whereas the average nCBV (median = 0.94, z = -0.92, P = 0.375) and nCBF (median = 0.93, z = -1.16, P = 0.25) were not significantly higher or lower than 1.0, indicating iso-perfusion in the tumor regions relative to normal contralesional homologous regions. These findings suggest that in LGG, hyperperfusion that is seen in high grade gliomas is not present, but, nevertheless, abnormally decreased regional CVR is present within and adjacent to LGG. Since the patients all demonstrated at least some residual function attributable to the cortical regions of impaired CVR, but were incapable of producing a BOLD response in these regions regardless of the tasks performed, such regionally decreased CVR is indicative of NVU. The low nCVR ratios indicate high prevalence of NVU in this LGG cohort, which is an important consideration in the interpretation of clinical presurgical mapping with functional magnetic resonance (MR) imaging.
CONCLUSION: Our preliminary study shows that BH CVR mapping is clinically feasible and demonstrates an unexpectedly high prevalence of NVU in patients with LGG.
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Affiliation(s)
- Jay J Pillai
- Jay J Pillai, Domenico Zacá, Neuroradiology Division, Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins University, School of Medicine and The Johns Hopkins Hospital, 600 N. Wolfe Street, Phipps B-100, Baltimore, MD 21287, United States
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Bick AS, Mayer A, Levin N. From research to clinical practice: implementation of functional magnetic imaging and white matter tractography in the clinical environment. J Neurol Sci 2011; 312:158-65. [PMID: 21864850 DOI: 10.1016/j.jns.2011.07.040] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Revised: 06/16/2011] [Accepted: 07/22/2011] [Indexed: 01/23/2023]
Abstract
In the last two decades functional magnetic resonance imaging (fMRI) has dominated research in neuroscience. However, only recently has it taken the first steps in translation to the clinical field. In this paper we describe the advantages of fMRI and DTI and the possible benefits of implementing these methods in clinical practice. We review the current clinical usages of fMRI and DTI and discuss the challenges and difficulties of translating these methods to clinical use. The most common application today is in neurosurgery. fMRI and DTI are done preoperatively for brain tumor patients who are having tumors removed and for epilepsy patients who are candidates for temporal resection. Imaging results supply the neurosurgeon with essential information regarding possible functional damage and thereby aid both in planning and performing surgery. Scientific research suggests more promising potential implementations of fMRI and DTI in improving diagnosis and rehabilitation. These advanced imaging methods can be used for pre-symptomatic diagnosis, as a differentiating biomarker in the absence of anatomical measurements, and for identification of mental response in the absence of motor-sensory abilities. These methods can aid and direct rehabilitation by predicting the success of possible interventions and rehabilitation options and by supplying a measure for biofeedback. This review opens a window to the state of the art neuroimaging methods being implemented these days into the clinical practice and provides a glance to the future clinical possibilities of fMRI and DTI.
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Affiliation(s)
- Atira S Bick
- fMRI Lab, Neurology Department, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
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Zaca D, Hua J, Pillai JJ. Cerebrovascular reactivity mapping for brain tumor presurgical planning. World J Clin Oncol 2011; 2:289-98. [PMID: 21773079 PMCID: PMC3139032 DOI: 10.5306/wjco.v2.i7.289] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Revised: 06/23/2011] [Accepted: 06/30/2011] [Indexed: 02/06/2023] Open
Abstract
This article provides a review of Blood Oxygen Level Dependent functional magnetic resonance imaging (BOLD fMRI) applications for presurgical mapping in patients with brain tumors who are being considered for lesion resection. Initially, the physical principle of the BOLD effect is discussed, followed by a general overview of the aims of presurgical planning. Subsequently, a review of sensorimotor, language and visual paradigms that are typically utilized in clinical fMRI is provided, followed by a brief description of studies demonstrating the clinical impact of preoperative BOLD fMRI. After this thorough introduction to presurgical fMRI, a detailed explanation of the phenomenon of neurovascular uncoupling (NVU), a major limitation of fMRI, is provided, followed by a discussion of the different approaches taken for BOLD cerebrovascular reactivity (CVR) mapping, which is an effective method of detecting NVU. We then include one clinical case which demonstrates the value of CVR mapping in clinical preoperative fMRI interpretation. The paper then concludes with a brief review of applications of CVR mapping other than for presurgical mapping.
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Affiliation(s)
- Domenico Zaca
- Domenico Zaca, Jay J Pillai, Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine and The Johns Hopkins Hospital, Baltimore, MD 21287, United States
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