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Weng HH, Noll KR, Johnson JM, Prabhu SS, Tsai YH, Chang SW, Huang YC, Lee JD, Yang JT, Yang CT, Tsai YH, Yang CY, Hazle JD, Schomer DF, Liu HL. Accuracy of Presurgical Functional MR Imaging for Language Mapping of Brain Tumors: A Systematic Review and Meta-Analysis. Radiology 2017; 286:512-523. [PMID: 28980887 DOI: 10.1148/radiol.2017162971] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Purpose To compare functional magnetic resonance (MR) imaging for language mapping (hereafter, language functional MR imaging) with direct cortical stimulation (DCS) in patients with brain tumors and to assess factors associated with its accuracy. Materials and Methods PubMed/MEDLINE and related databases were searched for research articles published between January 2000 and September 2016. Findings were pooled by using bivariate random-effects and hierarchic summary receiver operating characteristic curve models. Meta-regression and subgroup analyses were performed to evaluate whether publication year, functional MR imaging paradigm, magnetic field strength, statistical threshold, and analysis software affected classification accuracy. Results Ten articles with a total of 214 patients were included in the analysis. On a per-patient basis, the pooled sensitivity and specificity of functional MR imaging was 44% (95% confidence interval [CI]: 14%, 78%) and 80% (95% CI: 54%, 93%), respectively. On a per-tag basis (ie, each DCS stimulation site or "tag" was considered a separate data point across all patients), the pooled sensitivity and specificity were 67% (95% CI: 51%, 80%) and 55% (95% CI: 25%, 82%), respectively. The per-tag analysis showed significantly higher sensitivity for studies with shorter functional MR imaging session times (P = .03) and relaxed statistical threshold (P = .05). Significantly higher specificity was found when expressive language task (P = .02), longer functional MR imaging session times (P < .01), visual presentation of stimuli (P = .04), and stringent statistical threshold (P = .01) were used. Conclusion Results of this study showed moderate accuracy of language functional MR imaging when compared with intraoperative DCS, and the included studies displayed significant methodologic heterogeneity. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Hsu-Huei Weng
- From the Departments of Diagnostic Radiology (H.H.W., Yuan-Hsiung Tsai, S.W.C.), Neurology (Y.C.H., J.D.L.), and Neurosurgery (J.T.Y.), Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan (H.H.W.); Department of Psychology, National Chung Cheng University, Chiayi, Taiwan (H.H.W.); Department of Imaging Physics (H.H.W., J.D.H., H.L.L.), Department of Diagnostic Radiology (J.M.J., D.F.S.), Division of Diagnostic Imaging, Department of Neuro-Oncology, Section of Neuropsychology, Division of Cancer Medicine (K.R.N.), Department of Neurosurgery, Division of Surgery (S.S.P.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Division of Pulmonary and Critical Care Medicine of Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.T.Y.); Department of Respiratory Care, College of Medicine (C.T.Y.), Department of Respiratory Therapy (Ying-Huang Tsai), Chang Gung University, Taoyuan, Taiwan; Division of Pulmonary and Critical Care Medicine and Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi, Taiwan (Ying-Huang Tsai); and Faculty of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.Y.)
| | - Kyle R Noll
- From the Departments of Diagnostic Radiology (H.H.W., Yuan-Hsiung Tsai, S.W.C.), Neurology (Y.C.H., J.D.L.), and Neurosurgery (J.T.Y.), Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan (H.H.W.); Department of Psychology, National Chung Cheng University, Chiayi, Taiwan (H.H.W.); Department of Imaging Physics (H.H.W., J.D.H., H.L.L.), Department of Diagnostic Radiology (J.M.J., D.F.S.), Division of Diagnostic Imaging, Department of Neuro-Oncology, Section of Neuropsychology, Division of Cancer Medicine (K.R.N.), Department of Neurosurgery, Division of Surgery (S.S.P.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Division of Pulmonary and Critical Care Medicine of Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.T.Y.); Department of Respiratory Care, College of Medicine (C.T.Y.), Department of Respiratory Therapy (Ying-Huang Tsai), Chang Gung University, Taoyuan, Taiwan; Division of Pulmonary and Critical Care Medicine and Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi, Taiwan (Ying-Huang Tsai); and Faculty of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.Y.)
| | - Jason M Johnson
- From the Departments of Diagnostic Radiology (H.H.W., Yuan-Hsiung Tsai, S.W.C.), Neurology (Y.C.H., J.D.L.), and Neurosurgery (J.T.Y.), Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan (H.H.W.); Department of Psychology, National Chung Cheng University, Chiayi, Taiwan (H.H.W.); Department of Imaging Physics (H.H.W., J.D.H., H.L.L.), Department of Diagnostic Radiology (J.M.J., D.F.S.), Division of Diagnostic Imaging, Department of Neuro-Oncology, Section of Neuropsychology, Division of Cancer Medicine (K.R.N.), Department of Neurosurgery, Division of Surgery (S.S.P.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Division of Pulmonary and Critical Care Medicine of Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.T.Y.); Department of Respiratory Care, College of Medicine (C.T.Y.), Department of Respiratory Therapy (Ying-Huang Tsai), Chang Gung University, Taoyuan, Taiwan; Division of Pulmonary and Critical Care Medicine and Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi, Taiwan (Ying-Huang Tsai); and Faculty of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.Y.)
| | - Sujit S Prabhu
- From the Departments of Diagnostic Radiology (H.H.W., Yuan-Hsiung Tsai, S.W.C.), Neurology (Y.C.H., J.D.L.), and Neurosurgery (J.T.Y.), Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan (H.H.W.); Department of Psychology, National Chung Cheng University, Chiayi, Taiwan (H.H.W.); Department of Imaging Physics (H.H.W., J.D.H., H.L.L.), Department of Diagnostic Radiology (J.M.J., D.F.S.), Division of Diagnostic Imaging, Department of Neuro-Oncology, Section of Neuropsychology, Division of Cancer Medicine (K.R.N.), Department of Neurosurgery, Division of Surgery (S.S.P.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Division of Pulmonary and Critical Care Medicine of Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.T.Y.); Department of Respiratory Care, College of Medicine (C.T.Y.), Department of Respiratory Therapy (Ying-Huang Tsai), Chang Gung University, Taoyuan, Taiwan; Division of Pulmonary and Critical Care Medicine and Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi, Taiwan (Ying-Huang Tsai); and Faculty of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.Y.)
| | - Yuan-Hsiung Tsai
- From the Departments of Diagnostic Radiology (H.H.W., Yuan-Hsiung Tsai, S.W.C.), Neurology (Y.C.H., J.D.L.), and Neurosurgery (J.T.Y.), Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan (H.H.W.); Department of Psychology, National Chung Cheng University, Chiayi, Taiwan (H.H.W.); Department of Imaging Physics (H.H.W., J.D.H., H.L.L.), Department of Diagnostic Radiology (J.M.J., D.F.S.), Division of Diagnostic Imaging, Department of Neuro-Oncology, Section of Neuropsychology, Division of Cancer Medicine (K.R.N.), Department of Neurosurgery, Division of Surgery (S.S.P.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Division of Pulmonary and Critical Care Medicine of Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.T.Y.); Department of Respiratory Care, College of Medicine (C.T.Y.), Department of Respiratory Therapy (Ying-Huang Tsai), Chang Gung University, Taoyuan, Taiwan; Division of Pulmonary and Critical Care Medicine and Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi, Taiwan (Ying-Huang Tsai); and Faculty of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.Y.)
| | - Sheng-Wei Chang
- From the Departments of Diagnostic Radiology (H.H.W., Yuan-Hsiung Tsai, S.W.C.), Neurology (Y.C.H., J.D.L.), and Neurosurgery (J.T.Y.), Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan (H.H.W.); Department of Psychology, National Chung Cheng University, Chiayi, Taiwan (H.H.W.); Department of Imaging Physics (H.H.W., J.D.H., H.L.L.), Department of Diagnostic Radiology (J.M.J., D.F.S.), Division of Diagnostic Imaging, Department of Neuro-Oncology, Section of Neuropsychology, Division of Cancer Medicine (K.R.N.), Department of Neurosurgery, Division of Surgery (S.S.P.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Division of Pulmonary and Critical Care Medicine of Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.T.Y.); Department of Respiratory Care, College of Medicine (C.T.Y.), Department of Respiratory Therapy (Ying-Huang Tsai), Chang Gung University, Taoyuan, Taiwan; Division of Pulmonary and Critical Care Medicine and Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi, Taiwan (Ying-Huang Tsai); and Faculty of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.Y.)
| | - Yen-Chu Huang
- From the Departments of Diagnostic Radiology (H.H.W., Yuan-Hsiung Tsai, S.W.C.), Neurology (Y.C.H., J.D.L.), and Neurosurgery (J.T.Y.), Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan (H.H.W.); Department of Psychology, National Chung Cheng University, Chiayi, Taiwan (H.H.W.); Department of Imaging Physics (H.H.W., J.D.H., H.L.L.), Department of Diagnostic Radiology (J.M.J., D.F.S.), Division of Diagnostic Imaging, Department of Neuro-Oncology, Section of Neuropsychology, Division of Cancer Medicine (K.R.N.), Department of Neurosurgery, Division of Surgery (S.S.P.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Division of Pulmonary and Critical Care Medicine of Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.T.Y.); Department of Respiratory Care, College of Medicine (C.T.Y.), Department of Respiratory Therapy (Ying-Huang Tsai), Chang Gung University, Taoyuan, Taiwan; Division of Pulmonary and Critical Care Medicine and Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi, Taiwan (Ying-Huang Tsai); and Faculty of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.Y.)
| | - Jiann-Der Lee
- From the Departments of Diagnostic Radiology (H.H.W., Yuan-Hsiung Tsai, S.W.C.), Neurology (Y.C.H., J.D.L.), and Neurosurgery (J.T.Y.), Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan (H.H.W.); Department of Psychology, National Chung Cheng University, Chiayi, Taiwan (H.H.W.); Department of Imaging Physics (H.H.W., J.D.H., H.L.L.), Department of Diagnostic Radiology (J.M.J., D.F.S.), Division of Diagnostic Imaging, Department of Neuro-Oncology, Section of Neuropsychology, Division of Cancer Medicine (K.R.N.), Department of Neurosurgery, Division of Surgery (S.S.P.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Division of Pulmonary and Critical Care Medicine of Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.T.Y.); Department of Respiratory Care, College of Medicine (C.T.Y.), Department of Respiratory Therapy (Ying-Huang Tsai), Chang Gung University, Taoyuan, Taiwan; Division of Pulmonary and Critical Care Medicine and Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi, Taiwan (Ying-Huang Tsai); and Faculty of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.Y.)
| | - Jen-Tsung Yang
- From the Departments of Diagnostic Radiology (H.H.W., Yuan-Hsiung Tsai, S.W.C.), Neurology (Y.C.H., J.D.L.), and Neurosurgery (J.T.Y.), Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan (H.H.W.); Department of Psychology, National Chung Cheng University, Chiayi, Taiwan (H.H.W.); Department of Imaging Physics (H.H.W., J.D.H., H.L.L.), Department of Diagnostic Radiology (J.M.J., D.F.S.), Division of Diagnostic Imaging, Department of Neuro-Oncology, Section of Neuropsychology, Division of Cancer Medicine (K.R.N.), Department of Neurosurgery, Division of Surgery (S.S.P.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Division of Pulmonary and Critical Care Medicine of Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.T.Y.); Department of Respiratory Care, College of Medicine (C.T.Y.), Department of Respiratory Therapy (Ying-Huang Tsai), Chang Gung University, Taoyuan, Taiwan; Division of Pulmonary and Critical Care Medicine and Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi, Taiwan (Ying-Huang Tsai); and Faculty of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.Y.)
| | - Cheng-Ta Yang
- From the Departments of Diagnostic Radiology (H.H.W., Yuan-Hsiung Tsai, S.W.C.), Neurology (Y.C.H., J.D.L.), and Neurosurgery (J.T.Y.), Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan (H.H.W.); Department of Psychology, National Chung Cheng University, Chiayi, Taiwan (H.H.W.); Department of Imaging Physics (H.H.W., J.D.H., H.L.L.), Department of Diagnostic Radiology (J.M.J., D.F.S.), Division of Diagnostic Imaging, Department of Neuro-Oncology, Section of Neuropsychology, Division of Cancer Medicine (K.R.N.), Department of Neurosurgery, Division of Surgery (S.S.P.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Division of Pulmonary and Critical Care Medicine of Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.T.Y.); Department of Respiratory Care, College of Medicine (C.T.Y.), Department of Respiratory Therapy (Ying-Huang Tsai), Chang Gung University, Taoyuan, Taiwan; Division of Pulmonary and Critical Care Medicine and Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi, Taiwan (Ying-Huang Tsai); and Faculty of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.Y.)
| | - Ying-Huang Tsai
- From the Departments of Diagnostic Radiology (H.H.W., Yuan-Hsiung Tsai, S.W.C.), Neurology (Y.C.H., J.D.L.), and Neurosurgery (J.T.Y.), Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan (H.H.W.); Department of Psychology, National Chung Cheng University, Chiayi, Taiwan (H.H.W.); Department of Imaging Physics (H.H.W., J.D.H., H.L.L.), Department of Diagnostic Radiology (J.M.J., D.F.S.), Division of Diagnostic Imaging, Department of Neuro-Oncology, Section of Neuropsychology, Division of Cancer Medicine (K.R.N.), Department of Neurosurgery, Division of Surgery (S.S.P.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Division of Pulmonary and Critical Care Medicine of Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.T.Y.); Department of Respiratory Care, College of Medicine (C.T.Y.), Department of Respiratory Therapy (Ying-Huang Tsai), Chang Gung University, Taoyuan, Taiwan; Division of Pulmonary and Critical Care Medicine and Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi, Taiwan (Ying-Huang Tsai); and Faculty of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.Y.)
| | - Chun-Yuh Yang
- From the Departments of Diagnostic Radiology (H.H.W., Yuan-Hsiung Tsai, S.W.C.), Neurology (Y.C.H., J.D.L.), and Neurosurgery (J.T.Y.), Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan (H.H.W.); Department of Psychology, National Chung Cheng University, Chiayi, Taiwan (H.H.W.); Department of Imaging Physics (H.H.W., J.D.H., H.L.L.), Department of Diagnostic Radiology (J.M.J., D.F.S.), Division of Diagnostic Imaging, Department of Neuro-Oncology, Section of Neuropsychology, Division of Cancer Medicine (K.R.N.), Department of Neurosurgery, Division of Surgery (S.S.P.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Division of Pulmonary and Critical Care Medicine of Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.T.Y.); Department of Respiratory Care, College of Medicine (C.T.Y.), Department of Respiratory Therapy (Ying-Huang Tsai), Chang Gung University, Taoyuan, Taiwan; Division of Pulmonary and Critical Care Medicine and Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi, Taiwan (Ying-Huang Tsai); and Faculty of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.Y.)
| | - John D Hazle
- From the Departments of Diagnostic Radiology (H.H.W., Yuan-Hsiung Tsai, S.W.C.), Neurology (Y.C.H., J.D.L.), and Neurosurgery (J.T.Y.), Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan (H.H.W.); Department of Psychology, National Chung Cheng University, Chiayi, Taiwan (H.H.W.); Department of Imaging Physics (H.H.W., J.D.H., H.L.L.), Department of Diagnostic Radiology (J.M.J., D.F.S.), Division of Diagnostic Imaging, Department of Neuro-Oncology, Section of Neuropsychology, Division of Cancer Medicine (K.R.N.), Department of Neurosurgery, Division of Surgery (S.S.P.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Division of Pulmonary and Critical Care Medicine of Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.T.Y.); Department of Respiratory Care, College of Medicine (C.T.Y.), Department of Respiratory Therapy (Ying-Huang Tsai), Chang Gung University, Taoyuan, Taiwan; Division of Pulmonary and Critical Care Medicine and Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi, Taiwan (Ying-Huang Tsai); and Faculty of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.Y.)
| | - Donald F Schomer
- From the Departments of Diagnostic Radiology (H.H.W., Yuan-Hsiung Tsai, S.W.C.), Neurology (Y.C.H., J.D.L.), and Neurosurgery (J.T.Y.), Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan (H.H.W.); Department of Psychology, National Chung Cheng University, Chiayi, Taiwan (H.H.W.); Department of Imaging Physics (H.H.W., J.D.H., H.L.L.), Department of Diagnostic Radiology (J.M.J., D.F.S.), Division of Diagnostic Imaging, Department of Neuro-Oncology, Section of Neuropsychology, Division of Cancer Medicine (K.R.N.), Department of Neurosurgery, Division of Surgery (S.S.P.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Division of Pulmonary and Critical Care Medicine of Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.T.Y.); Department of Respiratory Care, College of Medicine (C.T.Y.), Department of Respiratory Therapy (Ying-Huang Tsai), Chang Gung University, Taoyuan, Taiwan; Division of Pulmonary and Critical Care Medicine and Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi, Taiwan (Ying-Huang Tsai); and Faculty of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.Y.)
| | - Ho-Ling Liu
- From the Departments of Diagnostic Radiology (H.H.W., Yuan-Hsiung Tsai, S.W.C.), Neurology (Y.C.H., J.D.L.), and Neurosurgery (J.T.Y.), Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan (H.H.W.); Department of Psychology, National Chung Cheng University, Chiayi, Taiwan (H.H.W.); Department of Imaging Physics (H.H.W., J.D.H., H.L.L.), Department of Diagnostic Radiology (J.M.J., D.F.S.), Division of Diagnostic Imaging, Department of Neuro-Oncology, Section of Neuropsychology, Division of Cancer Medicine (K.R.N.), Department of Neurosurgery, Division of Surgery (S.S.P.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Division of Pulmonary and Critical Care Medicine of Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.T.Y.); Department of Respiratory Care, College of Medicine (C.T.Y.), Department of Respiratory Therapy (Ying-Huang Tsai), Chang Gung University, Taoyuan, Taiwan; Division of Pulmonary and Critical Care Medicine and Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi, Taiwan (Ying-Huang Tsai); and Faculty of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.Y.)
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