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Moretto M, Luciani BF, Zigiotto L, Saviola F, Tambalo S, Cabalo DG, Annicchiarico L, Venturini M, Jovicich J, Sarubbo S. Resting State Functional Networks in Gliomas: Validation With Direct Electric Stimulation of a New Tool for Planning Brain Resections. Neurosurgery 2024:00006123-990000000-01188. [PMID: 38836617 DOI: 10.1227/neu.0000000000003012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/29/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Precise mapping of functional networks in patients with brain tumor is essential for tailoring personalized treatment strategies. Resting-state functional MRI (rs-fMRI) offers an alternative to task-based fMRI, capable of capturing multiple networks within a single acquisition, without necessitating task engagement. This study demonstrates a strong concordance between preoperative rs-fMRI maps and the gold standard intraoperative direct electric stimulation (DES) mapping during awake surgery. METHODS We conducted an analysis involving 28 patients with glioma who underwent awake surgery with DES mapping. A total of 100 DES recordings were collected to map sensorimotor (SMN), language (LANG), visual (VIS), and speech articulation cognitive domains. Preoperative rs-fMRI maps were generated using an updated version of the ReStNeuMap software, specifically designed for rs-fMRI data preprocessing and automatic detection of 7 resting-state networks (SMN, LANG, VIS, speech articulation, default mode, frontoparietal, and visuospatial). To evaluate the agreement between these networks and those mapped with invasive cortical mapping, we computed patient-specific distances between them and intraoperative DES recordings. RESULTS Automatically detected preoperative functional networks exhibited excellent agreement with intraoperative DES recordings. When we spatially compared DES points with their corresponding networks, we found that SMN, VIS, and speech articulatory DES points fell within the corresponding network (median distance = 0 mm), whereas for LANG a median distance of 1.6 mm was reported. CONCLUSION Our findings show the remarkable consistency between key functional networks mapped noninvasively using presurgical rs-fMRI and invasive cortical mapping. This evidence highlights the utility of rs-fMRI for personalized presurgical planning, particularly in scenarios where awake surgery with DES is not feasible to protect eloquent areas during tumor resection. We have made the updated tool for automated functional network estimation publicly available, facilitating broader utilization of rs-fMRI mapping in various clinical contexts, including presurgical planning, functional reorganization over follow-up periods, and informing future treatments such as radiotherapy.
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Affiliation(s)
- Manuela Moretto
- Center for Mind/Brain Sciences (CIMeC), University of Trento, Trento, Italy
| | | | - Luca Zigiotto
- Department of Neurosurgery, "S. Chiara" University-Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
- Department of Psychology, University of Trento, Trento, Italy
| | - Francesca Saviola
- Center for Mind/Brain Sciences (CIMeC), University of Trento, Trento, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Stefano Tambalo
- Center for Mind/Brain Sciences (CIMeC), University of Trento, Trento, Italy
| | - Donna Gift Cabalo
- Center for Mind/Brain Sciences (CIMeC), University of Trento, Trento, Italy
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Luciano Annicchiarico
- Department of Neurosurgery, "S. Chiara" University-Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Martina Venturini
- Department of Neurosurgery, "S. Chiara" University-Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Jorge Jovicich
- Center for Mind/Brain Sciences (CIMeC), University of Trento, Trento, Italy
| | - Silvio Sarubbo
- Center for Mind/Brain Sciences (CIMeC), University of Trento, Trento, Italy
- Department of Neurosurgery, "S. Chiara" University-Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
- Department of Cellular, Computation and Integrative Biology (CIBIO), University of Trento, Trento, Italy
- Centre for Medical Sciences (CISMED), University of Trento, Trento, Italy
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2
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Ayyash S, Davis AD, Alders GL, MacQueen G, Strother SC, Hassel S, Zamyadi M, Arnott SR, Harris JK, Lam RW, Milev R, Müller DJ, Kennedy SH, Rotzinger S, Frey BN, Minuzzi L, Hall GB. Assessing remission in major depressive disorder using a functional-structural data fusion pipeline: A CAN-BIND-1 study. IBRO Neurosci Rep 2024; 16:135-146. [PMID: 38293679 PMCID: PMC10826332 DOI: 10.1016/j.ibneur.2023.12.011] [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: 09/24/2023] [Accepted: 12/30/2023] [Indexed: 02/01/2024] Open
Abstract
Neural network-level changes underlying symptom remission in major depressive disorder (MDD) are often studied from a single perspective. Multimodal approaches to assess neuropsychiatric disorders are evolving, as they offer richer information about brain networks. A FATCAT-awFC pipeline was developed to integrate a computationally intense data fusion method with a toolbox, to produce a faster and more intuitive pipeline for combining functional connectivity with structural connectivity (denoted as anatomically weighted functional connectivity (awFC)). Ninety-three participants from the Canadian Biomarker Integration Network for Depression study (CAN-BIND-1) were included. Patients with MDD were treated with 8 weeks of escitalopram and adjunctive aripiprazole for another 8 weeks. Between-group connectivity (SC, FC, awFC) comparisons contrasted remitters (REM) with non-remitters (NREM) at baseline and 8 weeks. Additionally, a longitudinal study analysis was performed to compare connectivity changes across time for REM, from baseline to week-8. Association between cognitive variables and connectivity were also assessed. REM were distinguished from NREM by lower awFC within the default mode, frontoparietal, and ventral attention networks. Compared to REM at baseline, REM at week-8 revealed increased awFC within the dorsal attention network and decreased awFC within the frontoparietal network. A medium effect size was observed for most results. AwFC in the frontoparietal network was associated with neurocognitive index and cognitive flexibility for the NREM group at week-8. In conclusion, the FATCAT-awFC pipeline has the benefit of providing insight on the 'full picture' of connectivity changes for REMs and NREMs while making for an easy intuitive approach.
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Affiliation(s)
- Sondos Ayyash
- School of Biomedical Engineering, McMaster University, Hamilton, Ontario, Canada
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Andrew D Davis
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Rotman Research Institute, Baycrest, Toronto, Ontario, Canada
| | - Gésine L Alders
- Neuroscience Graduate Program, McMaster University, Hamilton, Ontario, Canada
| | - Glenda MacQueen
- Hotchkiss Brain Institute and Mathison Centre for Mental Health Research and Education, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Stephen C Strother
- Rotman Research Institute, Baycrest, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Ontario, Canada
| | - Stefanie Hassel
- Hotchkiss Brain Institute and Mathison Centre for Mental Health Research and Education, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mojdeh Zamyadi
- Rotman Research Institute, Baycrest, Toronto, Ontario, Canada
| | | | - Jacqueline K Harris
- Department of Computer Science, University of Alberta, Edmonton, Alberta, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Roumen Milev
- Departments of Psychiatry and Psychology, Queen's University, Providence Care Hospital, Kingston, Ontario, Canada
| | - Daniel J Müller
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Sidney H Kennedy
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Centre for Depression and Suicide Studies, and Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Susan Rotzinger
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Centre for Depression and Suicide Studies, and Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Neuroscience Graduate Program, McMaster University, Hamilton, Ontario, Canada
- Mood Disorders Treatment and Research Centre and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Luciano Minuzzi
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Neuroscience Graduate Program, McMaster University, Hamilton, Ontario, Canada
- Mood Disorders Treatment and Research Centre and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Geoffrey B Hall
- School of Biomedical Engineering, McMaster University, Hamilton, Ontario, Canada
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Neuroscience Graduate Program, McMaster University, Hamilton, Ontario, Canada
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Radwan AM, Emsell L, Vansteelandt K, Cleeren E, Peeters R, De Vleeschouwer S, Theys T, Dupont P, Sunaert S. Comparative validation of automated presurgical tractography based on constrained spherical deconvolution and diffusion tensor imaging with direct electrical stimulation. Hum Brain Mapp 2024; 45:e26662. [PMID: 38646998 PMCID: PMC11033921 DOI: 10.1002/hbm.26662] [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: 09/26/2023] [Revised: 01/27/2024] [Accepted: 03/08/2024] [Indexed: 04/25/2024] Open
Abstract
OBJECTIVES Accurate presurgical brain mapping enables preoperative risk assessment and intraoperative guidance. This cross-sectional study investigated whether constrained spherical deconvolution (CSD) methods were more accurate than diffusion tensor imaging (DTI)-based methods for presurgical white matter mapping using intraoperative direct electrical stimulation (DES) as the ground truth. METHODS Five different tractography methods were compared (three DTI-based and two CSD-based) in 22 preoperative neurosurgical patients undergoing surgery with DES mapping. The corticospinal tract (CST, N = 20) and arcuate fasciculus (AF, N = 7) bundles were reconstructed, then minimum distances between tractograms and DES coordinates were compared between tractography methods. Receiver-operating characteristic (ROC) curves were used for both bundles. For the CST, binary agreement, linear modeling, and posthoc testing were used to compare tractography methods while correcting for relative lesion and bundle volumes. RESULTS Distance measures between 154 positive (functional response, pDES) and negative (no response, nDES) coordinates, and 134 tractograms resulted in 860 data points. Higher agreement was found between pDES coordinates and CSD-based compared to DTI-based tractograms. ROC curves showed overall higher sensitivity at shorter distance cutoffs for CSD (8.5 mm) compared to DTI (14.5 mm). CSD-based CST tractograms showed significantly higher agreement with pDES, which was confirmed by linear modeling and posthoc tests (PFWE < .05). CONCLUSIONS CSD-based CST tractograms were more accurate than DTI-based ones when validated using DES-based assessment of motor and sensory function. This demonstrates the potential benefits of structural mapping using CSD in clinical practice.
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Affiliation(s)
- Ahmed Mohamed Radwan
- KU Leuven, Department of Imaging and PathologyTranslational MRILeuvenBelgium
- KU Leuven, Leuven Brain Institute (LBI), Department of NeurosciencesLeuvenBelgium
| | - Louise Emsell
- KU Leuven, Department of Imaging and PathologyTranslational MRILeuvenBelgium
- KU Leuven, Leuven Brain Institute (LBI), Department of NeurosciencesLeuvenBelgium
- KU Leuven, Department of Neurosciences, NeuropsychiatryLeuvenBelgium
- KU Leuven, Department of Geriatric PsychiatryUniversity Psychiatric Center (UPC)LeuvenBelgium
| | - Kristof Vansteelandt
- KU Leuven, Leuven Brain Institute (LBI), Department of NeurosciencesLeuvenBelgium
- KU Leuven, Department of Neurosciences, NeuropsychiatryLeuvenBelgium
- KU Leuven, Department of Geriatric PsychiatryUniversity Psychiatric Center (UPC)LeuvenBelgium
| | - Evy Cleeren
- UZ Leuven, Department of NeurologyLeuvenBelgium
- UZ Leuven, Department of NeurosurgeryLeuvenBelgium
| | | | - Steven De Vleeschouwer
- KU Leuven, Leuven Brain Institute (LBI), Department of NeurosciencesLeuvenBelgium
- UZ Leuven, Department of NeurosurgeryLeuvenBelgium
- KU Leuven, Department of NeurosciencesResearch Group Experimental Neurosurgery and NeuroanatomyLeuvenBelgium
| | - Tom Theys
- KU Leuven, Leuven Brain Institute (LBI), Department of NeurosciencesLeuvenBelgium
- UZ Leuven, Department of NeurosurgeryLeuvenBelgium
- KU Leuven, Department of NeurosciencesResearch Group Experimental Neurosurgery and NeuroanatomyLeuvenBelgium
| | - Patrick Dupont
- KU Leuven, Leuven Brain Institute (LBI), Department of NeurosciencesLeuvenBelgium
- KU Leuven, Laboratory for Cognitive NeurologyDepartment of NeurosciencesLeuvenBelgium
| | - Stefan Sunaert
- KU Leuven, Department of Imaging and PathologyTranslational MRILeuvenBelgium
- KU Leuven, Leuven Brain Institute (LBI), Department of NeurosciencesLeuvenBelgium
- UZ Leuven, Department of RadiologyLeuvenBelgium
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4
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Voets NL, Bartsch AJ, Plaha P. Functional MRI applications for intra-axial brain tumours: uses and nuances in surgical practise. Br J Neurosurg 2023; 37:1544-1559. [PMID: 36148501 DOI: 10.1080/02688697.2022.2123893] [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: 03/18/2022] [Accepted: 09/07/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Functional MRI (fMRI) has well-established uses to inform risks and plan maximally safe approaches in neurosurgery. In the field of brain tumour surgery, however, fMRI is currently in a state of clinical equipoise due to debate around both its sensitivity and specificity. MATERIALS AND METHODS In this review, we summarise the role and our experience of fMRI in neurosurgery for gliomas and metastases. We discuss nuances in the conduct and interpretation of fMRI that, based on our practise, most directly impact fMRI's usefulness in the neurosurgical setting. RESULTS Illustrated examples in which fMRI in our hands directly influences the neurosurgical treatment of brain tumours include evaluating the probability and nature of functional risks, especially for language functions. These presurgical risk assessments, in turn, help to predict the resectability of tumours, select or deselect patients for awake surgery, indicate the need for neurophysiological monitoring and guide the optimal use of intra-operative stimulation mapping. A further emerging application of fMRI is in measuring functional adaptation of functional networks after (partial) surgery, of potential use in the timing of further surgery. CONCLUSIONS In appropriately selected patients with a clearly defined surgical question, fMRI offers a valuable complementary tool in the pre-surgical evaluation of brain tumours. However, there is a great need for standards in the administration and analysis of fMRI as much as in the techniques that it is commonly evaluated against. Surprisingly little data exists that evaluates the accuracy of fMRI not just against complementary methods, but in terms of its ultimate clinical aim of minimising post-surgical morbidity.
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Affiliation(s)
- Natalie L Voets
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- GenesisCare Ltd, Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Andreas J Bartsch
- Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany
| | - Puneet Plaha
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Neurosurgery, University of Oxford, Oxford, UK
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5
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Maas DA, Douw L. Multiscale network neuroscience in neuro-oncology: How tumors, brain networks, and behavior connect across scales. Neurooncol Pract 2023; 10:506-517. [PMID: 38026586 PMCID: PMC10666814 DOI: 10.1093/nop/npad044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
Network neuroscience refers to the investigation of brain networks across different spatial and temporal scales, and has become a leading framework to understand the biology and functioning of the brain. In neuro-oncology, the study of brain networks has revealed many insights into the structure and function of cells, circuits, and the entire brain, and their association with both functional status (e.g., cognition) and survival. This review connects network findings from different scales of investigation, with the combined aim of informing neuro-oncological healthcare professionals on this exciting new field and also delineating the promising avenues for future translational and clinical research that may allow for application of network methods in neuro-oncological care.
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Affiliation(s)
- Dorien A Maas
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Anatomy and Neurosciences, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Linda Douw
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Anatomy and Neurosciences, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Amsterdam, The Netherlands
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6
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Sollmann N, Zhang H, Kloth C, Zimmer C, Wiestler B, Rosskopf J, Kreiser K, Schmitz B, Beer M, Krieg SM. Modern preoperative imaging and functional mapping in patients with intracranial glioma. ROFO-FORTSCHR RONTG 2023; 195:989-1000. [PMID: 37224867 DOI: 10.1055/a-2083-8717] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Magnetic resonance imaging (MRI) in therapy-naïve intracranial glioma is paramount for neuro-oncological diagnostics, and it provides images that are helpful for surgery planning and intraoperative guidance during tumor resection, including assessment of the involvement of functionally eloquent brain structures. This study reviews emerging MRI techniques to depict structural information, diffusion characteristics, perfusion alterations, and metabolism changes for advanced neuro-oncological imaging. In addition, it reflects current methods to map brain function close to a tumor, including functional MRI and navigated transcranial magnetic stimulation with derived function-based tractography of subcortical white matter pathways. We conclude that modern preoperative MRI in neuro-oncology offers a multitude of possibilities tailored to clinical needs, and advancements in scanner technology (e. g., parallel imaging for acceleration of acquisitions) make multi-sequence protocols increasingly feasible. Specifically, advanced MRI using a multi-sequence protocol enables noninvasive, image-based tumor grading and phenotyping in patients with glioma. Furthermore, the add-on use of preoperatively acquired MRI data in combination with functional mapping and tractography facilitates risk stratification and helps to avoid perioperative functional decline by providing individual information about the spatial location of functionally eloquent tissue in relation to the tumor mass. KEY POINTS:: · Advanced preoperative MRI allows for image-based tumor grading and phenotyping in glioma.. · Multi-sequence MRI protocols nowadays make it possible to assess various tumor characteristics (incl. perfusion, diffusion, and metabolism).. · Presurgical MRI in glioma is increasingly combined with functional mapping to identify and enclose individual functional areas.. · Advancements in scanner technology (e. g., parallel imaging) facilitate increasing application of dedicated multi-sequence imaging protocols.. CITATION FORMAT: · Sollmann N, Zhang H, Kloth C et al. Modern preoperative imaging and functional mapping in patients with intracranial glioma. Fortschr Röntgenstr 2023; 195: 989 - 1000.
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Affiliation(s)
- Nico Sollmann
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, München, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, München, Germany
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, United States
| | - Haosu Zhang
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, München, Germany
| | - Christopher Kloth
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, München, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, München, Germany
| | - Benedikt Wiestler
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, München, Germany
- TranslaTUM - Central Institute for Translational Cancer Research, Klinikum rechts der Isar, Technical University of Munich, München, Germany
| | - Johannes Rosskopf
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
- Section of Neuroradiology, Bezirkskrankenhaus Günzburg, Günzburg, Germany
| | - Kornelia Kreiser
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
- Department of Radiology and Neuroradiology, Universitäts- und Rehabilitationskliniken Ulm, Ulm, Germany
| | - Bernd Schmitz
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
- Section of Neuroradiology, Bezirkskrankenhaus Günzburg, Günzburg, Germany
| | - Meinrad Beer
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Sandro M Krieg
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, München, Germany
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, München, Germany
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Caredda C, Van Reeth E, Mahieu-Williame L, Sablong R, Sdika M, Schneider FC, Picart T, Guyotat J, Montcel B. Intraoperative identification of functional brain areas with RGB imaging using statistical parametric mapping: Simulation and clinical studies. Neuroimage 2023; 278:120286. [PMID: 37487945 DOI: 10.1016/j.neuroimage.2023.120286] [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: 03/25/2023] [Revised: 07/06/2023] [Accepted: 07/19/2023] [Indexed: 07/26/2023] Open
Abstract
Complementary technique to preoperative fMRI and electrical brain stimulation (EBS) for glioma resection could improve dramatically the surgical procedure and patient care. Intraoperative RGB optical imaging is a technique for localizing functional areas of the human cerebral cortex that can be used during neurosurgical procedures. However, it still lacks robustness to be used with neurosurgical microscopes as a clinical standard. In particular, a robust quantification of biomarkers of brain functionality is needed to assist neurosurgeons. We propose a methodology to evaluate and optimize intraoperative identification of brain functional areas by RGB imaging. This consist in a numerical 3D brain model based on Monte Carlo simulations to evaluate intraoperative optical setups for identifying functional brain areas. We also adapted fMRI Statistical Parametric Mapping technique to identify functional brain areas in RGB videos acquired for 12 patients. Simulation and experimental results were consistent and showed that the intraoperative identification of functional brain areas is possible with RGB imaging using deoxygenated hemoglobin contrast. Optical functional identifications were consistent with those provided by EBS and preoperative fMRI. We also demonstrated that a halogen lighting may be particularity adapted for functional optical imaging. We showed that an RGB camera combined with a quantitative modeling of brain hemodynamics biomarkers can evaluate in a robust way the functional areas during neurosurgery and serve as a tool of choice to complement EBS and fMRI.
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Affiliation(s)
- Charly Caredda
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1294, F69100, Lyon, France.
| | - Eric Van Reeth
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1294, F69100, Lyon, France
| | - Laurent Mahieu-Williame
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1294, F69100, Lyon, France
| | - Raphaël Sablong
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1294, F69100, Lyon, France
| | - Michaël Sdika
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1294, F69100, Lyon, France
| | - Fabien C Schneider
- Service de Radiologie, Centre Hospitalier Universitaire de Saint Etienne, TAPE EA7423, Université de Lyon, UJM Saint Etienne, F42023, France
| | - Thiébaud Picart
- Service de Neurochirurgie D, Hospices Civils de Lyon, Bron, France
| | - Jacques Guyotat
- Service de Neurochirurgie D, Hospices Civils de Lyon, Bron, France
| | - Bruno Montcel
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1294, F69100, Lyon, France.
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Yang Z, Zhao C, Zong S, Piao J, Zhao Y, Chen X. A review on surgical treatment options in gliomas. Front Oncol 2023; 13:1088484. [PMID: 37007123 PMCID: PMC10061125 DOI: 10.3389/fonc.2023.1088484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/24/2023] [Indexed: 03/17/2023] Open
Abstract
Gliomas are one of the most common primary central nervous system tumors, and surgical treatment remains the principal role in the management of any grade of gliomas. In this study, based on the introduction of gliomas, we review the novel surgical techniques and technologies in support of the extent of resection to achieve long-term disease control and summarize the findings on how to keep the balance between cytoreduction and neurological morbidity from a list of literature searched. With modern neurosurgical techniques, gliomas resection can be safely performed with low morbidity and extraordinary long-term functional outcomes.
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Affiliation(s)
- Zhongxi Yang
- Department of Neurosurgery, The First Hospital of Jilin University, Jilin, China
| | - Chen Zhao
- Department of Neurosurgery, The First Hospital of Jilin University, Jilin, China
| | - Shan Zong
- Department of Gynecology Oncology, The First Hospital of Jilin University, Jilin, China
| | - Jianmin Piao
- Department of Neurosurgery, The First Hospital of Jilin University, Jilin, China
| | - Yuhao Zhao
- Department of Neurosurgery, The First Hospital of Jilin University, Jilin, China
| | - Xuan Chen
- Department of Neurosurgery, The First Hospital of Jilin University, Jilin, China
- *Correspondence: Xuan Chen,
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9
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Gujar SK, Manzoor K, Wongsripuemtet J, Wang G, Ryan D, Agarwal S, Lindquist M, Caffo B, Pillai JJ, Sair HI. Identification of the Language Network from Resting-State fMRI in Patients with Brain Tumors: How Accurate Are Experts? AJNR Am J Neuroradiol 2023; 44:274-282. [PMID: 36822828 PMCID: PMC10187806 DOI: 10.3174/ajnr.a7806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/04/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND AND PURPOSE Resting-state fMRI helps identify neural networks in presurgical patients who may be limited in their ability to undergo task-fMRI. The purpose of this study was to determine the accuracy of identifying the language network from resting-state-fMRI independent component analysis (ICA) maps. MATERIALS AND METHODS Through retrospective analysis, patients who underwent both resting-state-fMRI and task-fMRI were compared by identifying the language network from the resting-state-fMRI data by 3 reviewers. Blinded to task-fMRI maps, these investigators independently reviewed resting-state-fMRI ICA maps to potentially identify the language network. Reviewers ranked up to 3 top choices for the candidate resting-state-fMRI language map. We evaluated associations between the probability of correct identification of the language network and some potential factors. RESULTS Patients included 29 men and 14 women with a mean age of 41 years. Reviewer 1 (with 17 years' experience) demonstrated the highest overall accuracy with 72%; reviewers 2 and 3 (with 2 and 7 years' experience, respectively) had a similar percentage of correct responses (50% and 55%). The highest accuracy used ICA50 and the top 3 choices (81%, 65%, and 60% for reviewers 1, 2, and 3, respectively). The lowest accuracy used ICA50, limiting each reviewer to the top choice (58%, 35%, and 42%). CONCLUSIONS We demonstrate variability in the accuracy of blinded identification of resting-state-fMRI language networks across reviewers with different years of experience.
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Affiliation(s)
- S K Gujar
- From the Division of Neuroradiology (S.K.G., K.M., J.W., D.R., S.A., J.J.P., H.I.S.), The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - K Manzoor
- From the Division of Neuroradiology (S.K.G., K.M., J.W., D.R., S.A., J.J.P., H.I.S.), The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - J Wongsripuemtet
- From the Division of Neuroradiology (S.K.G., K.M., J.W., D.R., S.A., J.J.P., H.I.S.), The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - G Wang
- Department of Biostatistics (G.W., M.L., B.C.)
| | - D Ryan
- From the Division of Neuroradiology (S.K.G., K.M., J.W., D.R., S.A., J.J.P., H.I.S.), The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - S Agarwal
- From the Division of Neuroradiology (S.K.G., K.M., J.W., D.R., S.A., J.J.P., H.I.S.), The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - M Lindquist
- Department of Biostatistics (G.W., M.L., B.C.)
| | - B Caffo
- Department of Biostatistics (G.W., M.L., B.C.)
| | - J J Pillai
- From the Division of Neuroradiology (S.K.G., K.M., J.W., D.R., S.A., J.J.P., H.I.S.), The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Neurosurgery (J.J.P.)
| | - H I Sair
- From the Division of Neuroradiology (S.K.G., K.M., J.W., D.R., S.A., J.J.P., H.I.S.), The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
- The Malone Center for Engineering in Healthcare (H.I.S.), The Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland
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10
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Anwar A, Radwan A, Zaky I, El Ayadi M, Youssef A. Resting state fMRI brain mapping in pediatric supratentorial brain tumors. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00713-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Functional mapping of eloquent brain areas is crucial for preoperative planning in patients with brain tumors. Resting state functional MRI (rs-fMRI) allows the localization of functional brain areas without the need for task performance, making it well-suited for the pediatric population. In this study the independent component analysis (ICA) rs-fMRI functional mapping results are reported in a group of 22 pediatric patients with supratentorial brain tumors. Additionally, the functional connectivity (FC) maps of the sensori-motor network (SMN) obtained using ICA and seed-based analysis (SBA) are compared.
Results
Different resting state networks (RSNs) were extracted using ICA with varying levels of sensitivity, notably, the SMN was identified in 100% of patients, followed by the Default mode network (DMN) (91%) and Language networks (80%). Additionally, FC maps of the SMN extracted by SBA were more extensive (mean volume = 25,288.36 mm3, standard deviation = 13,364.36 mm3) than those found on ICA (mean volume = 13,403.27 mm3, standard deviation = 9755.661 mm3). This was confirmed by statistical analysis using a Wilcoxon signed rank t test at p < 0.01.
Conclusions
Results clearly demonstrate the successful applicability of rs-fMRI for localizing different functional brain networks in the preoperative assessment of brain areas, and thus represent a further step in the integration of computational radiology research in a clinical setting.
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11
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Cirillo S, Battistella G, Castellano A, Sanvito F, Iadanza A, Bailo M, Barzaghi RL, Acerno S, Mortini P, Gorno-Tempini ML, Mandelli ML, Falini A. Comparison between inferior frontal gyrus intrinsic connectivity network and verb-generation task fMRI network for presurgical language mapping in healthy controls and in glioma patients. Brain Imaging Behav 2022; 16:2569-2585. [PMID: 35908147 DOI: 10.1007/s11682-022-00712-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 11/02/2022]
Abstract
Task-based functional MRI (tb-fMRI) represents an extremely valuable approach for the identification of language eloquent regions for presurgical mapping in patients with brain tumors. However, its routinely application is limited by patient-related factors, such as cognitive disability and difficulty in coping with long-time acquisitions, and by technical factors, such as lack of equipment availability for stimuli delivery. Resting-state fMRI (rs-fMRI) instead, allows the identification of distinct language networks in a 10-min acquisition without the need of performing active tasks and using specific equipment. Therefore, to test the feasibility of rs-fMRI as a preoperative mapping tool, we reconstructed a lexico-semantic intrinsic connectivity network (ICN) in healthy controls (HC) and in a case series of patients with gliomas and compared the organization of this language network with the one derived from tb-fMRI in the patient's group. We studied three patients with extra-frontal gliomas who underwent functional mapping with auditory verb-generation (AVG) task and rs-fMRI with a seed in the left inferior frontal gyrus (IFG). First, we identified the functional connected areas to the IFG in HC. We qualitatively compared these areas with those that showed functional activation in AVG task derived from Neurosynth meta-analysis. Last, in each patient we performed single-subject analyses both for rs- and tb-fMRI, and we evaluated the spatial overlap between the two approaches. In HC, the IFG-ICN network showed a predominant left fronto-temporal functional connectivity in regions overlapping with the AVG network derived from a meta-analysis. In two patients, rs- and tb-fMRI showed comparable patterns of activation in left fronto-temporal regions, with different levels of contralateral activations. The third patient could not accomplish the AVG task and thus it was not possible to make any comparison with the ICN. However, in this patient, task-free approach disclosed a consistent network of fronto-temporal regions as in HC, and additional parietal regions. Our preliminary findings support the value of rs-fMRI approach for presurgical mapping, particularly for identifying left fronto-temporal core language-related areas in glioma patients. In a preoperative setting, rs-fMRI approach could represent a powerful tool for the identification of eloquent language areas, especially in patients with language or cognitive impairments.
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Affiliation(s)
- Sara Cirillo
- Neuroradiology Unit and CERMAC, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giovanni Battistella
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Antonella Castellano
- Neuroradiology Unit and CERMAC, IRCCS Ospedale San Raffaele, Milan, Italy. .,Vita-Salute San Raffaele University, Milan, Italy.
| | | | - Antonella Iadanza
- Neuroradiology Unit and CERMAC, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Michele Bailo
- Vita-Salute San Raffaele University, Milan, Italy.,Neurosurgery and Gamma Knife Radiosurgery Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Stefania Acerno
- Neurosurgery and Gamma Knife Radiosurgery Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Pietro Mortini
- Vita-Salute San Raffaele University, Milan, Italy.,Neurosurgery and Gamma Knife Radiosurgery Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Maria Luisa Gorno-Tempini
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA.,Department of Psychiatry and Behavioral Science, and Weill Institute for Neurosciences, UCSF, San Francisco, CA, 94158, USA
| | - Maria Luisa Mandelli
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Andrea Falini
- Neuroradiology Unit and CERMAC, IRCCS Ospedale San Raffaele, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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12
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Aabedi AA, Young JS, Chang EF, Berger MS, Hervey-Jumper SL. Involvement of White Matter Language Tracts in Glioma: Clinical Implications, Operative Management, and Functional Recovery After Injury. Front Neurosci 2022; 16:932478. [PMID: 35898410 PMCID: PMC9309688 DOI: 10.3389/fnins.2022.932478] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/14/2022] [Indexed: 11/13/2022] Open
Abstract
To achieve optimal survival and quality of life outcomes in patients with glioma, the extent of tumor resection must be maximized without causing injury to eloquent structures. Preservation of language function is of particular importance to patients and requires careful mapping to reveal the locations of cortical language hubs and their structural and functional connections. Within this language network, accurate mapping of eloquent white matter tracts is critical, given the high risk of permanent neurological impairment if they are injured during surgery. In this review, we start by describing the clinical implications of gliomas involving white matter language tracts. Next, we highlight the advantages and limitations of methods commonly used to identify these tracts during surgery including structural imaging techniques, functional imaging, non-invasive stimulation, and finally, awake craniotomy. We provide a rationale for combining these complementary techniques as part of a multimodal mapping paradigm to optimize postoperative language outcomes. Next, we review local and long-range adaptations that take place as the language network undergoes remodeling after tumor growth and surgical resection. We discuss the probable cellular mechanisms underlying this plasticity with emphasis on the white matter, which until recently was thought to have a limited role in adults. Finally, we provide an overview of emerging developments in targeting the glioma-neuronal network interface to achieve better disease control and promote recovery after injury.
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Affiliation(s)
| | | | | | | | - Shawn L. Hervey-Jumper
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
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13
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TMS Seeded Diffusion Tensor Imaging Tractography Predicts Permanent Neurological Deficits. Cancers (Basel) 2022; 14:cancers14020340. [PMID: 35053503 PMCID: PMC8774180 DOI: 10.3390/cancers14020340] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/01/2022] [Accepted: 01/06/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary For brain tumor patients, surgeons must resect as much of the tumor as possible while preserving the patient’s function and quality of life. This requires preoperative imaging that accurately identifies important parts of the brain. Transcranial magnetic stimulation is a way of preoperatively finding the areas of the brain connected to motor function. However, few studies have investigated the accuracy and clinical relevance of the data. In this study, we examine the functional outcomes of patients who had TMS points resected and patients who did not. We aim to address key technical barriers to performing this analysis. We also aim to discern the appropriate role of TMS tractography in preoperative diagnostic imaging. Insights gained from this study can be used to select the right patients and plan for the optimal surgeries. Abstract Surgeons must optimize the onco-functional balance by maximizing the extent of resection and minimizing postoperative neurological morbidity. Optimal patient selection and surgical planning requires preoperative identification of nonresectable structures. Transcranial magnetic stimulation is a method of noninvasively mapping the cortical representations of the speech and motor systems. Despite recent promising data, its clinical relevance and appropriate role in a comprehensive mapping approach remains unknown. In this study, we aim to provide direct evidence regarding the clinical utility of transcranial magnetic stimulation by interrogating the eloquence of TMS points. Forty-two glioma patients were included in this retrospective study. We collected motor function outcomes 3 months postoperatively. We overlayed the postoperative MRI onto the preoperative MRI to visualize preoperative TMS points in the context of the surgical cavity. We then generated diffusion tensor imaging tractography to identify meaningful subsets of TMS points. We correlated the resection of preoperative imaging features with clinical outcomes. The resection of TMS-positive points was significantly predictive of permanent deficits (p = 0.05). However, four out of eight patients had TMS-positive points resected without a permanent deficit. DTI tractography at a 75% FA threshold identified which TMS points are essential and which are amenable to surgical resection. TMS combined with DTI tractography shows a significant prediction of postoperative neurological deficits with both a high positive predictive value and negative predictive value.
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14
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Wu C, Ferreira F, Fox M, Harel N, Hattangadi-Gluth J, Horn A, Jbabdi S, Kahan J, Oswal A, Sheth SA, Tie Y, Vakharia V, Zrinzo L, Akram H. Clinical applications of magnetic resonance imaging based functional and structural connectivity. Neuroimage 2021; 244:118649. [PMID: 34648960 DOI: 10.1016/j.neuroimage.2021.118649] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 09/24/2021] [Accepted: 10/10/2021] [Indexed: 12/23/2022] Open
Abstract
Advances in computational neuroimaging techniques have expanded the armamentarium of imaging tools available for clinical applications in clinical neuroscience. Non-invasive, in vivo brain MRI structural and functional network mapping has been used to identify therapeutic targets, define eloquent brain regions to preserve, and gain insight into pathological processes and treatments as well as prognostic biomarkers. These tools have the real potential to inform patient-specific treatment strategies. Nevertheless, a realistic appraisal of clinical utility is needed that balances the growing excitement and interest in the field with important limitations associated with these techniques. Quality of the raw data, minutiae of the processing methodology, and the statistical models applied can all impact on the results and their interpretation. A lack of standardization in data acquisition and processing has also resulted in issues with reproducibility. This limitation has had a direct impact on the reliability of these tools and ultimately, confidence in their clinical use. Advances in MRI technology and computational power as well as automation and standardization of processing methods, including machine learning approaches, may help address some of these issues and make these tools more reliable in clinical use. In this review, we will highlight the current clinical uses of MRI connectomics in the diagnosis and treatment of neurological disorders; balancing emerging applications and technologies with limitations of connectivity analytic approaches to present an encompassing and appropriate perspective.
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Affiliation(s)
- Chengyuan Wu
- Department of Neurological Surgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, 909 Walnut Street, Third Floor, Philadelphia, PA 19107, USA; Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, 909 Walnut Street, First Floor, Philadelphia, PA 19107, USA.
| | - Francisca Ferreira
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, 33 Queen Square, London WC1N 3BG, UK; Unit of Functional Neurosurgery, UCL Queen Square Institute of Neurology, 33 Queen Square, London WC1N 3BG, UK.
| | - Michael Fox
- Center for Brain Circuit Therapeutics, Departments of Neurology, Psychiatry, Radiology, and Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA 02115, USA.
| | - Noam Harel
- Center for Magnetic Resonance Research, University of Minnesota, 2021 Sixth Street S.E., Minneapolis, MN 55455, USA.
| | - Jona Hattangadi-Gluth
- Department of Radiation Medicine and Applied Sciences, Center for Precision Radiation Medicine, University of California, San Diego, 3855 Health Sciences Drive, La Jolla, CA 92037, USA.
| | - Andreas Horn
- Neurology Department, Movement Disorders and Neuromodulation Section, Charité - University Medicine Berlin, Charitéplatz 1, D-10117, Berlin, Germany.
| | - Saad Jbabdi
- Wellcome Centre for Integrative Neuroimaging, Centre for Functional MRI of the Brain, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK.
| | - Joshua Kahan
- Department of Neurology, Weill Cornell Medicine, 525 East 68th Street, New York, NY, 10065, USA.
| | - Ashwini Oswal
- Medical Research Council Brain Network Dynamics Unit, University of Oxford, Mansfield Rd, Oxford OX1 3TH, UK.
| | - Sameer A Sheth
- Department of Neurosurgery, Baylor College of Medicine, 7200 Cambridge, Ninth Floor, Houston, TX 77030, USA.
| | - Yanmei Tie
- Center for Brain Circuit Therapeutics, Departments of Neurology, Psychiatry, Radiology, and Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA 02115, USA; Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA 02115, USA.
| | - Vejay Vakharia
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, 33 Queen Square, London WC1N 3BG, UK.
| | - Ludvic Zrinzo
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, 33 Queen Square, London WC1N 3BG, UK; Unit of Functional Neurosurgery, UCL Queen Square Institute of Neurology, 33 Queen Square, London WC1N 3BG, UK.
| | - Harith Akram
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, 33 Queen Square, London WC1N 3BG, UK; Unit of Functional Neurosurgery, UCL Queen Square Institute of Neurology, 33 Queen Square, London WC1N 3BG, UK.
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15
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Berro DH, Lemée JM, Leiber LM, Emery E, Menei P, Ter Minassian A. Overt speech critically changes lateralization index and did not allow determination of hemispheric dominance for language: an fMRI study. BMC Neurosci 2021; 22:74. [PMID: 34852787 PMCID: PMC8638205 DOI: 10.1186/s12868-021-00671-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 09/09/2021] [Indexed: 11/25/2022] Open
Abstract
Background Pre-surgical mapping of language using functional MRI aimed principally to determine the dominant hemisphere. This mapping is currently performed using covert linguistic task in way to avoid motion artefacts potentially biasing the results. However, overt task is closer to natural speaking, allows a control on the performance of the task, and may be easier to perform for stressed patients and children. However, overt task, by activating phonological areas on both hemispheres and areas involved in pitch prosody control in the non-dominant hemisphere, is expected to modify the determination of the dominant hemisphere by the calculation of the lateralization index (LI). Objective Here, we analyzed the modifications in the LI and the interactions between cognitive networks during covert and overt speech task. Methods Thirty-three volunteers participated in this study, all but four were right-handed. They performed three functional sessions consisting of (1) covert and (2) overt generation of a short sentence semantically linked with an audibly presented word, from which we estimated the “Covert” and “Overt” contrasts, and a (3) resting-state session. The resting-state session was submitted to spatial independent component analysis to identify language network at rest (LANG), cingulo-opercular network (CO), and ventral attention network (VAN). The LI was calculated using the bootstrapping method. Results The LI of the LANG was the most left-lateralized (0.66 ± 0.38). The LI shifted from a moderate leftward lateralization for the Covert contrast (0.32 ± 0.38) to a right lateralization for the Overt contrast (− 0.13 ± 0.30). The LI significantly differed from each other. This rightward shift was due to the recruitment of right hemispheric temporal areas together with the nodes of the CO. Conclusion Analyzing the overt speech by fMRI allowed improvement in the physiological knowledge regarding the coordinated activity of the intrinsic connectivity networks. However, the rightward shift of the LI in this condition did not provide the basic information on the hemispheric language dominance. Overt linguistic task cannot be recommended for clinical purpose when determining hemispheric dominance for language. Supplementary Information The online version contains supplementary material available at 10.1186/s12868-021-00671-y.
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Affiliation(s)
- David Hassanein Berro
- Department of Neurosurgery, University Hospital of Caen Normandy, Avenue de la Côte de Nacre, 14000, Caen, France. .,Normandie Univ, UNICAEN, CEA, CNRS, ISTCT/CERVOxy group, GIP Cyceron, Caen, France. .,INSERM, CRCINA, Team 17, IRIS building, Angers, France.
| | - Jean-Michel Lemée
- INSERM, CRCINA, Team 17, IRIS building, Angers, France.,Department of Neurosurgery, University Hospital of Angers, Angers, France
| | | | - Evelyne Emery
- Department of Neurosurgery, University Hospital of Caen Normandy, Avenue de la Côte de Nacre, 14000, Caen, France.,INSERM, UMR-S U1237, PhIND group, GIP Cyceron, Caen, France
| | - Philippe Menei
- INSERM, CRCINA, Team 17, IRIS building, Angers, France.,Department of Neurosurgery, University Hospital of Angers, Angers, France
| | - Aram Ter Minassian
- Department of Anesthesiology, University Hospital of Angers, Angers, France.,LARIS, ISISV team, University of Angers, Angers, France
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16
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Beheshtian E, Jalilianhasanpour R, Modir Shanechi A, Sethi V, Wang G, Lindquist MA, Caffo BS, Agarwal S, Pillai JJ, Gujar SK, Sair HI. Identification of the Somatomotor Network from Language Task-based fMRI Compared with Resting-State fMRI in Patients with Brain Lesions. Radiology 2021; 301:178-184. [PMID: 34282966 DOI: 10.1148/radiol.2021204594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Resting-state functional MRI (rs-fMRI) is a potential alternative to task-based functional MRI (tb-fMRI) for somatomotor network (SMN) identification. Brain networks can also be generated from tb-fMRI by using independent component analysis (ICA). Purpose To investigate whether the SMN can be identified by using ICA from a language task without a motor component, the sentence completion functional MRI (sc-fMRI) task, compared with rs-fMRI. Materials and Methods The sc-fMRI and rs-fMRI scans in patients who underwent presurgical brain mapping between 2012 and 2016 were analyzed, using the same imaging parameters (other than scanning time) on a 3.0-T MRI scanner. ICA was performed on rs-fMRI and sc-fMRI scans with use of a tool to separate data sets into their spatial and temporal components. Two neuroradiologists independently determined the presence of the dorsal SMN (dSMN) and ventral SMN (vSMN) on each study. Groups were compared by using t tests, and logistic regression was performed to identify predictors of the presence of SMNs. Results One hundred patients (mean age, 40.9 years ± 14.8 [standard deviation]; 61 men) were evaluated. The dSMN and vSMN were identified in 86% (86 of 100) and 76% (76 of 100) of rs-fMRI scans and 85% (85 of 100) and 69% (69 of 100) of sc-fMRI scans, respectively. The concordance between rs-fMRI and sc-fMRI for presence of dSMN and vSMN was 75% (75 of 100 patients) and 53% (53 of 100 patients), respectively. In 10 of 14 patients (71%) where rs-fMRI did not show the dSMN, sc-fMRI demonstrated it. This rate was 67% for the vSMN (16 of 24 patients). Conclusion In the majority of patients, independent component analysis of sentence completion task functional MRI scans reliably demonstrated the somatomotor network compared with resting-state functional MRI scans. Identifying target networks with a single sentence completion scan could reduce overall functional MRI scanning times by eliminating the need for separate motor tasks. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Field and Birn in this issue.
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Affiliation(s)
- Elham Beheshtian
- From the Division of Neuroradiology, the Russell H. Morgan Department of Radiology and Radiological Science (E.B., R.J., A.M.S., S.A., J.J.P., S.K.G., H.I.S.) and the Department of Neurosurgery (J.J.P.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Baltimore, MD 21287; Division of Neuroradiology, Department of Radiology, Temple University Hospital, Philadelphia, Pa (V.S.); Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md (G.W., M.A.L., B.S.C.); and the Malone Center for Engineering in Healthcare, the Whiting School of Engineering, Johns Hopkins University, Baltimore, Md (H.I.S.)
| | - Rozita Jalilianhasanpour
- From the Division of Neuroradiology, the Russell H. Morgan Department of Radiology and Radiological Science (E.B., R.J., A.M.S., S.A., J.J.P., S.K.G., H.I.S.) and the Department of Neurosurgery (J.J.P.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Baltimore, MD 21287; Division of Neuroradiology, Department of Radiology, Temple University Hospital, Philadelphia, Pa (V.S.); Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md (G.W., M.A.L., B.S.C.); and the Malone Center for Engineering in Healthcare, the Whiting School of Engineering, Johns Hopkins University, Baltimore, Md (H.I.S.)
| | - Amirali Modir Shanechi
- From the Division of Neuroradiology, the Russell H. Morgan Department of Radiology and Radiological Science (E.B., R.J., A.M.S., S.A., J.J.P., S.K.G., H.I.S.) and the Department of Neurosurgery (J.J.P.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Baltimore, MD 21287; Division of Neuroradiology, Department of Radiology, Temple University Hospital, Philadelphia, Pa (V.S.); Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md (G.W., M.A.L., B.S.C.); and the Malone Center for Engineering in Healthcare, the Whiting School of Engineering, Johns Hopkins University, Baltimore, Md (H.I.S.)
| | - Varun Sethi
- From the Division of Neuroradiology, the Russell H. Morgan Department of Radiology and Radiological Science (E.B., R.J., A.M.S., S.A., J.J.P., S.K.G., H.I.S.) and the Department of Neurosurgery (J.J.P.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Baltimore, MD 21287; Division of Neuroradiology, Department of Radiology, Temple University Hospital, Philadelphia, Pa (V.S.); Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md (G.W., M.A.L., B.S.C.); and the Malone Center for Engineering in Healthcare, the Whiting School of Engineering, Johns Hopkins University, Baltimore, Md (H.I.S.)
| | - Guoqing Wang
- From the Division of Neuroradiology, the Russell H. Morgan Department of Radiology and Radiological Science (E.B., R.J., A.M.S., S.A., J.J.P., S.K.G., H.I.S.) and the Department of Neurosurgery (J.J.P.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Baltimore, MD 21287; Division of Neuroradiology, Department of Radiology, Temple University Hospital, Philadelphia, Pa (V.S.); Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md (G.W., M.A.L., B.S.C.); and the Malone Center for Engineering in Healthcare, the Whiting School of Engineering, Johns Hopkins University, Baltimore, Md (H.I.S.)
| | - Martin A Lindquist
- From the Division of Neuroradiology, the Russell H. Morgan Department of Radiology and Radiological Science (E.B., R.J., A.M.S., S.A., J.J.P., S.K.G., H.I.S.) and the Department of Neurosurgery (J.J.P.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Baltimore, MD 21287; Division of Neuroradiology, Department of Radiology, Temple University Hospital, Philadelphia, Pa (V.S.); Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md (G.W., M.A.L., B.S.C.); and the Malone Center for Engineering in Healthcare, the Whiting School of Engineering, Johns Hopkins University, Baltimore, Md (H.I.S.)
| | - Brian S Caffo
- From the Division of Neuroradiology, the Russell H. Morgan Department of Radiology and Radiological Science (E.B., R.J., A.M.S., S.A., J.J.P., S.K.G., H.I.S.) and the Department of Neurosurgery (J.J.P.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Baltimore, MD 21287; Division of Neuroradiology, Department of Radiology, Temple University Hospital, Philadelphia, Pa (V.S.); Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md (G.W., M.A.L., B.S.C.); and the Malone Center for Engineering in Healthcare, the Whiting School of Engineering, Johns Hopkins University, Baltimore, Md (H.I.S.)
| | - Shruti Agarwal
- From the Division of Neuroradiology, the Russell H. Morgan Department of Radiology and Radiological Science (E.B., R.J., A.M.S., S.A., J.J.P., S.K.G., H.I.S.) and the Department of Neurosurgery (J.J.P.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Baltimore, MD 21287; Division of Neuroradiology, Department of Radiology, Temple University Hospital, Philadelphia, Pa (V.S.); Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md (G.W., M.A.L., B.S.C.); and the Malone Center for Engineering in Healthcare, the Whiting School of Engineering, Johns Hopkins University, Baltimore, Md (H.I.S.)
| | - Jay J Pillai
- From the Division of Neuroradiology, the Russell H. Morgan Department of Radiology and Radiological Science (E.B., R.J., A.M.S., S.A., J.J.P., S.K.G., H.I.S.) and the Department of Neurosurgery (J.J.P.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Baltimore, MD 21287; Division of Neuroradiology, Department of Radiology, Temple University Hospital, Philadelphia, Pa (V.S.); Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md (G.W., M.A.L., B.S.C.); and the Malone Center for Engineering in Healthcare, the Whiting School of Engineering, Johns Hopkins University, Baltimore, Md (H.I.S.)
| | - Sachin K Gujar
- From the Division of Neuroradiology, the Russell H. Morgan Department of Radiology and Radiological Science (E.B., R.J., A.M.S., S.A., J.J.P., S.K.G., H.I.S.) and the Department of Neurosurgery (J.J.P.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Baltimore, MD 21287; Division of Neuroradiology, Department of Radiology, Temple University Hospital, Philadelphia, Pa (V.S.); Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md (G.W., M.A.L., B.S.C.); and the Malone Center for Engineering in Healthcare, the Whiting School of Engineering, Johns Hopkins University, Baltimore, Md (H.I.S.)
| | - Haris I Sair
- From the Division of Neuroradiology, the Russell H. Morgan Department of Radiology and Radiological Science (E.B., R.J., A.M.S., S.A., J.J.P., S.K.G., H.I.S.) and the Department of Neurosurgery (J.J.P.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Baltimore, MD 21287; Division of Neuroradiology, Department of Radiology, Temple University Hospital, Philadelphia, Pa (V.S.); Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md (G.W., M.A.L., B.S.C.); and the Malone Center for Engineering in Healthcare, the Whiting School of Engineering, Johns Hopkins University, Baltimore, Md (H.I.S.)
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17
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Nandakumar N, Manzoor K, Agarwal S, Pillai JJ, Gujar SK, Sair HI, Venkataraman A. A Multi-Scale Spatial and Temporal Attention Network on Dynamic Connectivity to Localize The Eloquent Cortex in Brain Tumor Patients. INFORMATION PROCESSING IN MEDICAL IMAGING : PROCEEDINGS OF THE ... CONFERENCE 2021; 12729:241-252. [PMID: 35706778 PMCID: PMC9195149 DOI: 10.1007/978-3-030-78191-0_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
We present a deep neural network architecture that combines multi-scale spatial attention with temporal attention to simultaneously localize the language and motor areas of the eloquent cortex from dynamic functional connectivity data. Our multi-scale spatial attention operates on graph-based features extracted from the connectivity matrices, thus honing in on the inter-regional interactions that collectively define the eloquent cortex. At the same time, our temporal attention model selects the intervals during which these interactions are most pronounced. The final stage of our model employs multi-task learning to differentiate between the eloquent subsystems. Our training strategy enables us to handle missing eloquent class labels by freezing the weights in those branches while updating the rest of the network weights. We evaluate our method on resting-state fMRI data from one synthetic dataset and one in-house brain tumor dataset while using task fMRI activations as ground-truth labels for the eloquent cortex. Our model achieves higher localization accuracies than conventional deep learning approaches. It also produces interpretable spatial and temporal attention features which can provide further insights for presurgical planning. Thus, our model shows translational promise for improving the safety of brain tumor resections.
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Affiliation(s)
- Naresh Nandakumar
- Dept. of Electrical and Computer Engineering, Johns Hopkins University, USA
| | - Komal Manzoor
- Dept. of Neuroradiology, Johns Hopkins School of Medicine, USA
| | - Shruti Agarwal
- Dept. of Neuroradiology, Johns Hopkins School of Medicine, USA
| | - Jay J Pillai
- Dept. of Neuroradiology, Johns Hopkins School of Medicine, USA
| | - Sachin K Gujar
- Dept. of Neuroradiology, Johns Hopkins School of Medicine, USA
| | - Haris I Sair
- Dept. of Neuroradiology, Johns Hopkins School of Medicine, USA
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18
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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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19
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Brahimaj BC, Kochanski RB, Pearce JJ, Guryildirim M, Gerard CS, Kocak M, Sani S, Byrne RW. Structural and Functional Imaging in Glioma Management. Neurosurgery 2021; 88:211-221. [PMID: 33313852 DOI: 10.1093/neuros/nyaa360] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/26/2020] [Indexed: 01/08/2023] Open
Abstract
The goal of glioma surgery is maximal safe resection in order to provide optimal tumor control and survival benefit to the patient. There are multiple imaging modalities beyond traditional contrast-enhanced magnetic resonance imaging (MRI) that have been incorporated into the preoperative workup of patients presenting with gliomas. The aim of these imaging modalities is to identify cortical and subcortical areas of eloquence, and their relationship to the lesion. In this article, multiple modalities are described with an emphasis on the underlying technology, clinical utilization, advantages, and disadvantages of each. functional MRI and its role in identifying hemispheric dominance and areas of language and motor are discussed. The nuances of magnetoencephalography and transcranial magnetic stimulation in localization of eloquent cortex are examined, as well as the role of diffusion tensor imaging in defining normal white matter tracts in glioma surgery. Lastly, we highlight the role of stimulated Raman spectroscopy in intraoperative histopathological diagnosis of tissue to guide tumor resection. Tumors may shift the normal arrangement of functional anatomy in the brain; thus, utilization of multiple modalities may be helpful in operative planning and patient counseling for successful surgery.
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Affiliation(s)
- Bledi C Brahimaj
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Ryan B Kochanski
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - John J Pearce
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Melike Guryildirim
- Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, Maryland
| | - Carter S Gerard
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington
| | - Mehmet Kocak
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, Illinois
| | - Sepehr Sani
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Richard W Byrne
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
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20
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Herbet G. Should Complex Cognitive Functions Be Mapped With Direct Electrostimulation in Wide-Awake Surgery? A Network Perspective. Front Neurol 2021; 12:635439. [PMID: 33912124 PMCID: PMC8072013 DOI: 10.3389/fneur.2021.635439] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/17/2021] [Indexed: 12/18/2022] Open
Affiliation(s)
- Guillaume Herbet
- Institute of Functional Genomics, INSERM, CNRS, University of Montpellier, Montpellier, France.,Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
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21
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Müller DMJ, Robe PA, Ardon H, Barkhof F, Bello L, Berger MS, Bouwknegt W, Van den Brink WA, Conti Nibali M, Eijgelaar RS, Furtner J, Han SJ, Hervey-Jumper SL, Idema AJS, Kiesel B, Kloet A, De Munck JC, Rossi M, Sciortino T, Vandertop WP, Visser M, Wagemakers M, Widhalm G, Witte MG, Zwinderman AH, De Witt Hamer PC. Quantifying eloquent locations for glioblastoma surgery using resection probability maps. J Neurosurg 2021; 134:1091-1101. [PMID: 32244208 DOI: 10.3171/2020.1.jns193049] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/21/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Decisions in glioblastoma surgery are often guided by presumed eloquence of the tumor location. The authors introduce the "expected residual tumor volume" (eRV) and the "expected resectability index" (eRI) based on previous decisions aggregated in resection probability maps. The diagnostic accuracy of eRV and eRI to predict biopsy decisions, resectability, functional outcome, and survival was determined. METHODS Consecutive patients with first-time glioblastoma surgery in 2012-2013 were included from 12 hospitals. The eRV was calculated from the preoperative MR images of each patient using a resection probability map, and the eRI was derived from the tumor volume. As reference, Sawaya's tumor location eloquence grades (EGs) were classified. Resectability was measured as observed extent of resection (EOR) and residual volume, and functional outcome as change in Karnofsky Performance Scale score. Receiver operating characteristic curves and multivariable logistic regression were applied. RESULTS Of 915 patients, 674 (74%) underwent a resection with a median EOR of 97%, functional improvement in 71 (8%), functional decline in 78 (9%), and median survival of 12.8 months. The eRI and eRV identified biopsies and EORs of at least 80%, 90%, or 98% better than EG. The eRV and eRI predicted observed residual volumes under 10, 5, and 1 ml better than EG. The eRV, eRI, and EG had low diagnostic accuracy for functional outcome changes. Higher eRV and lower eRI were strongly associated with shorter survival, independent of known prognostic factors. CONCLUSIONS The eRV and eRI predict biopsy decisions, resectability, and survival better than eloquence grading and may be useful preoperative indices to support surgical decisions.
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Affiliation(s)
- Domenique M J Müller
- 1Brain Tumor Center & Department of Neurosurgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - Pierre A Robe
- 2Department of Neurology & Neurosurgery, University Medical Center Utrecht, The Netherlands
| | - Hilko Ardon
- 3Department of Neurosurgery, St. Elisabeth Hospital, Tilburg, The Netherlands
| | - Frederik Barkhof
- 4Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Vrije Universiteit, University Medical Center, Amsterdam, The Netherlands
- 5Institutes of Neurology and Healthcare Engineering, University College London, United Kingdom
| | - Lorenzo Bello
- 6Neurosurgical Oncology Unit, Departments of Oncology and Remato-Oncology, Università degli Studi di Milano, Humanitas Research Hospital, IRCCS, Milan, Italy
| | - Mitchel S Berger
- 7Department of Neurological Surgery, University of California, San Francisco, California
| | - Wim Bouwknegt
- 8Department of Neurosurgery, Medical Center Slotervaart, Amsterdam, The Netherlands
| | | | - Marco Conti Nibali
- 6Neurosurgical Oncology Unit, Departments of Oncology and Remato-Oncology, Università degli Studi di Milano, Humanitas Research Hospital, IRCCS, Milan, Italy
| | - Roelant S Eijgelaar
- 10Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Julia Furtner
- 11Department of Biomedical Imaging and Image-Guided Therapy, Medical University Vienna, Austria
| | - Seunggu J Han
- 12Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon
| | - Shawn L Hervey-Jumper
- 7Department of Neurological Surgery, University of California, San Francisco, California
| | - Albert J S Idema
- 13Department of Neurosurgery, Northwest Clinics, Alkmaar, The Netherlands
| | - Barbara Kiesel
- 14Department of Neurosurgery, Medical University Vienna, Austria
| | - Alfred Kloet
- 15Department of Neurosurgery, Medical Center Haaglanden, The Hague, The Netherlands
| | - Jan C De Munck
- 4Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Vrije Universiteit, University Medical Center, Amsterdam, The Netherlands
| | - Marco Rossi
- 6Neurosurgical Oncology Unit, Departments of Oncology and Remato-Oncology, Università degli Studi di Milano, Humanitas Research Hospital, IRCCS, Milan, Italy
| | - Tommaso Sciortino
- 6Neurosurgical Oncology Unit, Departments of Oncology and Remato-Oncology, Università degli Studi di Milano, Humanitas Research Hospital, IRCCS, Milan, Italy
| | - W Peter Vandertop
- 1Brain Tumor Center & Department of Neurosurgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - Martin Visser
- 4Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Vrije Universiteit, University Medical Center, Amsterdam, The Netherlands
| | - Michiel Wagemakers
- 16Department of Neurosurgery, University of Groningen, University Medical Center Groningen, The Netherlands; and
| | - Georg Widhalm
- 14Department of Neurosurgery, Medical University Vienna, Austria
| | - Marnix G Witte
- 10Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Aeilko H Zwinderman
- 17Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, The Netherlands
| | - Philip C De Witt Hamer
- 1Brain Tumor Center & Department of Neurosurgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
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22
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Senova S, Lefaucheur JP, Brugières P, Ayache SS, Tazi S, Bapst B, Abhay K, Langeron O, Edakawa K, Palfi S, Bardel B. Case Report: Multimodal Functional and Structural Evaluation Combining Pre-operative nTMS Mapping and Neuroimaging With Intraoperative CT-Scan and Brain Shift Correction for Brain Tumor Surgical Resection. Front Hum Neurosci 2021; 15:646268. [PMID: 33716700 PMCID: PMC7947337 DOI: 10.3389/fnhum.2021.646268] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 02/08/2021] [Indexed: 01/11/2023] Open
Abstract
Background: Maximum safe resection of infiltrative brain tumors in eloquent area is the primary objective in surgical neuro-oncology. This goal can be achieved with direct electrical stimulation (DES) to perform a functional mapping of the brain in patients awake intraoperatively. When awake surgery is not possible, we propose a pipeline procedure that combines advanced techniques aiming at performing a dissection that respects the anatomo-functional connectivity of the peritumoral region. This procedure can benefit from intraoperative monitoring with computerized tomography scan (iCT-scan) and brain shift correction. Associated with this intraoperative monitoring, the additional value of preoperative investigation combining brain mapping by navigated transcranial magnetic stimulation (nTMS) with various neuroimaging modalities (tractography and resting state functional MRI) has not yet been reported. Case Report: A 42-year-old left-handed man had increased intracranial pressure (IICP), left hand muscle deficit, and dysarthria, related to an infiltrative tumor of the right frontal lobe with large mass effect and circumscribed contrast enhancement in motor and premotor cortical areas. Spectroscopy profile and intratumoral calcifications on CT-scan suggested an WHO grade III glioma, later confirmed by histology. The aforementioned surgical procedure was considered, since standard awake surgery was not appropriate for this patient. In preoperative time, nTMS mapping of motor function (deltoid, first interosseous, and tibialis anterior muscles) was performed, combined with magnetic resonance imaging (MRI)-based tractography reconstruction of 6 neural tracts (arcuate, corticospinal, inferior fronto-occipital, uncinate and superior and inferior longitudinal fasciculi) and resting-state functional MRI connectivity (rs-fMRI) of sensorimotor and language networks. In intraoperative time, DES mapping was performed with motor evoked response recording and tumor resection was optimized using non-rigid image transformation of the preoperative data (nTMS, tractography, and rs-fMRI) to iCT data. Image guidance was updated with correction for brain shift and tissue deformation using biomechanical modeling taking into account brain elastic properties. This correction was done at crucial surgical steps, i.e., when tumor bulged through the craniotomy after dura mater opening and when approaching the presumed eloquent brain regions. This procedure allowed a total resection of the tumor region with contrast enhancement as well as a complete regression of IICP and dysarthria. Hand paresis remained stable with no additional deficit. Postoperative nTMS mapping confirmed the good functional outcome. Conclusion: This case report and technical note highlights the value of preoperative functional evaluation by nTMS updated intraoperatively with correction of brain deformation by iCT. This multimodal approach may become the optimized technique of reference for patients with brain tumors in eloquent areas that are unsuitable for awake brain surgery.
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Affiliation(s)
- Suhan Senova
- Department of Neurosurgery, DMU CARe, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Creteil, France.,Translational Psychiatry (Equipe 15), IMRB - INSERM U955, Univ Paris-Est Creteil, Creteil, France
| | - Jean-Pascal Lefaucheur
- Department of Clinical Neurophysiology, DMU FIxIT, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Creteil, France.,Excitabilite Nerveuse et Therapeutique, EA 4391, Univ Paris-Est Creteil, Creteil, France
| | - Pierre Brugières
- Department of Neuroradiology, DMU FIxIT, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Creteil, France
| | - Samar S Ayache
- Department of Clinical Neurophysiology, DMU FIxIT, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Creteil, France.,Excitabilite Nerveuse et Therapeutique, EA 4391, Univ Paris-Est Creteil, Creteil, France
| | - Sanaa Tazi
- Department of Neurosurgery, DMU CARe, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Creteil, France.,Translational Psychiatry (Equipe 15), IMRB - INSERM U955, Univ Paris-Est Creteil, Creteil, France
| | - Blanche Bapst
- Department of Neuroradiology, DMU FIxIT, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Creteil, France
| | - Kou Abhay
- Department of Anesthesiology and Critical Care, DMU CARe, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Creteil, France
| | - Olivier Langeron
- Department of Anesthesiology and Critical Care, DMU CARe, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Creteil, France.,Experimental Neuropathology Unit, Institut Pasteur, Paris, France
| | - Kohtaroh Edakawa
- Department of Neurosurgery, DMU CARe, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Creteil, France.,Translational Psychiatry (Equipe 15), IMRB - INSERM U955, Univ Paris-Est Creteil, Creteil, France.,Department of Neurosurgery, Graduate School of Medicine Osaka University, Suita, Japan
| | - Stéphane Palfi
- Department of Neurosurgery, DMU CARe, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Creteil, France.,Translational Psychiatry (Equipe 15), IMRB - INSERM U955, Univ Paris-Est Creteil, Creteil, France
| | - Benjamin Bardel
- Department of Clinical Neurophysiology, DMU FIxIT, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Creteil, France.,Excitabilite Nerveuse et Therapeutique, EA 4391, Univ Paris-Est Creteil, Creteil, France
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23
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van Lieshout J, Debaene W, Rapp M, Noordmans HJ, Rutten GJ. fMRI Resting-State Connectivity between Language and Nonlanguage Areas as Defined by Intraoperative Electrocortical Stimulation in Low-Grade Glioma Patients. J Neurol Surg A Cent Eur Neurosurg 2021; 82:357-363. [PMID: 33618418 DOI: 10.1055/s-0040-1721757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND OBJECTIVES It remains to be determined whether noninvasive functional imaging techniques can rival the clinical potential of direct electrocortical stimulation (DES). In this study, we compared the results of resting-state functional magnetic resonance imaging (rs-fMRI) to those of DES for language mapping. Our goals were twofold: (1) to replicate a previous study that demonstrated that resting-state connectivity (RSC) was significantly larger between positive DES language sites than between negative DES language sites and (2) to compare the spatial resolution of rs-fMRI to that of DES. METHODS We conducted a retrospective study of nine low-grade glioma patients. Language sites were identified by intraoperative DES. We compared RSC values between and within groups of DES-positive and DES-negative regions of interest (ROIs). Both close-negative sites (i.e., DES-negative sites <1 cm apart from and on the same gyrus as DES-positive sites) and far-negative sites (i.e., purely randomly chosen sites not in the vicinity of the tumor or of the DES-positive sites but on the same lobe) were included. Receiver operating characteristics were used to quantify comparisons. RESULTS Functional connectivity between all positive language sites was on average significantly higher than between all close-negative sites and between all far-negative sites. The functional connectivity between the positive language ROIs and their respective close-negative control sites was not smaller than between all positive language sites. CONCLUSION rs-fMRI likely reflects similar neural information as detected with DES, but in its current form does not reach the spatial resolution of DES.
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Affiliation(s)
- Jasper van Lieshout
- Department of Neurosurgery, Universitatsklinikum Dusseldorf, Dusseldorf, Nordrhein-Westfalen, Germany
| | - Wouter Debaene
- Department of Cognitive Neuropsychology, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Noord-Brabant, The Netherlands
| | - Marion Rapp
- Department of Neurosurgery, Universitatsklinikum Dusseldorf, Dusseldorf, Nordrhein-Westfalen, Germany
| | | | - Geert-Jan Rutten
- Department of Neurosurgery, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands
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24
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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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25
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Sarubbo S, Annicchiarico L, Corsini F, Zigiotto L, Herbet G, Moritz-Gasser S, Dalpiaz C, Vitali L, Tate M, De Benedictis A, Amorosino G, Olivetti E, Rozzanigo U, Petralia B, Duffau H, Avesani P. Planning Brain Tumor Resection Using a Probabilistic Atlas of Cortical and Subcortical Structures Critical for Functional Processing: A Proof of Concept. Oper Neurosurg (Hagerstown) 2021; 20:E175-E183. [PMID: 33372966 DOI: 10.1093/ons/opaa396] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/13/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Functional preoperative planning for resection of intrinsic brain tumors in eloquent areas is still a challenge. Predicting subcortical functional framework is especially difficult. Direct electrical stimulation (DES) is the recommended technique for resection of these lesions. A reliable probabilistic atlas of the critical cortical epicenters and subcortical framework based on DES data was recently published. OBJECTIVE To propose a pipeline for the automated alignment of the corticosubcortical maps of this atlas with T1-weighted MRI. METHODS To test the alignment, we selected 10 patients who underwent resection of brain lesions by using DES. We aligned different cortical and subcortical functional maps to preoperative volumetric T1 MRIs (with/without gadolinium). For each patient we quantified the quality of the alignment, and we calculated the match between the location of the functional sites found at DES and the functional maps of the atlas. RESULTS We found an accurate brain extraction and alignment of the functional maps with both the T1 MRIs of each patient. The matching analysis between functional maps and functional responses collected during surgeries was 88% at cortical and, importantly, 100% at subcortical level, providing a further proof of the correct alignment. CONCLUSION We demonstrated quantitatively and qualitatively the reliability of this tool that may be used for presurgical planning, providing further functional information at the cortical level and a unique probabilistic prevision of distribution of the critical subcortical structures. Finally, this tool offers the chance for multimodal planning through integrating this functional information with other neuroradiological and neurophysiological techniques.
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Affiliation(s)
- Silvio Sarubbo
- Department of Neurosurgery, "S. Chiara" Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy.,Structural and Functional Connectivity Lab Project, "S. Chiara" Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Luciano Annicchiarico
- Department of Neurosurgery, "S. Chiara" Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy.,Structural and Functional Connectivity Lab Project, "S. Chiara" Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Francesco Corsini
- Department of Neurosurgery, "S. Chiara" Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy.,Structural and Functional Connectivity Lab Project, "S. Chiara" Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Luca Zigiotto
- Department of Neurosurgery, "S. Chiara" Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy.,Structural and Functional Connectivity Lab Project, "S. Chiara" Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Guillaume Herbet
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France.,National Institute for Health and Medical Research (INSERM), NSERM U1191, Institute of Functional Genomics, University of Montpellier, Montpellier, France
| | - Sylvie Moritz-Gasser
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France.,National Institute for Health and Medical Research (INSERM), NSERM U1191, Institute of Functional Genomics, University of Montpellier, Montpellier, France
| | - Chiara Dalpiaz
- Department of Anesthesiology and Intensive Care, "S. Chiara" Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Luca Vitali
- Department of Anesthesiology and Intensive Care, "S. Chiara" Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Matthew Tate
- Departments of Neurosurgery and Neurology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Alessandro De Benedictis
- Neurosurgery Unit, Department of Neuroscience, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Gabriele Amorosino
- Neuroinformatics Laboratory (NiLab), Bruno Kessler Foundation (FBK), Trento, Italy.,Center for Mind/Brain Sciences - CIMeC, University of Trento, Rovereto, Italy
| | - Emanuele Olivetti
- Neuroinformatics Laboratory (NiLab), Bruno Kessler Foundation (FBK), Trento, Italy.,Center for Mind/Brain Sciences - CIMeC, University of Trento, Rovereto, Italy
| | - Umberto Rozzanigo
- Department of Radiology, Division of Neuroradiology, "S. Chiara" Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Benedetto Petralia
- Department of Radiology, Division of Neuroradiology, "S. Chiara" Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France.,National Institute for Health and Medical Research (INSERM), NSERM U1191, Institute of Functional Genomics, University of Montpellier, Montpellier, France
| | - Paolo Avesani
- Neuroinformatics Laboratory (NiLab), Bruno Kessler Foundation (FBK), Trento, Italy.,Center for Mind/Brain Sciences - CIMeC, University of Trento, Rovereto, Italy
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26
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Almairac F, Deverdun J, Cochereau J, Coget A, Lemaitre AL, Moritz-Gasser S, Duffau H, Herbet G. Homotopic redistribution of functional connectivity in insula-centered diffuse low-grade glioma. Neuroimage Clin 2021; 29:102571. [PMID: 33508623 PMCID: PMC7840474 DOI: 10.1016/j.nicl.2021.102571] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE In the event of neural injury, the homologous contralateral brain areas may play a compensatory role to avoid or limit the functional loss. However, this dynamic strategy of functional redistribution is not clearly established, especially in the pathophysiological context of diffuse low-grade glioma. Our aim here was to assess the extent to which unilateral tumor infiltration of the insula dynamically modulates the functional connectivity of the contralesional one. METHODS Using resting-state functional connectivity MRI, a seed-to-ROI approach was employed in 52 insula-centered glioma patients (n = 30 left and 22 right) compared with 19 age-matched healthy controls. RESULTS Unsurprisingly, a significant decrease of the inter-insular connectivity was observed in both patient groups. More importantly, the analyses revealed a significant increase of the contralesional insular connectivity towards both cerebral hemispheres, especially in cortical areas forming the visual and the sensorimotor networks. This functional redistribution was not identified when the analyses were performed on three control regions for which the homologous area was not impaired by the tumor. This overall pattern of results indicates that massive infiltration of the insular cortex causes a significant redeployment of the contralesional functional connectivity. CONCLUSION This general finding suggests that the undamaged insula plays a role in the functional compensation usually observed in this patient population, and thus provides compelling support for the concept of homotopic functional plasticity in brain-damaged patients.
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Affiliation(s)
- Fabien Almairac
- Department of Neurosurgery, Pasteur 2 Hospital, Nice University Medical Center, Nice, France; Université Côte d'Azur, Nice, France
| | - Jeremy Deverdun
- I2FH, Institut d'Imagerie Fonctionnelle Humaine, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France; Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Jérôme Cochereau
- Department of Neurosurgery, La Miletrie Hospital, Poitiers University Medical Center, Poitiers, France; Institute of Functional Genomics, INSERM 1191, University of Montpellier, France; University of Montpellier, Montpellier, France
| | - Arthur Coget
- I2FH, Institut d'Imagerie Fonctionnelle Humaine, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France; Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Anne-Laure Lemaitre
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Sylvie Moritz-Gasser
- Institute of Functional Genomics, INSERM 1191, University of Montpellier, France; University of Montpellier, Montpellier, France; Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Hugues Duffau
- Institute of Functional Genomics, INSERM 1191, University of Montpellier, France; University of Montpellier, Montpellier, France; Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Guillaume Herbet
- Institute of Functional Genomics, INSERM 1191, University of Montpellier, France; University of Montpellier, Montpellier, France; Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France.
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27
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Nenning KH, Furtner J, Kiesel B, Schwartz E, Roetzer T, Fortelny N, Bock C, Grisold A, Marko M, Leutmezer F, Liu H, Golland P, Stoecklein S, Hainfellner JA, Kasprian G, Prayer D, Marosi C, Widhalm G, Woehrer A, Langs G. Distributed changes of the functional connectome in patients with glioblastoma. Sci Rep 2020; 10:18312. [PMID: 33110138 PMCID: PMC7591862 DOI: 10.1038/s41598-020-74726-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 09/09/2020] [Indexed: 12/22/2022] Open
Abstract
Glioblastoma might have widespread effects on the neural organization and cognitive function, and even focal lesions may be associated with distributed functional alterations. However, functional changes do not necessarily follow obvious anatomical patterns and the current understanding of this interrelation is limited. In this study, we used resting-state functional magnetic resonance imaging to evaluate changes in global functional connectivity patterns in 15 patients with glioblastoma. For six patients we followed longitudinal trajectories of their functional connectome and structural tumour evolution using bi-monthly follow-up scans throughout treatment and disease progression. In all patients, unilateral tumour lesions were associated with inter-hemispherically symmetric network alterations, and functional proximity of tumour location was stronger linked to distributed network deterioration than anatomical distance. In the longitudinal subcohort of six patients, we observed patterns of network alterations with initial transient deterioration followed by recovery at first follow-up, and local network deterioration to precede structural tumour recurrence by two months. In summary, the impact of focal glioblastoma lesions on the functional connectome is global and linked to functional proximity rather than anatomical distance to tumour regions. Our findings further suggest a relevance for functional network trajectories as a possible means supporting early detection of tumour recurrence.
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Affiliation(s)
- Karl-Heinz Nenning
- Computational Imaging Research Lab, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
| | - Julia Furtner
- Department of Biomedical Imaging and Image-Guided Therapy, Division for Neuro- and Musculo-Skeletal Radiology, Medical University of Vienna, Vienna, Austria
| | - Barbara Kiesel
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Ernst Schwartz
- Computational Imaging Research Lab, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Thomas Roetzer
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Nikolaus Fortelny
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Christoph Bock
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria.,Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Anna Grisold
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Martha Marko
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Fritz Leutmezer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Hesheng Liu
- A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Cambridge, USA
| | - Polina Golland
- Computer Science and Artificial Intelligence Lab, Massachusetts Institute of Technology, Cambridge, USA
| | - Sophia Stoecklein
- Department of Radiology, Ludwig-Maximilians-University, Munich, Germany
| | - Johannes A Hainfellner
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Gregor Kasprian
- Department of Biomedical Imaging and Image-Guided Therapy, Division for Neuro- and Musculo-Skeletal Radiology, Medical University of Vienna, Vienna, Austria
| | - Daniela Prayer
- Department of Biomedical Imaging and Image-Guided Therapy, Division for Neuro- and Musculo-Skeletal Radiology, Medical University of Vienna, Vienna, Austria
| | - Christine Marosi
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Georg Widhalm
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Adelheid Woehrer
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Georg Langs
- Computational Imaging Research Lab, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria. .,Computer Science and Artificial Intelligence Lab, Massachusetts Institute of Technology, Cambridge, USA.
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28
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Direct Evidence of Plasticity within Human Primary Motor and Somatosensory Cortices of Patients with Glioblastoma. Neural Plast 2020; 2020:8893708. [PMID: 33029127 PMCID: PMC7527884 DOI: 10.1155/2020/8893708] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 08/04/2020] [Accepted: 09/02/2020] [Indexed: 01/20/2023] Open
Abstract
Glioblastoma multiforme (GBM) is a devastating disease without cure. It is also the most common primary brain tumor in adults. Although aggressive surgical resection is standard of care, these operations are limited by tumor infiltration of critical cortical and subcortical regions. A better understanding of how the brain can recover and reorganize function in response to GBM would provide valuable clinical data. This ability, termed neuroplasticity, is not well understood in the adult human brain. A better understanding of neuroplasticity in GBM could allow for improved extent of resection, even in areas classically thought to have critical, static function. The best evidence to date has demonstrated neuroplasticity only in slower growing tumors or through indirect measures such as functional MRI or transcranial magnetic stimulation. In this novel study, we utilize a unique experimental paradigm to show direct evidence of plasticity via serial direct electrocortical stimulation (DES) within primary motor (M1) and somatosensory (S1) cortices in GBM patients. Six patients with glioblastoma multiforme in or near the primary motor or somatosensory cortex were included in this retrospective observational study. These patients had two awake craniotomies with DES to map cortical motor and sensory sites in M1 and S1. Five of six patients exhibited at least one site of neuroplasticity within M1 or S1. Out of the 51 total sites stimulated, 32 (62.7%) demonstrated plasticity. Of these sites, 14 (43.7%) were in M1 and 18 (56.3%) were in S1. These data suggest that even in patients with GBM in or near primary brain regions, significant functional reorganization is possible. This is a new finding which may lead to a better understanding of the fundamental factors promoting or inhibiting plasticity. Further exploration may aid in treatment of patients with brain tumors and other neurologic disorders.
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29
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Kumar VA, Heiba IM, Prabhu SS, Chen MM, Colen RR, Young AL, Johnson JM, Hou P, Noll K, Ferguson SD, Rao G, Lang FF, Schomer DF, Liu HL. The role of resting-state functional MRI for clinical preoperative language mapping. Cancer Imaging 2020; 20:47. [PMID: 32653026 PMCID: PMC7353792 DOI: 10.1186/s40644-020-00327-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 07/02/2020] [Indexed: 11/10/2022] Open
Abstract
Background Task-based functional MRI (tb-fMRI) is a well-established technique used to identify eloquent cortex, but has limitations, particularly in cognitively impaired patients who cannot perform language paradigms. Resting-state functional MRI (rs-fMRI) is a potential alternative modality for presurgical mapping of language networks that does not require task performance. The purpose of our study is to determine the utility of rs-fMRI for clinical preoperative language mapping when tb-fMRI is limited. Methods We retrospectively reviewed 134 brain tumor patients who underwent preoperative fMRI language mapping. rs-fMRI was post-processed with seed-based correlation (SBC) analysis, when language tb-fMRI was limited. Two neuroradiologists reviewed both the tb-fMRI and rs-fMRI results. Six neurosurgeons retrospectively rated the usefulness of rs-fMRI for language mapping in their patients. Results Of the 134 patients, 49 cases had limited tb-fMRI and rs-fMRI was post-processed. Two neuroradiologists found rs-fMRI beneficial for functional language mapping in 41(84%) and 43 (88%) cases respectively; Cohen’s kappa is 0.83, with a 95% confidence interval (0.61, 1.00). The neurosurgeons found rs-fMRI “definitely” useful in 26 cases (60%) and “somewhat” useful in 13 cases (30%) in locating potential eloquent language centers of clinical interest. Six unsuccessful rs-fMRI cases were due to: head motion (2 cases), nonspecific functionality connectivity outside the posterior language network (1 case), and an unknown system instability (3 cases). Conclusions This study is a proof of concept that shows SBC rs-fMRI may be a viable alternative for clinical language mapping when tb-fMRI is limited.
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Affiliation(s)
- Vinodh A Kumar
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Islam M Heiba
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Melissa M Chen
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rivka R Colen
- Department of Diagnostic Radiology, The University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Angela L Young
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jason M Johnson
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ping Hou
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kyle Noll
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sherise D Ferguson
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ganesh Rao
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Frederick F Lang
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Donald F Schomer
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ho-Ling Liu
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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30
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Plasticity of the Primary Motor Cortex in Patients with Primary Brain Tumors. Neural Plast 2020; 2020:3648517. [PMID: 32714384 PMCID: PMC7354670 DOI: 10.1155/2020/3648517] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 01/21/2023] Open
Abstract
There are two neuron-level mechanisms proposed to underlie neural plasticity: recruiting neurons nearby to support the lost function (ipsilesional plasticity) and uncovering latent pathways that can assume the function that was lost (contralesional plasticity). While both patterns have been demonstrated in patient groups following injury, the specific mechanisms underlying each mode of plasticity are poorly understood. In a retrospective case series of 13 patients, we utilize a novel paradigm that analyzes serial fMRI scans in patients harboring intrinsic brain tumors that vary in location and growth kinetics to better understand the mechanisms underlying these two modes of plasticity in the human primary motor cortex. Twelve patients in our series had some degree of primary motor cortex plasticity, an area previously thought to have limited plasticity. Patients harboring smaller lesions with slower growth kinetics and increasing distance from the primary motor region demonstrated recruitment of ipsilateral motor regions. Conversely, larger, faster-growing lesions in close proximity to the primary motor region were associated with activation of the contralesional primary motor cortex, along with increased activation of the supplementary motor area. These data increase our understanding of the adaptive abilities of the brain and may lead to improved treatment strategies for those suffering from motor loss secondary to brain injuries.
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31
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Manan HA, Franz EA, Yahya N. Functional connectivity changes in patients with brain tumours—A systematic review on resting state-fMRI. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.npbr.2020.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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32
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Voets NL, Plaha P, Parker Jones O, Pretorius P, Bartsch A. Presurgical Localization of the Primary Sensorimotor Cortex in Gliomas : When is Resting State FMRI Beneficial and Sufficient? Clin Neuroradiol 2020; 31:245-256. [PMID: 32274518 PMCID: PMC7943510 DOI: 10.1007/s00062-020-00879-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 01/22/2020] [Indexed: 10/27/2022]
Abstract
PURPOSE Functional magnetic resonance imaging (fMRI) has an established role in neurosurgical planning; however, ambiguity surrounds the comparative value of resting and task-based fMRI relative to anatomical localization of the sensorimotor cortex. This study was carried out to determine: 1) how often fMRI adds to prediction of motor risks beyond expert neuroradiological review, 2) success rates of presurgical resting and task-based sensorimotor mapping, and 3) the impact of accelerated resting fMRI acquisitions on network detectability. METHODS Data were collected at 2 centers from 71 patients with a primary brain tumor (31 women; mean age 41.9 ± 13.9 years) and 14 healthy individuals (6 women; mean age 37.9 ± 12.7 years). Preoperative 3T MRI included anatomical scans and resting fMRI using unaccelerated (TR = 3.5 s), intermediate (TR = 1.56 s) or high temporal resolution (TR = 0.72 s) sequences. Task fMRI finger tapping data were acquired in 45 patients. Group differences in fMRI reproducibility, spatial overlap and success frequencies were assessed with t‑tests and χ2-tests. RESULTS Radiological review identified the central sulcus in 98.6% (70/71) patients. Task-fMRI succeeded in 100% (45/45). Resting fMRI failed to identify a sensorimotor network in up to 10 patients; it succeeded in 97.9% (47/48) of accelerated fMRIs, compared to only 60.9% (14/23) of unaccelerated fMRIs ([Formula: see text](2) = 17.84, p < 0.001). Of the patients 12 experienced postoperative deterioration, largely predicted by anatomical proximity to the central sulcus. CONCLUSION The use of fMRI in patients with residual or intact presurgical motor function added value to uncertain anatomical localization in just a single peri-Rolandic glioma case. Resting fMRI showed high correspondence to task localization when acquired with accelerated sequences but offered limited success at standard acquisitions.
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Affiliation(s)
- Natalie L Voets
- Wellcome Centre for Integrative Neuroimaging, FMRIB Centre, John Radcliffe Hospital, University of Oxford, OX3 9DU, Headington, Oxford, UK. .,Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | - Puneet Plaha
- Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Oiwi Parker Jones
- Wellcome Centre for Integrative Neuroimaging, FMRIB Centre, John Radcliffe Hospital, University of Oxford, OX3 9DU, Headington, Oxford, UK
| | - Pieter Pretorius
- Department of Neuroradiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Andreas Bartsch
- Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany
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33
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Guerin JB, Greiner HM, Mangano FT, Leach JL. Functional MRI in Children: Current Clinical Applications. Semin Pediatr Neurol 2020; 33:100800. [PMID: 32331615 DOI: 10.1016/j.spen.2020.100800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Functional magnetic resonance imaging has become a critical research tool for evaluating brain function during active tasks and resting states. This has improved our understanding of developmental trajectories in children as well as the plasticity of neural networks in disease states. In the clinical setting, functional maps of eloquent cortex in patients with brain lesions and/or epilepsy provides crucial information for presurgical planning. Although children are inherently challenging to scan in this setting, preparing them appropriately and providing adequate resources can help achieve useful clinical data. This article will review the basic underlying physiologic aspects of functional magnetic resonance imaging, review clinically relevant research applications, describe known validation data compared to gold standard techniques and detail future directions of this technology.
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Affiliation(s)
- Julie B Guerin
- Department of Pediatric Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Radiology, Mayo Clinic, Rochester, MN
| | - Hansel M Greiner
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Francesco T Mangano
- Division of Pediatric Neurosurgery, University of Cincinnati College of Medicine Department of Neurosurgery, Cincinnati, OH
| | - James L Leach
- Department of Pediatric Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Radiology, Mayo Clinic, Rochester, MN.
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34
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Azad TD, Duffau H. Limitations of functional neuroimaging for patient selection and surgical planning in glioma surgery. Neurosurg Focus 2020; 48:E12. [DOI: 10.3171/2019.11.focus19769] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 11/01/2019] [Indexed: 11/06/2022]
Abstract
The optimal surgical management of gliomas requires a balance between surgical cytoreduction and preservation of neurological function. Preoperative functional neuroimaging, such as functional MRI (fMRI) and diffusion tensor imaging (DTI), has emerged as a possible tool to inform patient selection and surgical planning. However, evidence that preoperative fMRI or DTI improves extent of resection, limits neurological morbidity, and broadens surgical indications in classically eloquent areas is lacking. In this review, the authors describe facets of functional neuroimaging techniques that may limit their impact on neurosurgical oncology and critically evaluate the evidence supporting fMRI and DTI for patient selection and operative planning in glioma surgery. The authors also propose alternative applications for functional neuroimaging in the care of glioma patients.
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Affiliation(s)
- Tej D. Azad
- 1Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland; and
| | - Hugues Duffau
- 2Department of Neurosurgery, Hôpital Gui de Chauliac, Montpellier, France
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35
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Liu L, Zhang H, Wu J, Yu Z, Chen X, Rekik I, Wang Q, Lu J, Shen D. Overall survival time prediction for high-grade glioma patients based on large-scale brain functional networks. Brain Imaging Behav 2020; 13:1333-1351. [PMID: 30155788 DOI: 10.1007/s11682-018-9949-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
High-grade glioma (HGG) is a lethal cancer with poor outcome. Accurate preoperative overall survival (OS) time prediction for HGG patients is crucial for treatment planning. Traditional presurgical and noninvasive OS prediction studies have used radiomics features at the local lesion area based on the magnetic resonance images (MRI). However, the highly complex lesion MRI appearance may have large individual variability, which could impede accurate individualized OS prediction. In this paper, we propose a novel concept, namely brain connectomics-based OS prediction. It is based on presurgical resting-state functional MRI (rs-fMRI) and the non-local, large-scale brain functional networks where the global and systemic prognostic features rather than the local lesion appearance are used to predict OS. We propose that the connectomics features could capture tumor-induced network-level alterations that are associated with prognosis. We construct both low-order (by means of sparse representation with regional rs-fMRI signals) and high-order functional connectivity (FC) networks (characterizing more complex multi-regional relationship by synchronized dynamics FC time courses). Then, we conduct a graph-theoretic analysis on both networks for a jointly, machine-learning-based individualized OS prediction. Based on a preliminary dataset (N = 34 with bad OS, mean OS, ~400 days; N = 34 with good OS, mean OS, ~1030 days), we achieve a promising OS prediction accuracy (86.8%) on separating the individuals with bad OS from those with good OS. However, if using only conventionally derived descriptive features (e.g., age and tumor characteristics), the accuracy is low (63.2%). Our study highlights the importance of the rs-fMRI and brain functional connectomics for treatment planning.
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Affiliation(s)
- Luyan Liu
- Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, 1954 Huashan Road, Shanghai, 200030, China.,Department of Radiology and BRIC, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Han Zhang
- Department of Radiology and BRIC, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jinsong Wu
- Glioma Surgery Division, Neurosurgery Department of Huashan Hospital, Fudan University, Shanghai, 200040, China.,Shanghai Key Lab of Medical Image Computing and Computer-Assisted Intervention, Shanghai, 200040, China.,Neurosurgery Department of Huashan Hospital, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Zhengda Yu
- Glioma Surgery Division, Neurosurgery Department of Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Xiaobo Chen
- Department of Radiology and BRIC, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Islem Rekik
- Department of Radiology and BRIC, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,BASIRA Lab, CVIP Group, School of Science and Engineering, Computing, University of Dundee, Dundee, UK
| | - Qian Wang
- Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, 1954 Huashan Road, Shanghai, 200030, China.
| | - Junfeng Lu
- Glioma Surgery Division, Neurosurgery Department of Huashan Hospital, Fudan University, Shanghai, 200040, China. .,Shanghai Key Lab of Medical Image Computing and Computer-Assisted Intervention, Shanghai, 200040, China. .,Neurosurgery Department of Huashan Hospital, 12 Wulumuqi Zhong Road, Shanghai, 200040, China.
| | - Dinggang Shen
- Department of Radiology and BRIC, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. .,Department of Brain and Cognitive Engineering, Korea University, Seoul, 02841, Republic of Korea.
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Zacà D, Jovicich J, Corsini F, Rozzanigo U, Chioffi F, Sarubbo S. ReStNeuMap: a tool for automatic extraction of resting-state functional MRI networks in neurosurgical practice. J Neurosurg 2019; 131:764-771. [PMID: 30485221 DOI: 10.3171/2018.4.jns18474] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 04/17/2018] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Resting-state functional MRI (rs-fMRI) represents a promising and cost-effective alternative to task-based fMRI for presurgical mapping. However, the lack of clinically streamlined and reliable rs-fMRI analysis tools has prevented wide adoption of this technique. In this work, the authors introduce an rs-fMRI processing pipeline (ReStNeuMap) for automatic single-patient rs-fMRI network analysis. METHODS The authors provide a description of the rs-fMRI network analysis steps implemented in ReStNeuMap and report their initial experience with this tool after performing presurgical mapping in 6 patients. They verified the spatial agreement between rs-fMRI networks derived by ReStNeuMap and localization of activation with intraoperative direct electrical stimulation (DES). RESULTS The authors automatically extracted rs-fMRI networks including eloquent cortex in spatial proximity with the resected lesion in all patients. The distance between DES points and corresponding rs-fMRI networks was less than 1 cm in 78% of cases for motor, 100% of cases for visual, 87.5% of cases for language, and 100% of cases for speech articulation mapping. CONCLUSIONS The authors' initial experience with ReStNeuMap showed good spatial agreement between presurgical rs-fMRI predictions and DES findings during awake surgery. The availability of the rs-fMRI analysis tools for clinicians aiming to perform noninvasive mapping of brain functional networks may extend its application beyond surgical practice.
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Affiliation(s)
- Domenico Zacà
- 1Center for Mind/Brain Sciences, University of Trento; and
| | - Jorge Jovicich
- 1Center for Mind/Brain Sciences, University of Trento; and
| | - Francesco Corsini
- 2Division of Neurosurgery, Structural and Functional Connectivity Lab Project, and
| | - Umberto Rozzanigo
- 3Department of Radiology, Neuroradiology Unit, "S. Chiara" Hospital, Trento, Italy
| | - Franco Chioffi
- 2Division of Neurosurgery, Structural and Functional Connectivity Lab Project, and
| | - Silvio Sarubbo
- 2Division of Neurosurgery, Structural and Functional Connectivity Lab Project, and
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Sarubbo S, Zacà D, Novello L, Annicchiarico L, Corsini F, Rozzanigo U, Chioffi F, Jovicich J. Response to editorials. Resting-state brain functional MRI to complete the puzzle. J Neurosurg 2019; 131:762-763. [PMID: 30485179 DOI: 10.3171/2018.6.jns181568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Silvio Sarubbo
- 1Division of Neurosurgery, Structural and Functional Connectivity Lab Project, and
| | - Domenico Zacà
- 2Center for Mind/Brain Sciences, University of Trento; and
| | - Lisa Novello
- 2Center for Mind/Brain Sciences, University of Trento; and
| | - Luciano Annicchiarico
- 1Division of Neurosurgery, Structural and Functional Connectivity Lab Project, and
- 3Department of Neurosciences, Biomedicine and Movement Sciences, Section of Neurosurgery, University of Verona, Italy
| | - Francesco Corsini
- 1Division of Neurosurgery, Structural and Functional Connectivity Lab Project, and
| | - Umberto Rozzanigo
- 4Department of Radiology, Neuroradiology Unit, "S. Chiara" Hospital, Trento
| | - Franco Chioffi
- 1Division of Neurosurgery, Structural and Functional Connectivity Lab Project, and
| | - Jorge Jovicich
- 2Center for Mind/Brain Sciences, University of Trento; and
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Fekonja L, Wang Z, Bährend I, Rosenstock T, Rösler J, Wallmeroth L, Vajkoczy P, Picht T. Manual for clinical language tractography. Acta Neurochir (Wien) 2019; 161:1125-1137. [PMID: 31004240 PMCID: PMC6525736 DOI: 10.1007/s00701-019-03899-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 03/28/2019] [Indexed: 11/30/2022]
Abstract
Background We introduce a user-friendly, standardized protocol for tractography of the major language fiber bundles. Method The introduced method uses dMRI images for tractography whereas the ROI definition is based on structural T1 MPRAGE MRI templates, without normalization to MNI space. ROIs for five language-relevant fiber bundles were visualized on an axial, coronal, or sagittal view of T1 MPRAGE images. The ROIs were defined based upon the tracts’ obligatory pathways, derived from literature and own experiences in peritumoral tractography. Results The resulting guideline was evaluated for each fiber bundle in ten healthy subjects and ten patients by one expert and three raters. Overall, 300 ROIs were evaluated and compared. The targeted language fiber bundles could be tracked in 88% of the ROI pairs, based on the raters’ result blinded ROI placements. The evaluation indicated that the precision of the ROIs did not relate to the varying experience of the raters. Conclusions Our guideline introduces a standardized language tractography method for routine preoperative workup and for research contexts. The ROI placement guideline based on easy-to-identify anatomical landmarks proved to be user-friendly and accurate, also in inexperienced test persons.
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Affiliation(s)
- Lucius Fekonja
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany.
- Cluster of Excellence: "Matters of Activity. Image Space Material", Humboldt University, Berlin, Germany.
| | - Ziqian Wang
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ina Bährend
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tizian Rosenstock
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Judith Rösler
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Lara Wallmeroth
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Picht
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Cluster of Excellence: "Matters of Activity. Image Space Material", Humboldt University, Berlin, Germany
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O'Connor EE, Zeffiro TA. Why is Clinical fMRI in a Resting State? Front Neurol 2019; 10:420. [PMID: 31068901 PMCID: PMC6491723 DOI: 10.3389/fneur.2019.00420] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 04/05/2019] [Indexed: 12/28/2022] Open
Abstract
While resting state fMRI (rs-fMRI) has gained widespread application in neuroimaging clinical research, its penetration into clinical medicine has been more limited. We surveyed a neuroradiology professional group to ascertain their experience with rs-fMRI, identify perceived barriers to using rs-fMRI clinically and elicit suggestions about ways to facilitate its use in clinical practice. The electronic survey also collected information about demographics and work environment using Likert scales. We found that 90% of the respondents had adequate equipment to conduct rs-fMRI and 82% found rs-fMRI data easy to collect. Fifty-nine percent have used rs-fMRI in their past research and 72% reported plans to use rs-fMRI for research in the next year. Nevertheless, only 40% plan to use rs-fMRI in clinical practice in the next year and 82% agreed that their clinical fMRI use is largely confined to pre-surgical planning applications. To explore the reasons for the persistent low utilization of rs-fMRI in clinical applications, we identified barriers to clinical rs-fMRI use related to the availability of robust denoising procedures, single-subject analysis techniques, demonstration of functional connectivity map reliability, regulatory clearance, reimbursement, and neuroradiologist training opportunities. In conclusion, while rs-fMRI use in clinical neuroradiology practice is limited, enthusiasm appears to be quite high and there are several possible avenues in which further research and development may facilitate its penetration into clinical practice.
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Affiliation(s)
- Erin E O'Connor
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, MD, United States
| | - Thomas A Zeffiro
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, MD, United States
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40
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Yordanova YN, Cochereau J, Duffau H, Herbet G. Combining resting state functional MRI with intraoperative cortical stimulation to map the mentalizing network. Neuroimage 2018; 186:628-636. [PMID: 30500423 DOI: 10.1016/j.neuroimage.2018.11.046] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 11/02/2018] [Accepted: 11/26/2018] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE To infer the face-based mentalizing network from resting-state functional MRI (rsfMRI) using a seed-based correlation analysis with regions of interest identified during intraoperative cortical electrostimulation. METHODS We retrospectively included 23 patients in whom cortical electrostimulation induced transient face-based mentalizing impairment during 'awake' craniotomy for resection of a right-sided diffuse low-grade glioma. Positive stimulation sites were recorded and transferred to the patients' preoperative normalized MRI, and then used as seeds for subsequent seed-to-voxel functional connectivity analyses. The analyses, conducted with an uncorrected voxel-level p-value of 0.001 and a false-discovery-rate cluster-level p-value of 0.05, allowed identification of the cortical structures, functionally coupled with the mentalizing-related sites. RESULTS Two clusters of responsive stimulations were identified intraoperatively - one in the right dorsolateral prefrontal cortex (dlPFC, n = 13) and the other in the right inferior frontal gyrus (IFG, n = 10). A whole group level analysis revealed that stimulation sites correlated mainly with voxels located in the pars triangularis of the IFG, the dorsolateral and dorsomedial prefrontal cortices, the temporo-parietal junction, the posterior superior temporal sulcus, and the posterior inferior temporal/fusiform gyrus. Other analyses, taking into consideration the location of the responsive sites (IFG versus dlPFC cluster), highlighted only minor differences between both groups. CONCLUSIONS The present study successfully demonstrated the involvement of a large-scale neural network in the face-based mentalizing that strongly matches networks, classically identified using task-based fMRI paradigms. We thus validated the combination of rsfMRI and stimulation mapping as a powerful approach to identify functional networks in brain-damaged patients.
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Affiliation(s)
- Yordanka Nikolova Yordanova
- Department of Neurosurgery, 'Percy' Military Hospital, 101 avenue Henri Barbusse, 92140, Clamart, France; National Institute for Health and Medical Research (INSERM), U1051, Team "Plasticity of the Central Nervous System, Human Stem Cells and Glial Tumors", Institute for Neurosciences of Montpellier, France.
| | - Jérôme Cochereau
- Department of Neurosurgery, Gui de Chauliac Hospital, 80 avenue Augustin Fliche, 34295, France; National Institute for Health and Medical Research (INSERM), U1051, Team "Plasticity of the Central Nervous System, Human Stem Cells and Glial Tumors", Institute for Neurosciences of Montpellier, France.
| | - Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, 80 avenue Augustin Fliche, 34295, France; National Institute for Health and Medical Research (INSERM), U1051, Team "Plasticity of the Central Nervous System, Human Stem Cells and Glial Tumors", Institute for Neurosciences of Montpellier, France; University of Montpellier, France.
| | - Guillaume Herbet
- Department of Neurosurgery, Gui de Chauliac Hospital, 80 avenue Augustin Fliche, 34295, France; National Institute for Health and Medical Research (INSERM), U1051, Team "Plasticity of the Central Nervous System, Human Stem Cells and Glial Tumors", Institute for Neurosciences of Montpellier, France; University of Montpellier, France.
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Abstract
For the neurosurgical oncologist, a specialty practice in gliomas represents an intersection of tailored surgical approaches, emerging intraoperative technologies, expanding surgical trial portfolios, and new paradigms in glioma biology. Assembling these disparate pieces into a cohesive career trajectory is a difficult task but ultimately enables the subspecialist to navigate all domains relevant to improving glioma patient outcomes. Within the larger clinical and basic science community, thoughtful integration and intensive collaborations are essential mechanisms when building a multidisciplinary glioma program.
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Affiliation(s)
- Nader Sanai
- Division of Neurosurgical Oncology, Ivy Brain Tumor Center, Barrow Neurological Institute, 2910 North Third Avenue, Phoenix, AZ 85013, USA.
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Liouta E, Katsaros VK, Stranjalis G, Leks E, Klose U, Bisdas S. Motor and language deficits correlate with resting state functional magnetic resonance imaging networks in patients with brain tumors. J Neuroradiol 2018; 46:199-206. [PMID: 30179690 DOI: 10.1016/j.neurad.2018.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 07/10/2018] [Accepted: 08/15/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Evidence of pre-operative resting state functional magnetic resonance (RS-fMRI) validation by correlating it with clinical pre-operative status in brain tumor patients is scarce. Our aim was to validate the functional relevance of RS-fMRI by investigating the association between RS-fMRI and pre-operative motor and language function performance in patients with brain tumor. MATERIALS AND METHODS Sixty-nine patients with brain tumors were prospectively recruited. Patients with tumors near precentral gyrus (n = 49) underwent assessment for apparent (paresis) and subtle (finger tapping) deficits. Patients with left frontal tumors in the vicinity of the inferior frontal gyrus (n = 29) underwent assessment for gross (aphasia) and mild language (phonological verbal fluency) deficits. RS-fMRI results were extracted by spatial independent component analysis (ICA). RESULTS Motor group: paretic patients showed significantly (P = 0.01) decreased BOLD signal in ipsilesional precentral gyrus when compared to contralesional one. Significantly (P < 0.01) lower BOLD signal was also observed in ipsilesional precentral gyrus of paretics when compared with the non-paretics. In asymptomatic patients, a strong positive correlation (r = 0.68, P < 0.01) between ipsilesional motor cortex BOLD signal and contralesional finger tapping performance was observed. Language group: patients with aphasia showed significantly (P = 0.01) decreased RS-fMRI BOLD signal in left BA 44 when compared with non- aphasics. In asymptomatic patients, a strong positive correlation (r = 0.72, P < 0.01) between BA 44 BOLD signal and phonological fluency performance was observed. CONCLUSIONS Our results showed that RS-fMRI BOLD signal of motor and language networks were significantly affected by the tumors implying the usefulness of the method for assessment of the underlying functions in brain tumors patients.
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Affiliation(s)
- Evangelia Liouta
- Department of Neurosurgery, University of Athens, "Evangelismos" Hospital, Athens, Greece; Department of Neuroradiology, University Hospital of Tübingen, Tübingen, Germany.
| | - Vasileios K Katsaros
- Department of Radiology, General Anti-Cancer and Oncological Hospital of Athens "St. Savvas", Athens, Greece; Department of Neurosurgery, University of Athens, "Evangelismos" Hospital, Athens, Greece; Department of Neuroradiology, University Hospital of Tübingen, Tübingen, Germany
| | - George Stranjalis
- Department of Neurosurgery, University of Athens, "Evangelismos" Hospital, Athens, Greece
| | - Edyta Leks
- Department of Biomedical Magnetic Resonance, University Hospital of Tübingen, Tübingen, Germany
| | - Uwe Klose
- Department of Neuroradiology, University Hospital of Tübingen, Tübingen, Germany
| | - Sotirios Bisdas
- Department of Neuroradiology, University Hospital of Tübingen, Tübingen, Germany; Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, UK; Institute of Neurology, University College London, London, UK
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43
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Wongsripuemtet J, Tyan AE, Carass A, Agarwal S, Gujar SK, Pillai JJ, Sair HI. Preoperative Mapping of the Supplementary Motor Area in Patients with Brain Tumor Using Resting-State fMRI with Seed-Based Analysis. AJNR Am J Neuroradiol 2018; 39:1493-1498. [PMID: 30002054 DOI: 10.3174/ajnr.a5709] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 05/08/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The supplementary motor area can be a critical region in the preoperative planning of patients undergoing brain tumor resection because it plays a role in both language and motor function. While primary motor regions have been successfully identified using resting-state fMRI, there is variability in the literature regarding the identification of the supplementary motor area for preoperative planning. The purpose of our study was to compare resting-state fMRI to task-based fMRI for localization of the supplementary motor area in a large cohort of patients with brain tumors presenting for preoperative brain mapping. MATERIALS AND METHODS Sixty-six patients with brain tumors were evaluated with resting-state fMRI using seed-based analysis of hand and orofacial motor regions. Rates of supplementary motor area localization were compared with those in healthy controls and with localization results by task-based fMRI. RESULTS Localization of the supplementary motor area using hand motor seed regions was more effective than seeding using orofacial motor regions for both patients with brain tumor (95.5% versus 34.8%, P < .001) and controls (95.2% versus 45.2%, P < .001). Bilateral hand motor seeding was superior to unilateral hand motor seeding in patients with brain tumor for either side (95.5% versus 75.8%/75.8% for right/left, P < .001). No difference was found in the ability to identify the supplementary motor area between patients with brain tumors and controls. CONCLUSIONS In addition to task-based fMRI, seed-based analysis of resting-state fMRI represents an equally effective method for supplementary motor area localization in patients with brain tumors, with the best results obtained with bilateral hand motor region seeding.
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Affiliation(s)
- J Wongsripuemtet
- From the Russell H. Morgan Department of Radiology and Radiological Sciences (J.W., A.E.T., S.A., S.K.G., J.J.P., H.I.S.).,Department of Radiology (J.W.), Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - A E Tyan
- From the Russell H. Morgan Department of Radiology and Radiological Sciences (J.W., A.E.T., S.A., S.K.G., J.J.P., H.I.S.)
| | - A Carass
- Department of Computer Science and Department of Electrical and Computer Engineering (A.C.), Johns Hopkins University, Baltimore, Maryland
| | - S Agarwal
- From the Russell H. Morgan Department of Radiology and Radiological Sciences (J.W., A.E.T., S.A., S.K.G., J.J.P., H.I.S.)
| | - S K Gujar
- From the Russell H. Morgan Department of Radiology and Radiological Sciences (J.W., A.E.T., S.A., S.K.G., J.J.P., H.I.S.)
| | - J J Pillai
- From the Russell H. Morgan Department of Radiology and Radiological Sciences (J.W., A.E.T., S.A., S.K.G., J.J.P., H.I.S.).,Department of Neurosurgery (J.J.P.), Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - H I Sair
- From the Russell H. Morgan Department of Radiology and Radiological Sciences (J.W., A.E.T., S.A., S.K.G., J.J.P., H.I.S.)
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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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Volz LJ, Kocher M, Lohmann P, Shah NJ, Fink GR, Galldiks N. Functional magnetic resonance imaging in glioma patients: from clinical applications to future perspectives. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF RADIOPHARMACEUTICAL CHEMISTRY AND BIOLOGY 2018; 62:295-302. [PMID: 29761998 DOI: 10.23736/s1824-4785.18.03101-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Functional magnetic resonance imaging (fMRI) allows the non-invasive assessment of human brain activity in vivo. In glioma patients, fMRI is frequently used to determine the individual functional anatomy of the motor and language network in a presurgical setting to optimize surgical procedures and prevent extensive damage to functionally eloquent areas. Novel developments based on resting-state fMRI may help to improve presurgical planning for patients which are unable to perform structured tasks and might extend presurgical mapping to include additional functional networks. Recent advances indicate a promising potential for future applications of fMRI in glioma patients which might help to identify neoplastic tissue or predict the long-term functional outcome of individual patients.
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Affiliation(s)
- Lukas J Volz
- Department of Neurology, University of Cologne, Cologne, Germany - .,SAGE Center for the Study of the Mind and Brain, University of California - Santa Barbara, Santa Barbara, CA, USA -
| | - Martin Kocher
- Institute of Neuroscience and Medicine, Jülich Research Center, Jülich, Germany.,Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Cologne, Germany
| | - Philipp Lohmann
- Institute of Neuroscience and Medicine, Jülich Research Center, Jülich, Germany
| | - Nadim J Shah
- Institute of Neuroscience and Medicine, Jülich Research Center, Jülich, Germany.,Department of Neurology, RWTH Aachen University, Aachen, Germany.,JARA-BRAIN Institute for Translational Medicine (INM-3, -4), Forschungszentrum Jülich, Jülich, Germany
| | - Gereon R Fink
- Department of Neurology, University of Cologne, Cologne, Germany.,Institute of Neuroscience and Medicine, Jülich Research Center, Jülich, Germany
| | - Norbert Galldiks
- Department of Neurology, University of Cologne, Cologne, Germany.,Institute of Neuroscience and Medicine, Jülich Research Center, Jülich, Germany.,Center of Integrated Oncology (CIO), Universities of Cologne and Bonn, Cologne, Germany
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Hsu AL, Hou P, Johnson JM, Wu CW, Noll KR, Prabhu SS, Ferguson SD, Kumar VA, Schomer DF, Hazle JD, Chen JH, Liu HL. IClinfMRI Software for Integrating Functional MRI Techniques in Presurgical Mapping and Clinical Studies. Front Neuroinform 2018; 12:11. [PMID: 29593520 PMCID: PMC5854683 DOI: 10.3389/fninf.2018.00011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 02/23/2018] [Indexed: 01/25/2023] Open
Abstract
Task-evoked and resting-state (rs) functional magnetic resonance imaging (fMRI) techniques have been applied to the clinical management of neurological diseases, exemplified by presurgical localization of eloquent cortex, to assist neurosurgeons in maximizing resection while preserving brain functions. In addition, recent studies have recommended incorporating cerebrovascular reactivity (CVR) imaging into clinical fMRI to evaluate the risk of lesion-induced neurovascular uncoupling (NVU). Although each of these imaging techniques possesses its own advantage for presurgical mapping, a specialized clinical software that integrates the three complementary techniques and promptly outputs the analyzed results to radiology and surgical navigation systems in a clinical format is still lacking. We developed the Integrated fMRI for Clinical Research (IClinfMRI) software to facilitate these needs. Beyond the independent processing of task-fMRI, rs-fMRI, and CVR mapping, IClinfMRI encompasses three unique functions: (1) supporting the interactive rs-fMRI mapping while visualizing task-fMRI results (or results from published meta-analysis) as a guidance map, (2) indicating/visualizing the NVU potential on analyzed fMRI maps, and (3) exporting these advanced mapping results in a Digital Imaging and Communications in Medicine (DICOM) format that are ready to export to a picture archiving and communication system (PACS) and a surgical navigation system. In summary, IClinfMRI has the merits of efficiently translating and integrating state-of-the-art imaging techniques for presurgical functional mapping and clinical fMRI studies.
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Affiliation(s)
- Ai-Ling Hsu
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.,Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Ping Hou
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jason M Johnson
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Changwei W Wu
- Graduate Institute of Humanities in Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kyle R Noll
- Section of Neuropsychology, Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Sherise D Ferguson
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Vinodh A Kumar
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Donald F Schomer
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - John D Hazle
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jyh-Horng Chen
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Ho-Ling Liu
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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Temporal reliability of ultra-high field resting-state MRI for single-subject sensorimotor and language mapping. Neuroimage 2018; 168:499-508. [DOI: 10.1016/j.neuroimage.2016.11.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/29/2016] [Accepted: 11/12/2016] [Indexed: 11/19/2022] Open
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Ghinda DC, Wu JS, Duncan NW, Northoff G. How much is enough-Can resting state fMRI provide a demarcation for neurosurgical resection in glioma? Neurosci Biobehav Rev 2017; 84:245-261. [PMID: 29198588 DOI: 10.1016/j.neubiorev.2017.11.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 11/20/2017] [Accepted: 11/27/2017] [Indexed: 01/09/2023]
Abstract
This study represents a systematic review of the insights provided by resting state functional MRI (rs-fMRI) use in the glioma population. Following PRISMA guidelines, 45 studies were included in the review and were classified in glioma-related neuronal changes (n=28) and eloquent area localization (n=17). Despite the heterogeneous nature of the studies, there is considerable evidence of diffuse functional reorganization occurring in the setting of gliomas with local and interhemispheric functional connectivity alterations involving different functional networks. The studies showed evidence of decreased long distance functional connectivity and increased global local efficiency occurring in the setting of gliomas. The tumour grade seems to correlate with distinct functional connectivity changes. Overall, there is a potential clinical utility of rs-fMRI for identifying the functional brain network disruptions occurring in the setting of gliomas. Further studies utilizing standardized analytical methods are required to elucidate the mechanism through which gliomas induce global changes in brain connectivity.
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Affiliation(s)
- Diana C Ghinda
- Ottawa Hospital Research Institute, University of Ottawa, Division of Neurosurgery, The Ottawa Hospital, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada; Mind, Brain Imaging and Neuroethics, Canada Research Chair, EJLB-Michael Smith Chair for Neuroscience and Mental Health, Royal Ottawa Mental Health Centre, University of Ottawa Institute of Mental Health Research, 1145 Carling Avenue, Rm. 6435, Ottawa, ON, K1Z 7K4, Canada.
| | - Jin-Song Wu
- Glioma Surgery Division, Department of Neurological Surgery, Huashan Hospital, Fudan University, 518 Wuzhong E Rd, Shanghai, China.
| | - Niall W Duncan
- Brain and Consciousness Research Center, Taipei Medical University-Shuang Ho Hospital, 250 Wu-Xing Street, Taipei, 11031, Taiwan.
| | - Georg Northoff
- Mind, Brain Imaging and Neuroethics, Canada Research Chair, EJLB-Michael Smith Chair for Neuroscience and Mental Health, Royal Ottawa Mental Health Centre, University of Ottawa Institute of Mental Health Research, 1145 Carling Avenue, Rm. 6435, Ottawa, ON, K1Z 7K4, Canada; Mental Health Center/7th Hospital, Zhejiang University School of Medicine, 305 Tianmu Road, Hangzhou, Zhejiang Province, 310013, China.
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Sair HI, Agarwal S, Pillai JJ. Application of Resting State Functional MR Imaging to Presurgical Mapping. Neuroimaging Clin N Am 2017; 27:635-644. [DOI: 10.1016/j.nic.2017.06.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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