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Jalilianhasanpour R, Beheshtian E, Ryan D, Luna LP, Agarwal S, Pillai JJ, Sair HI, Gujar SK. Role of Functional Magnetic Resonance Imaging in the Presurgical Mapping of Brain Tumors. Radiol Clin North Am 2021; 59:377-393. [PMID: 33926684 DOI: 10.1016/j.rcl.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
When planning for brain tumor resection, a balance between maximizing resection and minimizing injury to eloquent brain parenchyma is paramount. The advent of blood oxygenation level-dependent functional magnetic resonance (fMR) imaging has allowed researchers and clinicians to reliably measure physiologic fluctuations in brain oxygenation related to neuronal activity with good spatial resolution. fMR imaging can offer a unique insight into preoperative planning for brain tumors by identifying eloquent areas of the brain affected or spared by the neoplasm. This article discusses the fMR imaging techniques and their applications in neurosurgical planning.
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Affiliation(s)
- Rozita Jalilianhasanpour
- Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Elham Beheshtian
- Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Daniel Ryan
- Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Licia P Luna
- Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Shruti Agarwal
- Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Jay J Pillai
- Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA; Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Haris I Sair
- Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA; The Malone Center for Engineering in Healthcare, The Whiting School of Engineering, Johns Hopkins University, 3400 North Charles Street, Baltimore, MD 21218, USA
| | - Sachin K Gujar
- Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA.
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McGlynn E, Nabaei V, Ren E, Galeote‐Checa G, Das R, Curia G, Heidari H. The Future of Neuroscience: Flexible and Wireless Implantable Neural Electronics. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2021; 8:2002693. [PMID: 34026431 PMCID: PMC8132070 DOI: 10.1002/advs.202002693] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 01/15/2021] [Indexed: 05/04/2023]
Abstract
Neurological diseases are a prevalent cause of global mortality and are of growing concern when considering an ageing global population. Traditional treatments are accompanied by serious side effects including repeated treatment sessions, invasive surgeries, or infections. For example, in the case of deep brain stimulation, large, stiff, and battery powered neural probes recruit thousands of neurons with each pulse, and can invoke a vigorous immune response. This paper presents challenges in engineering and neuroscience in developing miniaturized and biointegrated alternatives, in the form of microelectrode probes. Progress in design and topology of neural implants has shifted the goal post toward highly specific recording and stimulation, targeting small groups of neurons and reducing the foreign body response with biomimetic design principles. Implantable device design recommendations, fabrication techniques, and clinical evaluation of the impact flexible, integrated probes will have on the treatment of neurological disorders are provided in this report. The choice of biocompatible material dictates fabrication techniques as novel methods reduce the complexity of manufacture. Wireless power, the final hurdle to truly implantable neural interfaces, is discussed. These aspects are the driving force behind continued research: significant breakthroughs in any one of these areas will revolutionize the treatment of neurological disorders.
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Affiliation(s)
- Eve McGlynn
- Microelectronics LabJames Watt School of EngineeringUniversity of GlasgowGlasgowG12 8QQUnited Kingdom
| | - Vahid Nabaei
- Microelectronics LabJames Watt School of EngineeringUniversity of GlasgowGlasgowG12 8QQUnited Kingdom
| | - Elisa Ren
- Laboratory of Experimental Electroencephalography and NeurophysiologyDepartment of BiomedicalMetabolic and Neural SciencesUniversity of Modena and Reggio EmiliaModena41125Italy
| | - Gabriel Galeote‐Checa
- Microelectronics LabJames Watt School of EngineeringUniversity of GlasgowGlasgowG12 8QQUnited Kingdom
| | - Rupam Das
- Microelectronics LabJames Watt School of EngineeringUniversity of GlasgowGlasgowG12 8QQUnited Kingdom
| | - Giulia Curia
- Laboratory of Experimental Electroencephalography and NeurophysiologyDepartment of BiomedicalMetabolic and Neural SciencesUniversity of Modena and Reggio EmiliaModena41125Italy
| | - Hadi Heidari
- Microelectronics LabJames Watt School of EngineeringUniversity of GlasgowGlasgowG12 8QQUnited Kingdom
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Olaru M, Nillo RM, Mukherjee P, Sugrue LP. A quantitative approach for measuring laterality in clinical fMRI for preoperative language mapping. Neuroradiology 2021; 63:1489-1500. [PMID: 33772347 PMCID: PMC8376727 DOI: 10.1007/s00234-021-02685-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 03/01/2021] [Indexed: 11/16/2022]
Abstract
Purpose fMRI is increasingly used for presurgical language mapping, but lack of standard methodology has made it difficult to combine/compare data across institutions or determine the relative efficacy of different approaches. Here, we describe a quantitative analytic framework for determining language laterality in clinical fMRI that addresses these concerns. Methods We retrospectively analyzed fMRI data from 59 patients who underwent presurgical language mapping at our institution with identical imaging and behavioral protocols. First, we compared the efficacy of different regional masks in capturing language activations. Then, we systematically explored how laterality indices (LIs) computed from these masks vary as a function of task and activation threshold. Finally, we determined the percentile threshold that maximized the correlation between the results of our LI approach and the laterality assessments from the original clinical radiology reports. Results First, we found that a regional mask derived from a meta-analysis of the fMRI literature better captured language task activations than masks based on anatomically defined language areas. Then, we showed that an LI approach based on this functional mask and percentile thresholding of subject activation can quantify the relative ability of different language tasks to lateralize language function at the population level. Finally, we determined that the 92nd percentile of subject-level activation provides the optimal LI threshold with which to reproduce the original clinical reports. Conclusion A quantitative framework for determining language laterality that uses a functionally-derived language mask and percentile thresholding of subject activation can combine/compare results across tasks and patients and reproduce clinical assessments of language laterality. Supplementary Information The online version contains supplementary material available at 10.1007/s00234-021-02685-z.
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Affiliation(s)
- Maria Olaru
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Ryan M Nillo
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Pratik Mukherjee
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Leo P Sugrue
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA.
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Overcast WB, Davis KM, Ho CY, Hutchins GD, Green MA, Graner BD, Veronesi MC. Advanced imaging techniques for neuro-oncologic tumor diagnosis, with an emphasis on PET-MRI imaging of malignant brain tumors. Curr Oncol Rep 2021; 23:34. [PMID: 33599882 PMCID: PMC7892735 DOI: 10.1007/s11912-021-01020-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW This review will explore the latest in advanced imaging techniques, with a focus on the complementary nature of multiparametric, multimodality imaging using magnetic resonance imaging (MRI) and positron emission tomography (PET). RECENT FINDINGS Advanced MRI techniques including perfusion-weighted imaging (PWI), MR spectroscopy (MRS), diffusion-weighted imaging (DWI), and MR chemical exchange saturation transfer (CEST) offer significant advantages over conventional MR imaging when evaluating tumor extent, predicting grade, and assessing treatment response. PET performed in addition to advanced MRI provides complementary information regarding tumor metabolic properties, particularly when performed simultaneously. 18F-fluoroethyltyrosine (FET) PET improves the specificity of tumor diagnosis and evaluation of post-treatment changes. Incorporation of radiogenomics and machine learning methods further improve advanced imaging. The complementary nature of combining advanced imaging techniques across modalities for brain tumor imaging and incorporating technologies such as radiogenomics has the potential to reshape the landscape in neuro-oncology.
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Affiliation(s)
- Wynton B. Overcast
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 N University Blvd. Room 0663, Indianapolis, IN 46202 USA
| | - Korbin M. Davis
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 N University Blvd. Room 0663, Indianapolis, IN 46202 USA
| | - Chang Y. Ho
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Goodman Hall, 355 West 16th Street, Suite 4100, Indianapolis, IN 46202 USA
| | - Gary D. Hutchins
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Research 2 Building (R2), Room E124, 920 W. Walnut Street, Indianapolis, IN 46202-5181 USA
| | - Mark A. Green
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Research 2 Building (R2), Room E124, 920 W. Walnut Street, Indianapolis, IN 46202-5181 USA
| | - Brian D. Graner
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Goodman Hall, 355 West 16th Street, Suite 4100, Indianapolis, IN 46202 USA
| | - Michael C. Veronesi
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Research 2 Building (R2), Room E174, 920 W. Walnut Street, Indianapolis, IN 46202-5181 USA
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Manan HA, Franz EA, Yahya N. The utilisation of resting-state fMRI as a pre-operative mapping tool in patients with brain tumours in comparison to task-based fMRI and intraoperative mapping: A systematic review. Eur J Cancer Care (Engl) 2021; 30:e13428. [PMID: 33592671 DOI: 10.1111/ecc.13428] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 01/25/2021] [Accepted: 01/28/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE Resting-state functional Magnetic Resonance Imaging (rs-fMRI) is suggested to be a viable option for pre-operative mapping for patients with brain tumours. However, it remains an open issue whether the tool is useful in the clinical setting compared to task-based fMRI (T-fMRI) and intraoperative mapping. Thus, a systematic review was conducted to investigate the usefulness of this technique. METHODS A systematic literature search of rs-fMRI methods applied as a pre-operative mapping tool was conducted using the PubMed/MEDLINE and Cochrane Library electronic databases following PRISMA guidelines. RESULTS Results demonstrated that 50% (six out of twelve) of the studies comparing rs-fMRI and T-fMRI showed good concordance for both language and sensorimotor networks. In comparison to intraoperative mapping, 86% (six out of seven) studies found a good agreement to rs-fMRI. Finally, 87% (twenty out of twenty-three) studies agreed that rs-fMRI is a suitable and useful pre-operative mapping tool. CONCLUSIONS rs-fMRI is a promising technique for pre-operative mapping in assessing the functional brain areas. However, the agreement between rs-fMRI with other techniques, including T-fMRI and intraoperative maps, is not yet optimal. Studies to ascertain and improve the sophistication in pre-processing of rs-fMRI imaging data are needed.
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Affiliation(s)
- Hanani Abdul Manan
- Makmal Pemprosesan Imej Kefungsian (Functional Image Processing Laboratory, Department of Radiology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Elizabeth A Franz
- Department of Psychology and fMRIotago, University of Otago, Dunedin, New Zealand
| | - Noorazrul Yahya
- Diagnostic Imaging & Radiotherapy Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Utility of Preoperative Blood-Oxygen-Level-Dependent Functional MR Imaging in Patients with a Central Nervous System Neoplasm. Neuroimaging Clin N Am 2021; 31:93-102. [PMID: 33220831 PMCID: PMC10040207 DOI: 10.1016/j.nic.2020.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Functional neuroimaging provides means to understand the relationship between brain structure and associated functions. Functional MR (fMR) imaging can offer a unique insight into preoperative planning for central nervous system (CNS) neoplasms by identifying areas of the brain effected or spared by the neoplasm. BOLD (blood-oxygen-level-dependent) fMR imaging can be reliably used to map eloquent cortex presurgically and is sufficiently accurate for neurosurgical planning. In patients with brain tumors undergoing neurosurgical intervention, fMR imaging can decrease postoperative morbidity. This article discusses the applications, significance, and interpretation of BOLD fMR imaging, and its applications in presurgical planning for CNS neoplasms.
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Stopa BM, Senders JT, Broekman MLD, Vangel M, Golby AJ. Preoperative functional MRI use in neurooncology patients: a clinician survey. Neurosurg Focus 2021; 48:E11. [PMID: 32006949 DOI: 10.3171/2019.11.focus19779] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 11/05/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Functional MRI (fMRI) is increasingly being investigated for use in neurosurgical patient care. In the current study, the authors characterize the clinical use of fMRI by surveying neurosurgeons' use of and attitudes toward fMRI as a surgical planning tool in neurooncology patients. METHODS A survey was developed to inquire about clinicians' use of and experiences with preoperative fMRI in the neurooncology patient population, including example case images. The survey was distributed to all neurosurgical departments with a residency program in the US. RESULTS After excluding incomplete surveys and responders that do not use fMRI (n = 11), 50 complete responses were included in the final analysis. Responders were predominantly from academic programs (88%), with 20 years or more in practice (40%), with a main area of practice in neurooncology (48%) and treating an adult population (90%). All 50 responders currently use fMRI in neurooncology patients, mostly for low- (94%) and high-grade glioma (82%). The leading decision factors for ordering fMRI were location of mass in dominant hemisphere, location in a functional area, motor symptoms, and aphasia. Across 10 cases, language fMRI yielded the highest interrater reliability agreement (Fleiss' kappa 0.437). The most common reasons for ordering fMRI were to identify language laterality, plan extent of resection, and discuss neurological risks with patients. Clinicians reported that fMRI results were not obtained when ordered a median 10% of the time and were suboptimal a median 27% of the time. Of responders, 70% reported that they had ever resected an fMRI-positive functional site, of whom 77% did so because the site was "cleared" by cortical stimulation. Responders reported disagreement between fMRI and awake surgery 30% of the time. Overall, 98% of responders reported that if results of fMRI and intraoperative mapping disagreed, they would rely on intraoperative mapping. CONCLUSIONS Although fMRI is increasingly being adopted as a practical preoperative planning tool for brain tumor resection, there remains a substantial degree of discrepancy with regard to its current use and presumed utility. There is a need for further research to evaluate the use of preoperative fMRI in neurooncology patients. As fMRI continues to gain prominence, it will be important for clinicians to collectively share best practices and develop guidelines for the use of fMRI in the preoperative planning phase of brain tumor patients.
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Affiliation(s)
- Brittany M Stopa
- 1Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joeky T Senders
- 1Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,2Department of Neurosurgery, University Medical Center, Utrecht, The Netherlands
| | - Marike L D Broekman
- 3Department of Neurosurgery, Haaglanden Medical Center, The Hague, The Netherlands; and
| | | | - Alexandra J Golby
- Departments of4Radiology and.,5Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Reuter G, Moïse M, Roll W, Martin D, Lombard A, Scholtes F, Stummer W, Suero Molina E. Conventional and advanced imaging throughout the cycle of care of gliomas. Neurosurg Rev 2021; 44:2493-2509. [PMID: 33411093 DOI: 10.1007/s10143-020-01448-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/18/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
Although imaging of gliomas has evolved tremendously over the last decades, published techniques and protocols are not always implemented into clinical practice. Furthermore, most of the published literature focuses on specific timepoints in glioma management. This article reviews the current literature on conventional and advanced imaging techniques and chronologically outlines their practical relevance for the clinical management of gliomas throughout the cycle of care. Relevant articles were located through the Pubmed/Medline database and included in this review. Interpretation of conventional and advanced imaging techniques is crucial along the entire process of glioma care, from diagnosis to follow-up. In addition to the described currently existing techniques, we expect deep learning or machine learning approaches to assist each step of glioma management through tumor segmentation, radiogenomics, prognostication, and characterization of pseudoprogression. Thorough knowledge of the specific performance, possibilities, and limitations of each imaging modality is key for their adequate use in glioma management.
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Affiliation(s)
- Gilles Reuter
- Department of Neurosurgery, University Hospital of Liège, Liège, Belgium. .,GIGA-CRC In-vivo Imaging Center, ULiege, Liège, Belgium.
| | - Martin Moïse
- Department of Radiology, University Hospital of Liège, Liège, Belgium
| | - Wolfgang Roll
- Department of Nuclear Medicine, University Hospital of Münster, Münster, Germany
| | - Didier Martin
- Department of Neurosurgery, University Hospital of Liège, Liège, Belgium
| | - Arnaud Lombard
- Department of Neurosurgery, University Hospital of Liège, Liège, Belgium
| | - Félix Scholtes
- Department of Neurosurgery, University Hospital of Liège, Liège, Belgium.,Department of Neuroanatomy, University of Liège, Liège, Belgium
| | - Walter Stummer
- Department of Neurosurgery, University Hospital of Münster, Münster, Germany
| | - Eric Suero Molina
- Department of Neurosurgery, University Hospital of Münster, Münster, Germany
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Ades-Aron B, Lemberskiy G, Veraart J, Golfinos J, Fieremans E, Novikov DS, Shepherd T. Improved Task-based Functional MRI Language Mapping in Patients with Brain Tumors through Marchenko-Pastur Principal Component Analysis Denoising. Radiology 2020; 298:365-373. [PMID: 33289611 DOI: 10.1148/radiol.2020200822] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Functional MRI improves preoperative planning in patients with brain tumors, but task-correlated signal intensity changes are only 2%-3% above baseline. This makes accurate functional mapping challenging. Marchenko-Pastur principal component analysis (MP-PCA) provides a novel strategy to separate functional MRI signal from noise without requiring user input or prior data representation. Purpose To determine whether MP-PCA denoising improves activation magnitude for task-based functional MRI language mapping in patients with brain tumors. Materials and Methods In this Health Insurance Portability and Accountability Act-compliant study, MP-PCA performance was first evaluated by using simulated functional MRI data with a known ground truth. Right-handed, left-language-dominant patients with brain tumors who successfully performed verb generation, sentence completion, and finger tapping functional MRI tasks were retrospectively identified between January 2017 and August 2018. On the group level, for each task, histograms of z scores for original and MP-PCA denoised data were extracted from relevant regions and contralateral homologs were seeded by a neuroradiologist blinded to functional MRI findings. Z scores were compared with paired two-sided t tests, and distributions were compared with effect size measurements and the Kolmogorov-Smirnov test. The number of voxels with a z score greater than 3 was used to measure task sensitivity relative to task duration. Results Twenty-three patients (mean age ± standard deviation, 43 years ± 18; 13 women) were evaluated. MP-PCA denoising led to a higher median z score of task-based functional MRI voxel activation in left hemisphere cortical regions for verb generation (from 3.8 ± 1.0 to 4.5 ± 1.4; P < .001), sentence completion (from 3.7 ± 1.0 to 4.3 ± 1.4; P < .001), and finger tapping (from 6.9 ± 2.4 to 7.9 ± 2.9; P < .001). Median z scores did not improve in contralateral homolog regions for verb generation (from -2.7 ± 0.54 to -2.5 ± 0.40; P = .90), sentence completion (from -2.3 ± 0.21 to -2.4 ± 0.37; P = .39), or finger tapping (from -2.3 ± 1.20 to -2.7 ± 1.40; P = .07). Individual functional MRI task durations could be truncated by at least 40% after MP-PCA without degradation of clinically relevant correlations between functional cortex and functional MRI tasks. Conclusion Denoising with Marchenko-Pastur principal component analysis led to higher task correlations in relevant cortical regions during functional MRI language mapping in patients with brain tumors. © RSNA, 2020 Online supplemental material is available for this article.
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Affiliation(s)
- Benjamin Ades-Aron
- From the Center for Biomedical Imaging, Department of Radiology (B.A.A., G.L., J.V., E.F., D.S.N., T.S.) and Department of Neurosurgery (J.G.), New York University School of Medicine, 2nd Floor, 660 First Ave, New York, NY 10016; and Department of Electrical and Computer Engineering, New York University Tandon School of Engineering, New York, NY (B.A.A.)
| | - Gregory Lemberskiy
- From the Center for Biomedical Imaging, Department of Radiology (B.A.A., G.L., J.V., E.F., D.S.N., T.S.) and Department of Neurosurgery (J.G.), New York University School of Medicine, 2nd Floor, 660 First Ave, New York, NY 10016; and Department of Electrical and Computer Engineering, New York University Tandon School of Engineering, New York, NY (B.A.A.)
| | - Jelle Veraart
- From the Center for Biomedical Imaging, Department of Radiology (B.A.A., G.L., J.V., E.F., D.S.N., T.S.) and Department of Neurosurgery (J.G.), New York University School of Medicine, 2nd Floor, 660 First Ave, New York, NY 10016; and Department of Electrical and Computer Engineering, New York University Tandon School of Engineering, New York, NY (B.A.A.)
| | - John Golfinos
- From the Center for Biomedical Imaging, Department of Radiology (B.A.A., G.L., J.V., E.F., D.S.N., T.S.) and Department of Neurosurgery (J.G.), New York University School of Medicine, 2nd Floor, 660 First Ave, New York, NY 10016; and Department of Electrical and Computer Engineering, New York University Tandon School of Engineering, New York, NY (B.A.A.)
| | - Els Fieremans
- From the Center for Biomedical Imaging, Department of Radiology (B.A.A., G.L., J.V., E.F., D.S.N., T.S.) and Department of Neurosurgery (J.G.), New York University School of Medicine, 2nd Floor, 660 First Ave, New York, NY 10016; and Department of Electrical and Computer Engineering, New York University Tandon School of Engineering, New York, NY (B.A.A.)
| | - Dmitry S Novikov
- From the Center for Biomedical Imaging, Department of Radiology (B.A.A., G.L., J.V., E.F., D.S.N., T.S.) and Department of Neurosurgery (J.G.), New York University School of Medicine, 2nd Floor, 660 First Ave, New York, NY 10016; and Department of Electrical and Computer Engineering, New York University Tandon School of Engineering, New York, NY (B.A.A.)
| | - Timothy Shepherd
- From the Center for Biomedical Imaging, Department of Radiology (B.A.A., G.L., J.V., E.F., D.S.N., T.S.) and Department of Neurosurgery (J.G.), New York University School of Medicine, 2nd Floor, 660 First Ave, New York, NY 10016; and Department of Electrical and Computer Engineering, New York University Tandon School of Engineering, New York, NY (B.A.A.)
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Ghinda DC, Yang Y, Wu S, Lu J, Su L, Damiani S, Tumati S, Jansen G, Duffau H, Wu JS, Northoff G. Personalized Multimodal Demarcation of Peritumoral Tissue in Glioma. JCO Precis Oncol 2020; 4:1128-1140. [PMID: 35050774 DOI: 10.1200/po.20.00115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Gliomas are life-threatening brain tumors, and the extent of surgical resection is one of the strongest influences on survival rate. However, the proper distinction of infiltrated tissue remains elusive. The aim of this study was to use multimodal analyses to demarcate peritumoral tissue (PT) from tumoral (TT) and healthy tissue (HT). METHODS A total of 40 patients with histologically confirmed glioma were recruited. We analyzed resting-state functional magnetic resonance imaging (rs-fMRI) using the voxel-based mean blood-oxygen-level-dependent (BOLD) signal and the corresponding structural MRI (s-MRI) alongside RNA sequencing, whole-exome sequencing, and histology results of biopsy samples obtained from PT, HT, and TT. RESULTS We demarcated a functionally defined PT area where the mean BOLD signal gradually decreased near the edge of the tumor and extended beyond the TT borders (as defined by s-MRI), which was confirmed on a case-by-case basis. Correspondingly, genetic analyses showed a gene expression pattern and mutational landscape of the PT that were distinct from that seen in HT and TT. The genetic characterization of PT relative to HT and TT converged with the MRI-defined PT zones. This was confirmed in three individual cases after additional histologic analysis. A wider PT was associated with a longer progression-free survival, which suggests PT might act as an intermediate area between TT and HT. CONCLUSION Combined multimodal imaging and genetic analyses can allow for an objective demarcation of the PT in glioma and a robust classification of the degree of infiltration of the PT. These findings could help improve both neurosurgical resection and radio-oncologic therapy.
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Affiliation(s)
- Diana C Ghinda
- Department of Neurosurgery, The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Glioma Surgery Division, Neurologic Surgery Department, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Mind, Brain Imaging, and Neuroethics, Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada
| | - Yufei Yang
- Genetron Health (Beijing) Co Ltd, Beijing, China
| | - Shuai Wu
- Glioma Surgery Division, Neurologic Surgery Department, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Junfeng Lu
- Glioma Surgery Division, Neurologic Surgery Department, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lan Su
- Genetron Health (Beijing) Co Ltd, Beijing, China
| | - Stefano Damiani
- Department of Brain and Behavioral Science, University of Pavia, Pavia, Italy
| | - Shankar Tumati
- Mind, Brain Imaging, and Neuroethics, Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada
| | - Gerard Jansen
- Department of Neuropathology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Hugues Duffau
- Department of Neurosurgery, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France.,Brain Plasticity, Stem Cells, and Glial Tumors Team, National Institute for Health and Medical Research, Montpellier, France
| | - Jin-Song Wu
- Glioma Surgery Division, Neurologic Surgery Department, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Georg Northoff
- Mind, Brain Imaging, and Neuroethics, Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada
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Abstract
Neurovascular uncoupling (NVU) is one of the most important confounds of blood oxygen level dependent (BOLD) functional magnetic resonance imaging (fMR imaging) in the setting of focal brain lesions such as brain tumors. This article reviews the assessment of NVU related to focal brain lesions with emphasis on the use of cerebrovascular reactivity mapping measurement methods and resting state BOLD fMR imaging metrics in the detection of NVU, as well as the use of amplitude of low-frequency fluctuation metrics to mitigate the effects of NVU on clinical fMR imaging activation.
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Affiliation(s)
- Shruti Agarwal
- Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Haris I Sair
- Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA; The Malone Center for Engineering in Healthcare, The Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Jay J Pillai
- Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA; Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA.
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Park KY, Lee JJ, Dierker D, Marple LM, Hacker CD, Roland JL, Marcus DS, Milchenko M, Miller-Thomas MM, Benzinger TL, Shimony JS, Snyder AZ, Leuthardt EC. Mapping language function with task-based vs. resting-state functional MRI. PLoS One 2020; 15:e0236423. [PMID: 32735611 PMCID: PMC7394427 DOI: 10.1371/journal.pone.0236423] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 07/06/2020] [Indexed: 01/21/2023] Open
Abstract
Background Use of functional MRI (fMRI) in pre-surgical planning is a non-invasive method for pre-operative functional mapping for patients with brain tumors, especially tumors located near eloquent cortex. Currently, this practice predominantly involves task-based fMRI (T-fMRI). Resting state fMRI (RS-fMRI) offers an alternative with several methodological advantages. Here, we compare group-level analyses of RS-fMRI vs. T-fMRI as methods for language localization. Purpose To contrast RS-fMRI vs. T-fMRI as techniques for localization of language function. Methods We analyzed data obtained in 35 patients who had both T-fMRI and RS-fMRI scans during the course of pre-surgical evaluation. The RS-fMRI data were analyzed using a previously trained resting-state network classifier. The T-fMRI data were analyzed using conventional techniques. Group-level results obtained by both methods were evaluated in terms of two outcome measures: (1) inter-subject variability of response magnitude and (2) sensitivity/specificity analysis of response topography, taking as ground truth previously reported maps of the language system based on intraoperative cortical mapping as well as meta-analytic maps of language task fMRI responses. Results Both fMRI methods localized major components of the language system (areas of Broca and Wernicke) although not with equal inter-subject consistency. Word-stem completion T-fMRI strongly activated Broca's area but also several task-general areas not specific to language. RS-fMRI provided a more specific representation of the language system. Conclusion We demonstrate several advantages of classifier-based mapping of language representation in the brain. Language T-fMRI activated task-general (i.e., not language-specific) functional systems in addition to areas of Broca and Wernicke. In contrast, classifier-based analysis of RS-fMRI data generated maps confined to language-specific regions of the brain.
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Affiliation(s)
- Ki Yun Park
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - John J. Lee
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Donna Dierker
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Laura M. Marple
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Carl D. Hacker
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Jarod L. Roland
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, United States of America
| | - Daniel S. Marcus
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Mikhail Milchenko
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Michelle M. Miller-Thomas
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Tammie L. Benzinger
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Joshua S. Shimony
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, United States of America
- * E-mail:
| | - Abraham Z. Snyder
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Eric C. Leuthardt
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, United States of America
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63
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Opposits G, Aranyi C, Glavák C, Cselik Z, Trón L, Sipos D, Hadjiev J, Berényi E, Repa I, Emri M, Kovács Á. OAR sparing 3D radiotherapy planning supported by fMRI brain mapping investigations. Med Dosim 2020; 45:e1-e8. [PMID: 32505630 DOI: 10.1016/j.meddos.2020.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 03/21/2020] [Accepted: 04/08/2020] [Indexed: 11/28/2022]
Abstract
The human brain as an organ has numerous functions; some of them can be visualized by functional imaging techniques (e.g., functional MRI [fMRI] or positron emission tomography). The localization of the appropriate activity clusters requires sophisticated instrumentation and complex measuring protocol. As the inclusion of the activation pattern in modern self-tailored 3D based radiotherapy has notable advantages, this method is applied frequently. Unfortunately, no standardized method has been published yet for the integration of the fMRI data into the planning process and the detailed description of the individual applications is usually missing. Thirteen patients with brain tumors, receiving fMRI based RT planning were enrolled in this study. The delivered dose maps were exported from the treatment planning system and processed for further statistical analysis. Two parameters were introduced to measure the geometrical distance Hausdorff Distance (HD), and volumetric overlap Dice Similarity Coefficient (DSC) of fMRI corrected and not corrected dose matrices as calculated by 3D planning to characterize similarity and/or dissimilarity of these dose matrices. Statistical analysis of bootstrapped HD and DSC data was performed to determine confidence intervals of these parameters. The calculated confidence intervals for HD and DSC were (5.04, 7.09), (0.79, 0.86), respectively for the 40 Gy and (5.2, 7.85), (0.74, 0.83), respectively for the 60 Gy dose volumes. These data indicate that in the case of HD < 5.04 and/or DSC > 0.86, the 40 Gy dose volumes obtained with and without fMRI activation pattern do not show a significant difference (5% significance level). The same conditions for the 60 Gy dose volumes were HD < 5.2 and/or DSC > 0.83. At the same time, with HD > 7.09 and/or DSC < 0.79 for 40 Gy and HD > 7.85 and/or DSC < 0.74 for 60 Gy the impact of fMRI utilization in RT planning is excessive. The fMRI activation clusters can be used in daily RT planning routine to spare activation clusters as critical areas in the brain and avoid their high dose irradiation. Parameters HD (as distance) and DSC (as overlap) can be used to characterize the difference and similarity between the radiotherapy planning target volumes and indicate whether the fMRI delivered activation patterns and consequent fMRI corrected planning volumes are reliable or not.
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Affiliation(s)
- Gábor Opposits
- University of Debrecen, Faculty of Medicine, Department of Medical Imaging, Division of Nuclear Medicine and Translational Imaging, Nagyerdei krt. 98., Debrecen 4032, Hungary.
| | - Csaba Aranyi
- University of Debrecen, Faculty of Medicine, Department of Medical Imaging, Division of Nuclear Medicine and Translational Imaging, Nagyerdei krt. 98., Debrecen 4032, Hungary
| | - Csaba Glavák
- Kaposi Somogy County Teaching Hospital Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, Kaposvár, Hungary
| | - Zsolt Cselik
- Veszprém County Hospital, Oncoradiology, Veszprém, Hungary
| | - Lajos Trón
- University of Debrecen, Faculty of Medicine, Department of Medical Imaging, Division of Nuclear Medicine and Translational Imaging, Nagyerdei krt. 98., Debrecen 4032, Hungary
| | - Dávid Sipos
- Kaposi Somogy County Teaching Hospital Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, Kaposvár, Hungary; University of Pécs Doctoral School of Health Sciences, Pécs, Hungary
| | - Janaki Hadjiev
- Kaposi Somogy County Teaching Hospital Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, Kaposvár, Hungary
| | - Ervin Berényi
- University of Debrecen, Faculty of Medicine, Department of Medical Imaging, Division of Nuclear Medicine and Translational Imaging, Nagyerdei krt. 98., Debrecen 4032, Hungary
| | - Imre Repa
- Kaposi Somogy County Teaching Hospital Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, Kaposvár, Hungary
| | - Miklós Emri
- University of Debrecen, Faculty of Medicine, Department of Medical Imaging, Division of Nuclear Medicine and Translational Imaging, Nagyerdei krt. 98., Debrecen 4032, Hungary
| | - Árpád Kovács
- University of Debrecen, Faculty of Medicine, Department of Oncoradiology, Debrecen, Hungary; Kaposi Somogy County Teaching Hospital Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, Kaposvár, Hungary; University of Pécs Doctoral School of Health Sciences, Pécs, Hungary
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Hassan SA, Campos MA, Kasawara KT, Bonetti LV, Patterson KK, Beal DS, Fregonezi GAF, Stanbrook MB, Reid WD. Changes in Oxyhemoglobin Concentration in the Prefrontal Cortex during Cognitive-Motor Dual Tasks in People with Chronic Obstructive Pulmonary Disease. COPD 2020; 17:289-296. [PMID: 32441147 DOI: 10.1080/15412555.2020.1767561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Cognitive and motor impairment are well documented in chronic obstructive pulmonary disease (COPD) patients, but their relationship has not been studied. This study evaluated and compared cognitive and motor performance during dual tasks and related dorsolateral prefrontal cortex (PFC) changes in oxygenated hemoglobin (ΔO2Hb), a proxy measure of neural activity, in patients with COPD and age-matched healthy individuals. Participants performed three single tasks: (1) backwards spelling cognitive task; (2) 30 m preferred paced walk; (3) 30 m fast walk, and two dual tasks: (4) preferred paced walk + backwards spelling; (5) fast paced walk + backwards spelling. The ΔO2Hb from left and right dorsolateral PFC were measured using functional near-infrared spectroscopy. Gait velocity was measured using a Zeno walkway. Compared to healthy adults (n = 20), patients with COPD (n = 15) had higher ΔO2Hb during single preferred (-0.344 ± 0.185 vs. 0.325 ± 0.208 µM; p = 0.011) and fast paced walk (-0.249 ± 0.120 vs. 0.486 ± 0.182 µM; p = 0.001) in right PFC. Among healthy adults, ΔO2Hb were higher bilaterally during preferred paced walking dual versus single task (right: 0.096 ± 0.159 vs. -0.344 ± 0.185 µM, p = 0.013; left: 0.114 ± 0.150 vs. -0.257 ± 0.175 µM, p = 0.049) and in right PFC during fast walking dual versus single task (0.102 ± 0.228 vs. -0.249 ± 0.120, p = 0.021). Patients with COPD did not increase O2Hb during dual versus single tasks. Patients with COPD exhibited slower velocity than older adults during all walking tasks. The lack of further increase in O2Hb from single to dual tasks in patients with COPD, may indicate reduced cognitive-motor capacity and contribute to poorer motor performance limiting safe ambulation. Dual tasking rehabilitation may improve neural efficiency to offset these risks.
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Affiliation(s)
- S Ahmed Hassan
- Physical Therapy, University of Toronto, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Leandro Viçosa Bonetti
- Post-Graduation Program in Health Sciences, Universidade de Caxias do Sul, Caxias do Sul, Rio Grande do Sul, Brazil.,Department of Physical Therapy, Universidade de Caxias do Sul, Caxias do Sul, Rio Grande do Sul, Brazil
| | - Kara K Patterson
- Physical Therapy, University of Toronto, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.,KITE - Toronto Rehab-University Health Network, Toronto, Ontario, Canada
| | - Deryk S Beal
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.,Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada.,Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada
| | - Guilherme A F Fregonezi
- PneumoCardioVascular Lab/HUOL, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares and Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - Matthew B Stanbrook
- Division of Respirology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - W Darlene Reid
- Physical Therapy, University of Toronto, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.,KITE - Toronto Rehab-University Health Network, Toronto, Ontario, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
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Sollmann N, Zhang H, Fratini A, Wildschuetz N, Ille S, Schröder A, Zimmer C, Meyer B, Krieg SM. Risk Assessment by Presurgical Tractography Using Navigated TMS Maps in Patients with Highly Motor- or Language-Eloquent Brain Tumors. Cancers (Basel) 2020; 12:cancers12051264. [PMID: 32429502 PMCID: PMC7281396 DOI: 10.3390/cancers12051264] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 04/29/2020] [Accepted: 05/10/2020] [Indexed: 11/30/2022] Open
Abstract
Patients with functionally eloquent brain lesions are at risk of functional decline in the course of resection. Given tumor-related plastic reshaping and reallocation of function, individual data are needed for patient counseling and risk assessment prior to surgery. This study evaluates the utility of mapping by navigated transcranial magnetic stimulation (nTMS) and nTMS-based diffusion tensor imaging fiber tracking (DTI FT) for individual risk evaluation of surgery-related decline of motor or language function in the clinical setting. In total, 250 preoperative nTMS mappings (100 language and 150 motor mappings) derived from 216 patients (mean age: 57.0 ± 15.5 years, 58.8% males; glioma World Health Organization (WHO) grade I & II: 4.2%, glioma WHO grade III & IV: 83.4%, arteriovenous malformations: 1.9%, cavernoma: 2.3%, metastasis: 8.2%) were included. Deterministic tractography based on nTMS motor or language maps as seed regions was performed with 25%, 50%, and 75% of the individual fractional anisotropy threshold (FAT). Lesion-to-tract distances (LTDs) were measured between the tumor mass and the corticospinal tract (CST), arcuate fascicle (AF), or other closest language-related tracts. LTDs were compared between patients and correlated to the functional status (no/transient/permanent surgery-related paresis or aphasia). Significant differences were found between patients with no or transient surgery-related deficits and patients with permanent surgery-related deficits regarding LTDs in relation to the CST (p < 0.0001), AF (p ≤ 0.0491), or other closest language-related tracts (p ≤ 0.0435). The cut-off values for surgery-related paresis or aphasia were ≤12 mm (LTD—CST) and ≤16 mm (LTD—AF) or ≤25 mm (LTD—other closest language-related tract), respectively. Moreover, there were significant associations between the status of surgery-related deficits and the LTD when considering the CST (range r: −0.3994 to −0.3910, p < 0.0001) or AF (range r: −0.2918 to −0.2592, p = 0.0135 and p = 0.0473 for 25% and 50% FAT). In conclusion, this is the largest study evaluating the application of both preoperative functional mapping and function-based tractography for motor and language function for risk stratification in patients with functionally eloquent tumors. The LTD may qualify as a viable marker that can be seamlessly assessed in the clinical neurooncological setup.
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Affiliation(s)
- Nico Sollmann
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany; (N.S.); (H.Z.); (A.F.); (N.W.); (S.I.); (A.S.); (B.M.)
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany;
| | - Haosu Zhang
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany; (N.S.); (H.Z.); (A.F.); (N.W.); (S.I.); (A.S.); (B.M.)
| | - Alessia Fratini
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany; (N.S.); (H.Z.); (A.F.); (N.W.); (S.I.); (A.S.); (B.M.)
| | - Noémie Wildschuetz
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany; (N.S.); (H.Z.); (A.F.); (N.W.); (S.I.); (A.S.); (B.M.)
| | - Sebastian Ille
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany; (N.S.); (H.Z.); (A.F.); (N.W.); (S.I.); (A.S.); (B.M.)
| | - Axel Schröder
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany; (N.S.); (H.Z.); (A.F.); (N.W.); (S.I.); (A.S.); (B.M.)
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, 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; (N.S.); (H.Z.); (A.F.); (N.W.); (S.I.); (A.S.); (B.M.)
| | - Sandro M. Krieg
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany; (N.S.); (H.Z.); (A.F.); (N.W.); (S.I.); (A.S.); (B.M.)
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany
- Correspondence:
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66
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Han SJ, Teton Z, Gupta K, Kawamoto A, Raslan AM. Novel Use of Stimulating Fence-Post Technique for Functional Mapping of Subcortical White Matter During Tumor Resection: A Technical Case Series. Oper Neurosurg (Hagerstown) 2020; 19:264-270. [DOI: 10.1093/ons/opaa027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 01/12/2020] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Maximal safe resection remains a key principle in infiltrating glioma management. Stimulation mapping is a key adjunct for minimizing functional morbidity while “fence-post” procedures use catheters or dye to mark the tumor border at the start of the procedure prior to brain shift.
Objective
To report a novel technique using stereotactically placed electrodes to guide tumor resection near critical descending subcortical fibers.
Methods
Navigated electrodes were placed prior to tumor resection along the deep margin bordering presumed eloquent tracts. Stimulation was administered through these depth electrodes for subcortical motor and language mapping.
Results
Twelve patients were included in this preliminary technical report. Seven patients (7/12, 58%) were in asleep cases, while the other 5 cases (5/12, 42%) were performed awake. Mapping of motor fibers was performed in 8 cases, and language mapping was done in 1 case. In 3 cases, both motor and language mapping were performed using the same depth electrode spanning corticospinal tract and the arcuate fasciculus.
Conclusion
Stereotactic depth electrode placement coupled with stimulation mapping of white matter tracts can be used concomitantly to demarcate the border between deep tumor margins and eloquent brain, thus helping to maximize extent of resection while minimizing functional morbidity.
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Affiliation(s)
- Seunggu Jude Han
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
| | - Zoe Teton
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
- Department of Neurology, Oregon Health & Science University, Portland, Oregon
| | - Kunal Gupta
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
| | - Aaron Kawamoto
- School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Ahmed M Raslan
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
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67
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Catalino MP, Yao S, Green D, Laws ER, Golby AJ, Tie Y. Mapping cognitive and emotional networks in neurosurgical patients using resting-state functional magnetic resonance imaging. Neurosurg Focus 2020; 48:E9. [PMID: 32006946 PMCID: PMC7712886 DOI: 10.3171/2019.11.focus19773] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 11/13/2019] [Indexed: 01/15/2023]
Abstract
Neurosurgery has been at the forefront of a paradigm shift from a localizationist perspective to a network-based approach to brain mapping. Over the last 2 decades, we have seen dramatic improvements in the way we can image the human brain and noninvasively estimate the location of critical functional networks. In certain patients with brain tumors and epilepsy, intraoperative electrical stimulation has revealed direct links between these networks and their function. The focus of these techniques has rightfully been identification and preservation of so-called "eloquent" brain functions (i.e., motor and language), but there is building momentum for more extensive mapping of cognitive and emotional networks. In addition, there is growing interest in mapping these functions in patients with a broad range of neurosurgical diseases. Resting-state functional MRI (rs-fMRI) is a noninvasive imaging modality that is able to measure spontaneous low-frequency blood oxygen level-dependent signal fluctuations at rest to infer neuronal activity. Rs-fMRI may be able to map cognitive and emotional networks for individual patients. In this review, the authors give an overview of the rs-fMRI technique and associated cognitive and emotional resting-state networks, discuss the potential applications of rs-fMRI, and propose future directions for the mapping of cognition and emotion in neurosurgical patients.
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Affiliation(s)
- Michael P Catalino
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School Boston, MA
- Department of Neurosurgery, University of North Carolina Hospitals, Chapel Hill, NC
| | - Shun Yao
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School Boston, MA
- Department of Neurosurgery and Pituitary Tumor Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Deborah Green
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Edward R Laws
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School Boston, MA
| | - Alexandra J Golby
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School Boston, MA
| | - Yanmei Tie
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School Boston, MA
- Corresponding Author: Yanmei Tie, Ph.D., Assistant Professor, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Hale Building for Transformative Medicine, 8016G, 60 Fenwood Road, Boston, MA 02115, USA, , Tel: 617-732-8249
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Oelschlägel M, Meyer T, Morgenstern U, Wahl H, Gerber J, Reiß G, Koch E, Steiner G, Kirsch M, Schackert G, Sobottka SB. Mapping of language and motor function during awake neurosurgery with intraoperative optical imaging. Neurosurg Focus 2020; 48:E3. [PMID: 32006940 DOI: 10.3171/2019.11.focus19759] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 11/15/2019] [Indexed: 11/06/2022]
Abstract
Intraoperative optical imaging (IOI) is a marker-free, contactless, and noninvasive imaging technique that is able to visualize metabolic changes of the brain surface following neuronal activation. Although it has been used in the past mainly for the identification of functional brain areas under general anesthesia, the authors investigated the potential of the method during awake surgery. Measurements were performed in 10 patients who underwent resection of lesions within or adjacent to cortical language or motor sites. IOI was applied in 3 different scenarios: identification of motor areas by using finger-tapping tasks, identification of language areas by using speech tasks (overt and silent speech), and a novel approach-the application of IOI as a feedback tool during direct electrical stimulation (DES) mapping of language. The functional maps, which were calculated from the IOI data (activity maps), were qualitatively compared with the functional MRI (fMRI) and the electrophysiological testing results during the surgical procedure to assess their potential benefit for surgical decision-making.The results reveal that the intraoperative identification of motor sites with IOI in good agreement with the preoperatively acquired fMRI and the intraoperative electrophysiological measurements is possible. Because IOI provides spatially highly resolved maps with minimal additional hardware effort, the application of the technique for motor site identification seems to be beneficial in awake procedures. The identification of language processing sites with IOI was also possible, but in the majority of cases significant differences between fMRI, IOI, and DES were visible, and therefore according to the authors' findings the IOI results are too unspecific to be useful for intraoperative decision-making with respect to exact language localization. For this purpose, DES mapping will remain the method of choice.Nevertheless, the IOI technique can provide additional value during the language mapping procedure with DES. Using a simple difference imaging approach, the authors were able to visualize and calculate the spatial extent of activation for each stimulation. This might enable surgeons in the future to optimize the mapping process. Additionally, differences between tumor and nontumor stimulation sites were observed with respect to the spatial extent of the changes in cortical optical properties. These findings provide further evidence that the method allows the assessment of the functional state of neurovascular coupling and is therefore suited for the delineation of pathologically altered tissue.
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Affiliation(s)
- Martin Oelschlägel
- 1Clinical Sensoring and Monitoring, Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden
| | - Tobias Meyer
- 2ABX-CRO Advanced Pharmaceutical Services Forschungsgesellschaft mbH, Dresden
| | - Ute Morgenstern
- 3Institute of Biomedical Engineering, Faculty of Electrical and Computer Engineering, Technische Universität Dresden
| | - Hannes Wahl
- 4Institute and Polyclinic of Diagnostic and Interventional Neuroradiology, Carl Gustav Carus University Hospital, Technische Universität Dresden
| | - Johannes Gerber
- 4Institute and Polyclinic of Diagnostic and Interventional Neuroradiology, Carl Gustav Carus University Hospital, Technische Universität Dresden
| | - Gilfe Reiß
- 6Department of Neurosurgery, Carl Gustav Carus University Hospital, Technische Universität Dresden, Saxony, Germany
| | - Edmund Koch
- 1Clinical Sensoring and Monitoring, Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden
| | - Gerald Steiner
- 1Clinical Sensoring and Monitoring, Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden
| | - Matthias Kirsch
- 5Department of Neurosurgery, Asklepios Kliniken Schildautal Seesen; and
| | - Gabriele Schackert
- 6Department of Neurosurgery, Carl Gustav Carus University Hospital, Technische Universität Dresden, Saxony, Germany
| | - Stephan B Sobottka
- 6Department of Neurosurgery, Carl Gustav Carus University Hospital, Technische Universität Dresden, Saxony, Germany
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Yao S, Liebenthal E, Juvekar P, Bunevicius A, Vera M, Rigolo L, Golby AJ, Tie Y. Sex Effect on Presurgical Language Mapping in Patients With a Brain Tumor. Front Neurosci 2020; 14:4. [PMID: 32038154 PMCID: PMC6992642 DOI: 10.3389/fnins.2020.00004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 01/06/2020] [Indexed: 12/12/2022] Open
Abstract
Differences between males and females in brain development and in the organization and hemispheric lateralization of brain functions have been described, including in language. Sex differences in language organization may have important implications for language mapping performed to assess, and minimize neurosurgical risk to, language function. This study examined the effect of sex on the activation and functional connectivity of the brain, measured with presurgical functional magnetic resonance imaging (fMRI) language mapping in patients with a brain tumor. We carried out a retrospective analysis of data from neurosurgical patients treated at our institution who met the criteria of pathological diagnosis (malignant brain tumor), tumor location (left hemisphere), and fMRI paradigms [sentence completion (SC); antonym generation (AG); and resting-state fMRI (rs-fMRI)]. Forty-seven patients (22 females, mean age = 56.0 years) were included in the study. Across the SC and AG tasks, females relative to males showed greater activation in limited areas, including the left inferior frontal gyrus classically associated with language. In contrast, males relative to females showed greater activation in extended areas beyond the classic language network, including the supplementary motor area (SMA) and precentral gyrus. The rs-fMRI functional connectivity of the left SMA in the females was stronger with inferior temporal pole (TP) areas, and in the males with several midline areas. The findings are overall consistent with theories of greater reliance on specialized language areas in females relative to males, and generalized brain areas in males relative to females, for language function. Importantly, the findings suggest that sex could affect fMRI language mapping. Thus, considering sex as a variable in presurgical language mapping merits further investigation.
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Affiliation(s)
- Shun Yao
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
- Center for Pituitary Tumor Surgery, Department of Neurosurgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Wuhan School of Clinical Medicine, Southern Medical University, Wuhan, China
| | - Einat Liebenthal
- Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
- Institute for Technology in Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA, United States
| | - Parikshit Juvekar
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Adomas Bunevicius
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Matthew Vera
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Laura Rigolo
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Alexandra J. Golby
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Yanmei Tie
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
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70
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Zhang L. Glioma characterization based on magnetic resonance imaging: Challenge overview and future perspective. GLIOMA 2020. [DOI: 10.4103/glioma.glioma_9_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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71
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Utilization of functional MRI language paradigms for pre-operative mapping: a systematic review. Neuroradiology 2019; 62:353-367. [DOI: 10.1007/s00234-019-02322-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 11/08/2019] [Indexed: 12/18/2022]
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72
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García-Casares N, Alfaro-Rubio F, Ramos-Rodríguez JR, Ocaña-Ledesma Á, Márquez-Márquez B, Fernández-Sánchez VE, Ibáñez-Botella G, Arráez-Sánchez MÁ, Serrano-Castro PJ. Preoperative evaluation by functional magnetic resonance imaging in patients with dysembryoplastic neuroepithelial tumours: A case series. Neurocirugia (Astur) 2019; 31:158-164. [PMID: 31784351 DOI: 10.1016/j.neucir.2019.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 09/01/2019] [Accepted: 09/21/2019] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Dysembryoplastic neuroepithelial tumours (DNET) are a type of benign glioneuronal neoplasia of typically temporal location that produce drug-resistant epileptic seizures in children and young adults. OBJECTIVE This work aims to assess the usefulness of functional magnetic resonance imaging (fMRI) in the preoperative study in four patients with DNET. A Philips Intera 3.0 Tesla magnetic resonance imaging scanner and the Blood-Oxygen-Level-Dependent (BOLD) technique were used to obtain the images, making it possible to locate the eloquent areas for language and motor areas through the application of specific paradigms. RESULTS In one case the tumour was adjacent to Broca's area, in two cases it coincided with Wernicke's area, in one patient it was<1cm from the motor area for the hand and in another close to memory. Only two of the patients were operated on, without postoperative functional deficit. Hemispheric activation contralateral to the tumour suggestive of neuroplasticity was observed in one of the patients. CONCLUSIONS fMRI is a non-invasive method that allows us to assess the proximity of lesions to eloquent areas, which is key in the evaluation of surgical risk. In addition, it allowed the detection of probable neuroplasticity in one case, which guaranteed the success of the surgery.
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Affiliation(s)
- Natalia García-Casares
- Departamento de Medicina, Facultad de Medicina, Universidad de Málaga, Málaga, España; Centro de Investigaciones Médico-Sanitarias (CIMES). Universidad de Málagaa, Málaga, España; Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España.
| | - Francisco Alfaro-Rubio
- Centro de Investigaciones Médico-Sanitarias (CIMES). Universidad de Málagaa, Málaga, España
| | | | - Álvaro Ocaña-Ledesma
- Departamento de Medicina, Facultad de Medicina, Universidad de Málaga, Málaga, España
| | - Bernarda Márquez-Márquez
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España; Departamento de Neurocirugía, Hospital Regional de Málaga, Málaga, España
| | - Victoria E Fernández-Sánchez
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España; Departamento de Neurología, Hospital Regional de Málaga, Málaga, España
| | - Guillermo Ibáñez-Botella
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España; Departamento de Neurocirugía, Hospital Regional de Málaga, Málaga, España
| | - Miguel Ángel Arráez-Sánchez
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España; Departamento de Neurocirugía, Hospital Regional de Málaga, Málaga, España
| | - Pedro J Serrano-Castro
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España; Departamento de Neurología, Hospital Regional de Málaga, Málaga, España
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Chaudhry AA, Naim S, Gul M, Chaudhry A, Chen M, Jandial R, Badie B. Utility of Preoperative Blood-Oxygen-Level-Dependent Functional MR Imaging in Patients with a Central Nervous System Neoplasm. Radiol Clin North Am 2019; 57:1189-1198. [PMID: 31582044 DOI: 10.1016/j.rcl.2019.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Functional neuroimaging provides means to understand the relationship between brain structure and associated functions. Functional MR (fMR) imaging can offer a unique insight into preoperative planning for central nervous system (CNS) neoplasms by identifying areas of the brain effected or spared by the neoplasm. BOLD (blood-oxygen-level-dependent) fMR imaging can be reliably used to map eloquent cortex presurgically and is sufficiently accurate for neurosurgical planning. In patients with brain tumors undergoing neurosurgical intervention, fMR imaging can decrease postoperative morbidity. This article discusses the applications, significance, and interpretation of BOLD fMR imaging, and its applications in presurgical planning for CNS neoplasms.
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Affiliation(s)
- Ammar A Chaudhry
- Precision Imaging Lab, Department of Diagnostic Radiology, City of Hope National Cancer Center, 1500 East Duarte Road, Los Angeles, CA 91010, USA.
| | - Sohaib Naim
- Department of Diagnostic Radiology, City of Hope National Cancer Center, 1500 East Duarte Road, Los Angeles, CA 91010, USA
| | - Maryam Gul
- Department of Diagnostic Radiology, City of Hope National Cancer Center, 1500 East Duarte Road, Los Angeles, CA 91010, USA
| | - Abbas Chaudhry
- Department of Diagnostic Radiology, City of Hope National Cancer Center, 1500 East Duarte Road, Los Angeles, CA 91010, USA
| | - Mike Chen
- Department of Neurosurgery, City of Hope National Cancer Center, 1500 East Duarte Road, Los Angeles, CA 91010, USA
| | - Rahul Jandial
- Department of Neurosurgery, City of Hope National Cancer Center, 1500 East Duarte Road, Los Angeles, CA 91010, USA
| | - Behnam Badie
- Department of Neurosurgery, City of Hope National Cancer Center, 1500 East Duarte Road, Los Angeles, CA 91010, USA
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Kreidenhuber R, De Tiège X, Rampp S. Presurgical Functional Cortical Mapping Using Electromagnetic Source Imaging. Front Neurol 2019; 10:628. [PMID: 31249552 PMCID: PMC6584755 DOI: 10.3389/fneur.2019.00628] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/28/2019] [Indexed: 02/03/2023] Open
Abstract
Preoperative localization of functionally eloquent cortex (functional cortical mapping) is common clinical practice in order to avoid or reduce postoperative morbidity. This review aims at providing a general overview of magnetoencephalography (MEG) and high-density electroencephalography (hdEEG) based methods and their clinical role as compared to common alternatives for functional cortical mapping of (1) verbal language function, (2) sensorimotor cortex, (3) memory, (4) visual, and (5) auditory cortex. We highlight strengths, weaknesses and limitations of these functional cortical mapping modalities based on findings in the recent literature. We also compare their performance relative to other non-invasive functional cortical mapping methods, such as functional Magnetic Resonance Imaging (fMRI), Transcranial Magnetic Stimulation (TMS), and to invasive methods like the intracarotid Amobarbital Test (WADA-Test) or intracranial investigations.
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Affiliation(s)
- Rudolf Kreidenhuber
- Department of Neurology, Christian-Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria
| | - Xavier De Tiège
- Laboratoire de Cartographie Fonctionelle du Cerveau, ULB Neuroscience Institute, Université Libre de Bruxelles, Brussels, Belgium.,Department of Functional Neuroimaging, Service of Nuclear Medicine, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Stefan Rampp
- Department of Neurosurgery, University Hospital Erlangen, Erlangen, Germany.,Department of Neurosurgery, University Hospital Halle, Halle, Germany
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Roland JL, Hacker CD, Snyder AZ, Shimony JS, Zempel JM, Limbrick DD, Smyth MD, Leuthardt EC. A comparison of resting state functional magnetic resonance imaging to invasive electrocortical stimulation for sensorimotor mapping in pediatric patients. Neuroimage Clin 2019; 23:101850. [PMID: 31077983 PMCID: PMC6514367 DOI: 10.1016/j.nicl.2019.101850] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 04/21/2019] [Accepted: 05/02/2019] [Indexed: 01/11/2023]
Abstract
Localizing neurologic function within the brain remains a significant challenge in clinical neurosurgery. Invasive mapping with direct electrocortical stimulation currently is the clinical gold standard but is impractical in young or cognitively delayed patients who are unable to reliably perform tasks. Resting state functional magnetic resonance imaging non-invasively identifies resting state networks without the need for task performance, hence, is well suited to pediatric patients. We compared sensorimotor network localization by resting state fMRI to cortical stimulation sensory and motor mapping in 16 pediatric patients aged 3.1 to 18.6 years. All had medically refractory epilepsy that required invasive electrographic monitoring and stimulation mapping. The resting state fMRI data were analyzed using a previously trained machine learning classifier that has previously been evaluated in adults. We report comparable functional localization by resting state fMRI compared to stimulation mapping. These results provide strong evidence for the utility of resting state functional imaging in the localization of sensorimotor cortex across a wide range of pediatric patients.
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Affiliation(s)
- Jarod L Roland
- Department of Neurological Surgery, Washington University in St. Louis, St. Louis, MO, United States of America.
| | - Carl D Hacker
- Department of Neurological Surgery, Washington University in St. Louis, St. Louis, MO, United States of America
| | - Abraham Z Snyder
- Mallinckrodt Institute Radiology, Washington University in St. Louis, St. Louis, MO, United States of America; Neurology, Washington University in St. Louis, St. Louis, MO, United States of America
| | - Joshua S Shimony
- Mallinckrodt Institute Radiology, Washington University in St. Louis, St. Louis, MO, United States of America
| | - John M Zempel
- Neurology, Washington University in St. Louis, St. Louis, MO, United States of America
| | - David D Limbrick
- Department of Neurological Surgery, Washington University in St. Louis, St. Louis, MO, United States of America
| | - Matthew D Smyth
- Department of Neurological Surgery, Washington University in St. Louis, St. Louis, MO, United States of America
| | - Eric C Leuthardt
- Department of Neurological Surgery, Washington University in St. Louis, St. Louis, MO, United States of America; Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, United States of America; Neuroscience, Washington University in St. Louis, St. Louis, MO, United States of America; Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO, United States of America; Center for Innovation in Neuroscience and Technology, Washington University in St. Louis, St. Louis, MO, United States of America; Brain Laser Center, Washington University in St. Louis, St. Louis, MO, United States of America
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76
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Suzuki Y. Selection of neuropsychological tasks from a language test battery that optimally related to the function of each cortical area: Toward making a cognitive cortical map. NEUROIMAGE-CLINICAL 2019; 22:101799. [PMID: 30991619 PMCID: PMC6447742 DOI: 10.1016/j.nicl.2019.101799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/24/2019] [Accepted: 03/26/2019] [Indexed: 11/25/2022]
Abstract
We developed a cortical language map from performance data on a language test battery in patients with brain lesions. The research problem was how to select the subtest that was most related to the function of each cortical area from the battery. When studied by voxel-based lesion-symptom mapping (VLSM), patients were divided into two groups: those with and without a lesion at each particular region. We considered the task that optimally discriminated between the two groups to be the task most related to the function of a given region. One hundred and fifty left-lesioned patients were examined using the Japanese Standard Language Test of Aphasia (SLTA), which is composed of 26 subtests. Using logistic discriminant analysis, we selected the subtest that optimally discriminated the lesioned and non-lesioned groups for each cortical region. Patients with left middle frontal gyrus (area 46) lesions were optimally discriminated from patients without lesions in that area by the speech sound–kana letter choice matching subtest. Patients with lesions in the inferior postcentral gyrus were optimally distinguished by the disturbance of word repetition. Patients with lesions in the anterior cingulate gyrus were characterized by impaired performance on the category fluency subtest. Voxel-based discriminant analysis can thus select the subtest that can be regarded as most related to the function of each cortical area. From a cognitive test battery, we selected the subtest most related to the function of each cortical area. We conducted voxel-based lesion-symptom mapping using t-test and logistic regression. The t-statistic and G-statistic can be used as indicators of differences in task performance. This method is useful for clarifying the primary function of each region of cortex.
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Affiliation(s)
- Yasuhiro Suzuki
- Department of Neurology, Shizuoka Saiseikai general hospital, 1-1-1 Oshika, Suruga-ku, Shizuoka 422-8527, Japan.
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77
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Voss HU, Peck KK, Petrovich Brennan NM, Pogosbekyan EL, Zakharova NE, Batalov AI, Pronin IN, Potapov AA, Holodny AI. A vascular-task response dependency and its application in functional imaging of brain tumors. J Neurosci Methods 2019; 322:10-22. [PMID: 30991031 DOI: 10.1016/j.jneumeth.2019.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 03/21/2019] [Accepted: 04/09/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Preoperative functional MRI (fMRI) is limited by a muted BOLD response caused by abnormal vasoreactivity and resultant neurovascular uncoupling adjacent to malignant brain tumors. We propose to overcome this limitation and more accurately identify eloquent areas adjacent to brain tumors by independently assessing vasoreactivity using breath-holding and incorporating these data into the fMRI analysis. METHODS Local vasoreactivity using a breath-holding paradigm with the same timing as the functional motor and language tasks was determined in 16 patients (9 glioblastomas, 1 anaplastic astrocytoma, 5 low grade astrocytomas, and 1 metastasis) and 6 healthy control subjects. We derived an fMRI model based on an observed vaso-task response dependency that takes into account the altered hemodynamics adjacent to brain tumors. RESULTS In both healthy controls and brain tumor subjects, we found a statistical dependency between breath-hold and task BOLD response. In tumor subjects, activation maps that take into account this vaso-task dependency demonstrated clinically meaningful areas of activation that were not seen using the task-only analysis in about half of the cases studied. This included localization of language areas adjacent to brain tumors. CONCLUSIONS The present preliminary results demonstrate that neurovascular uncoupling known to affect the accuracy of BOLD fMRI adjacent to brain tumors may be, at least partially, overcome by incorporating an observed vaso-task dependency in the BOLD signal analysis.
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Affiliation(s)
- Henning U Voss
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA.
| | - Kyung K Peck
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Functional MRI Laboratory, Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | | | | | - Artyom I Batalov
- Department of Radiology, Burdenko Neurosurgery Center, Moscow, Russia
| | - Igor N Pronin
- Department of Radiology, Burdenko Neurosurgery Center, Moscow, Russia
| | | | - Andrei I Holodny
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA; Functional MRI Laboratory, Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Brain Tumor Center, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Department of Neuroscience, Weill-Cornell Graduate School of the Medical Sciences, New York, NY, USA
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78
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Functional neuroimaging in patients presenting with somatoform disorders: A model for investigating persisting symptoms after tick bites and post-treatment Lyme disease syndrome? Med Mal Infect 2019; 49:150-156. [PMID: 30736992 DOI: 10.1016/j.medmal.2019.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 01/08/2019] [Indexed: 12/13/2022]
Abstract
Approximately 10% of patients presenting with Lyme disease experience fatigue, musculoskeletal pain, concentration disorders, or short-term memory deficits in the six months following treatment. This entity has been defined as post-Lyme disease syndrome or post-treatment Lyme disease syndrome. The pathophysiology of this syndrome is unknown, but neither persistence of the bacterium nor effectiveness of antibiotics are currently reported in the literature. The French High Council for Public Health (French acronym HCSP) has recently defined a new entity called "persistent polymorphic symptoms after a tick bite" allowing for designing studies to better understand these subjective presentations, for which objective biomarkers are currently lacking. This entity encompasses patients experiencing fatigue and generalized pain in the months following a tick bite and can be associated with several subjective symptoms with major impact on the quality of life. In the field of somatoform disorders, this article reviews functional neuroimaging studies in patients presenting with subjective complaints and discusses potential clinical implications for persisting symptoms after tick bites and post-treatment Lyme disease syndrome.
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79
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Jeng XJ, Chen X. Variable selection via adaptive false negative control in linear regression. Electron J Stat 2019. [DOI: 10.1214/19-ejs1649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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80
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Rosazza C, Zacà D, Bruzzone MG. Pre-surgical Brain Mapping: To Rest or Not to Rest? Front Neurol 2018; 9:520. [PMID: 30018589 PMCID: PMC6038713 DOI: 10.3389/fneur.2018.00520] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 06/12/2018] [Indexed: 12/16/2022] Open
Affiliation(s)
- Cristina Rosazza
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico “Carlo Besta,”, Milan, Italy
| | - Domenico Zacà
- Center for Mind/Brain Sciences (CIMeC), University of Trento, Trento, Italy
| | - Maria G. Bruzzone
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico “Carlo Besta,”, Milan, Italy
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81
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Merčep E, Deán-Ben XL, Razansky D. Imaging of blood flow and oxygen state with a multi-segment optoacoustic ultrasound array. PHOTOACOUSTICS 2018; 10:48-53. [PMID: 29988801 PMCID: PMC6032509 DOI: 10.1016/j.pacs.2018.04.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/03/2018] [Accepted: 04/23/2018] [Indexed: 05/03/2023]
Abstract
Changes in hemodynamic parameters are directly linked to biological function and physiological activity. Characterization of hemodynamics is commonly performed by Doppler ultrasound, which provides accurate measurements of blood flow velocity. Multi-spectral optoacoustic tomography is rapidly undergoing clinical translation fostered by its unique and complementary capacity for label-free mapping of the blood volume and the distribution of oxy- and deoxy-hemoglobin in blood. Here we report on a hybrid optoacoustic and ultrasound imaging approach that enables multi-modal imaging of blood flow and oxygen state using a multi-segment detector array. We further demonstrate rendering of multi-modal pulse-echo ultrasound, multi-spectral optoacoustic tomography, and color Doppler images from carotid artery of a healthy subject.
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Affiliation(s)
- Elena Merčep
- Faculty of Medicine, Technical University of Munich, Germany
- iThera Medical GmbH, Munich, Germany
| | - Xosé Luís Deán-Ben
- Institute for Biological and Medical Imaging (IBMI), Helmholtz Center Munich, Neuherberg, Germany
| | - Daniel Razansky
- Faculty of Medicine, Technical University of Munich, Germany
- Institute for Biological and Medical Imaging (IBMI), Helmholtz Center Munich, Neuherberg, Germany
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82
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Foster MT, Harishchandra LS, Mallucci C. Pediatric Central Nervous System Tumors: State-of-the-Art and Debated Aspects. Front Pediatr 2018; 6:309. [PMID: 30443540 PMCID: PMC6223202 DOI: 10.3389/fped.2018.00309] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 10/01/2018] [Indexed: 01/23/2023] Open
Abstract
Pediatric neuro-oncology surgery continues to progress in sophistication, largely driven by advances in technology used to aid the following aspects of surgery: operative planning (advanced MRI techniques including fMRI and DTI), intraoperative navigation [preoperative MRI, intra-operative MRI (ioMRI) and intra-operative ultrasound (ioUS)], tumor visualization (microscopy, endoscopy, fluorescence), tumor resection techniques (ultrasonic aspirator, micro-instruments, micro-endoscopic instruments), delineation of the resection extent (ioMRI, ioUS, and fluorescence), and intraoperative safety (neurophysiological monitoring, ioMRI). This article discusses the aforementioned technological advances, and their multimodal use to optimize safe pediatric neuro-oncology surgery.
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Affiliation(s)
- Mitchell T Foster
- Department of Neurosurgery, Alder Hey NHS Foundation Trust, Liverpool, United Kingdom
| | | | - Conor Mallucci
- Department of Neurosurgery, Alder Hey NHS Foundation Trust, Liverpool, United Kingdom
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