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Chabert S, Salas R, Cantor E, Veloz A, Cancino A, González M, Torres F, Bennett C. Hemodynamic response function description in patients with glioma. J Neuroradiol 2024; 51:101156. [PMID: 37805126 DOI: 10.1016/j.neurad.2023.10.001] [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: 01/17/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 10/09/2023]
Abstract
INTRODUCTION Functional magnetic resonance imaging is a powerful tool that has provided many insights into cognitive sciences. Yet, as its analysis is mostly based on the knowledge of an a priori canonical hemodynamic response function (HRF), its reliability in patients' applications has been questioned. There have been reports of neurovascular uncoupling in patients with glioma, but no specific description of the Hemodynamic Response Function (HRF) in glioma has been reported so far. The aim of this work is to describe the HRF in patients with glioma. METHODS Forty patients were included. MR images were acquired on a 1.5T scanner. Activated clusters were identified using a fuzzy general linear model; HRFs were adjusted with a double-gamma function. Analyses were undertaken considering the tumor grade, age, sex, tumor location, and activated location. RESULTS Differences are found in the occipital, limbic, insular, and sub-lobar areas, but not in the frontal, temporal, and parietal lobes. The presence of a glioma slows the time-to-peak and onset times by 5.2 and 3.8 % respectively; high-grade gliomas present 8.1 % smaller HRF widths than low-grade gliomas. DISCUSSION AND CONCLUSION There is significant HRF variation due to the presence of glioma, but the magnitudes of the observed differences are small. Most processing pipelines should be robust enough for this magnitude of variation and little if any impact should be visible on functional maps. The differences that have been observed in the literature between functional mapping obtained with magnetic resonance vs. that obtained with direct electrostimulation during awake surgery are more probably due to the intrinsic difference in the mapping process: fMRI mapping detects all recruited areas while intra-surgical mapping indicates only the areas indispensable for the realization of a certain task. Surgical mapping might not be the gold standard to use when trying to validate the fMRI mapping process.
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Affiliation(s)
- Stéren Chabert
- School of Biomedical Engineering, Universidad de Valparaiso, General Cruz 222, Valparaiso, Chile; Millennium Science Initiative Intelligent Healthcare Engineering, Santiago, Chile.
| | - Rodrigo Salas
- School of Biomedical Engineering, Universidad de Valparaiso, General Cruz 222, Valparaiso, Chile; Millennium Science Initiative Intelligent Healthcare Engineering, Santiago, Chile
| | - Erika Cantor
- Institute of Statistics, Universidad de Valparaíso, Valparaíso, Chile
| | - Alejandro Veloz
- School of Biomedical Engineering, Universidad de Valparaiso, General Cruz 222, Valparaiso, Chile
| | - Astrid Cancino
- Millennium Science Initiative Intelligent Healthcare Engineering, Santiago, Chile; Doctorado en Ciencias e Ingeniería para la Salud, Universidad de Valparaiso, Valparaiso, Chile
| | - Matías González
- Neurosurgery Department, Hospital Carlos van Buren, Valparaiso, Chile
| | - Francisco Torres
- Millennium Science Initiative Intelligent Healthcare Engineering, Santiago, Chile; Radiology Department, Hospital Carlos van Buren, Valparaiso, Chile
| | - Carlos Bennett
- Neurosurgery Department, Hospital Carlos van Buren, Valparaiso, Chile
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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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Lakhani DA, Sabsevitz DS, Chaichana KL, Quiñones-Hinojosa A, Middlebrooks EH. Current State of Functional MRI in the Presurgical Planning of Brain Tumors. Radiol Imaging Cancer 2023; 5:e230078. [PMID: 37861422 DOI: 10.1148/rycan.230078] [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] [Indexed: 10/21/2023]
Abstract
Surgical resection of brain tumors is challenging because of the delicate balance between maximizing tumor removal and preserving vital brain functions. Functional MRI (fMRI) offers noninvasive preoperative mapping of widely distributed brain areas and is increasingly used in presurgical functional mapping. However, its impact on survival and functional outcomes is still not well-supported by evidence. Task-based fMRI (tb-fMRI) maps blood oxygen level-dependent (BOLD) signal changes during specific tasks, while resting-state fMRI (rs-fMRI) examines spontaneous brain activity. rs-fMRI may be useful for patients who cannot perform tasks, but its reliability is affected by tumor-induced changes, challenges in data processing, and noise. Validation studies comparing fMRI with direct cortical stimulation (DCS) show variable concordance, particularly for cognitive functions such as language; however, concordance for tb-fMRI is generally greater than that for rs-fMRI. Preoperative fMRI, in combination with MRI tractography and intraoperative DCS, may result in improved survival and extent of resection and reduced functional deficits. fMRI has the potential to guide surgical planning and help identify targets for intraoperative mapping, but there is currently limited prospective evidence of its impact on patient outcomes. This review describes the current state of fMRI for preoperative assessment in patients undergoing brain tumor resection. Keywords: MR-Functional Imaging, CNS, Brain/Brain Stem, Anatomy, Oncology, Functional MRI, Functional Anatomy, Task-based, Resting State, Surgical Planning, Brain Tumor © RSNA, 2023.
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Affiliation(s)
- Dhairya A Lakhani
- From the Department of Radiology, West Virginia University, Morgantown, WV (D.A.L.); and Departments of Psychiatry and Psychology (D.S.S.), Neurosurgery (K.L.C., A.Q.H., E.H.M.), and Radiology (E.H.M.), Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL 32224
| | - David S Sabsevitz
- From the Department of Radiology, West Virginia University, Morgantown, WV (D.A.L.); and Departments of Psychiatry and Psychology (D.S.S.), Neurosurgery (K.L.C., A.Q.H., E.H.M.), and Radiology (E.H.M.), Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL 32224
| | - Kaisorn L Chaichana
- From the Department of Radiology, West Virginia University, Morgantown, WV (D.A.L.); and Departments of Psychiatry and Psychology (D.S.S.), Neurosurgery (K.L.C., A.Q.H., E.H.M.), and Radiology (E.H.M.), Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL 32224
| | - Alfredo Quiñones-Hinojosa
- From the Department of Radiology, West Virginia University, Morgantown, WV (D.A.L.); and Departments of Psychiatry and Psychology (D.S.S.), Neurosurgery (K.L.C., A.Q.H., E.H.M.), and Radiology (E.H.M.), Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL 32224
| | - Erik H Middlebrooks
- From the Department of Radiology, West Virginia University, Morgantown, WV (D.A.L.); and Departments of Psychiatry and Psychology (D.S.S.), Neurosurgery (K.L.C., A.Q.H., E.H.M.), and Radiology (E.H.M.), Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL 32224
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Kang KM, Kim KM, Kim IS, Kim JH, Kang H, Ji SY, Dho YS, Oh H, Park HP, Seo HG, Kim SM, Choi SH, Park CK. Functional Magnetic Resonance Imaging and Diffusion Tensor Imaging for Language Mapping in Brain Tumor Surgery: Validation With Direct Cortical Stimulation and Cortico-Cortical Evoked Potential. Korean J Radiol 2023; 24:553-563. [PMID: 37271209 DOI: 10.3348/kjr.2022.1001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/17/2023] [Accepted: 03/23/2023] [Indexed: 06/06/2023] Open
Abstract
OBJECTIVE Functional magnetic resonance imaging (fMRI) and diffusion tensor imaging-derived tractography (DTI-t) contribute to the localization of language areas, but their accuracy remains controversial. This study aimed to investigate the diagnostic performance of preoperative fMRI and DTI-t obtained with a simultaneous multi-slice technique using intraoperative direct cortical stimulation (DCS) or corticocortical evoked potential (CCEP) as reference standards. MATERIALS AND METHODS This prospective study included 26 patients (23-74 years; male:female, 13:13) with tumors in the vicinity of Broca's area who underwent preoperative fMRI and DTI-t. A site-by-site comparison between preoperative (fMRI and DTI-t) and intraoperative language mapping (DCS or CCEP) was performed for 226 cortical sites to calculate the sensitivity and specificity of fMRI and DTI-t for mapping Broca's areas. For sites with positive signals on fMRI or DTI-t, the true-positive rate (TPR) was calculated based on the concordance and discordance between fMRI and DTI-t. RESULTS Among 226 cortical sites, DCS was performed in 100 sites and CCEP was performed in 166 sites. The specificities of fMRI and DTI-t ranged from 72.4% (63/87) to 96.8% (122/126), respectively. The sensitivities of fMRI (except for verb generation) and DTI-t were 69.2% (9/13) to 92.3% (12/13) with DCS as the reference standard, and 40.0% (16/40) or lower with CCEP as the reference standard. For sites with preoperative fMRI or DTI-t positivity (n = 82), the TPR was high when fMRI and DTI-t were concordant (81.2% and 100% using DCS and CCEP, respectively, as the reference standards) and low when fMRI and DTI-t were discordant (≤ 24.2%). CONCLUSION fMRI and DTI-t are sensitive and specific for mapping Broca's area compared with DCS and specific but insensitive compared with CCEP. A site with a positive signal on both fMRI and DTI-t represents a high probability of being an essential language area.
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Affiliation(s)
- Koung Mi Kang
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Min Kim
- Department of Neurosurgery, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | | | - Joo Hyun Kim
- Department of Clinical Science, MR, Philips Healthcare Korea, Seoul, Korea
| | - Ho Kang
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - So Young Ji
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yun-Sik Dho
- Neuro-Oncology Clinic, National Cancer Center, Goyang, Korea
| | - Hyongmin Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hee-Pyoung Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sung-Min Kim
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Hong Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
| | - Chul-Kee Park
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
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Pre-Operative Functional Mapping in Patients with Brain Tumors by fMRI and MEG: Advantages and Disadvantages in the Use of One Technique over the Other. Life (Basel) 2023; 13:life13030609. [PMID: 36983765 PMCID: PMC10051860 DOI: 10.3390/life13030609] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 02/24/2023] Open
Abstract
Pre-operative mapping of brain functions is crucial to plan neurosurgery and investigate potential plasticity processes. Due to its availability, functional magnetic resonance imaging (fMRI) is widely used for this purpose; on the other hand, the demanding cost and maintenance limit the use of magnetoencephalography (MEG), despite several studies reporting its accuracy in localizing brain functions of interest in patient populations. In this review paper, we discuss the strengths and weaknesses of both techniques, from a methodological perspective first; then, we scrutinized and commented on the findings from 16 studies, identified by a database search, that made pre-operative assessments using both techniques in patients with brain tumors. We commented on the results by accounting for study limitations associated with small sample sizes and variability in the used tasks. Overall, we found that, although some studies reported the superiority for MEG, the majority of them underlined the complementary use of these techniques and suggested assessment using both. Indeed, both fMRI and MEG present some disadvantages, although the development of novel devices and processing procedures has enabled ever more accurate assessments. In particular, the development of new, more feasible MEG devices will allow widespread availability of this technique and its routinely combined use with fMRI.
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Al-Arfaj HK, Al-Sharydah AM, AlSuhaibani SS, Alaqeel S, Yousry T. Task-Based and Resting-State Functional MRI in Observing Eloquent Cerebral Areas Personalized for Epilepsy and Surgical Oncology Patients: A Review of the Current Evidence. J Pers Med 2023; 13:jpm13020370. [PMID: 36836604 PMCID: PMC9964201 DOI: 10.3390/jpm13020370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/23/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023] Open
Abstract
Functional magnetic resonance imaging (fMRI) is among the newest techniques of advanced neuroimaging that offer the opportunity for neuroradiologists, neurophysiologists, neuro-oncologists, and neurosurgeons to pre-operatively plan and manage different types of brain lesions. Furthermore, it plays a fundamental role in the personalized evaluation of patients with brain tumors or patients with an epileptic focus for preoperative planning. While the implementation of task-based fMRI has increased in recent years, the existing resources and evidence related to this technique are limited. We have, therefore, conducted a comprehensive review of the available resources to compile a detailed resource for physicians who specialize in managing patients with brain tumors and seizure disorders. This review contributes to the existing literature because it highlights the lack of studies on fMRI and its precise role and applicability in observing eloquent cerebral areas in surgical oncology and epilepsy patients, which we believe is underreported. Taking these considerations into account would help to better understand the role of this advanced neuroimaging technique and, ultimately, improve patient life expectancy and quality of life.
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Affiliation(s)
| | - Abdulaziz Mohammad Al-Sharydah
- Diagnostic and Interventional Radiology Department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam 34221, Saudi Arabia
- Correspondence: ; Fax: +966-013-8676697
| | - Sari Saleh AlSuhaibani
- Diagnostic and Interventional Radiology Department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam 34221, Saudi Arabia
| | - Soliman Alaqeel
- Medical Imaging Department, Dammam Medical Complex, Ministry of Health, Dammam 11176, Saudi Arabia
| | - Tarek Yousry
- Division of Neuroradiology and Neurophysics, Lysholm Department of Neuroradiology, UCL IoN, UCLH, London NW1 2BU, UK
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Bennett C, González M, Tapia G, Riveros R, Torres F, Loyola N, Veloz A, Chabert S. Cortical mapping in glioma surgery: correlation of fMRI and direct electrical stimulation with Human Connectome Project parcellations. Neurosurg Focus 2022; 53:E2. [PMID: 36455268 DOI: 10.3171/2022.9.focus2283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 09/27/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE Noninvasive brain mapping with functional MRI (fMRI) and mapping with direct electrical stimulation (DES) are important tools in glioma surgery, but the evidence is inconclusive regarding the sensitivity and specificity of fMRI. The Human Connectome Project (HCP) proposed a new cortical parcellation that has not been thoroughly tested in a clinical setting. The main goal of this study was to evaluate the correlation of fMRI and DES mapping with HCP areas in a clinical setting, and to evaluate the performance of fMRI mapping in motor and language tasks in patients with glioma, using DES as the gold standard. METHODS Forty patients with supratentorial gliomas were examined using preoperative fMRI and underwent awake craniotomy with DES. Functional activation maps were visualized on a 3D representation of the cortex, classified according to HCP areas, and compared with surgical mapping. RESULTS Functional MRI was successful in identifying language and motor HCP areas in most cases, including novel areas such as 55b and the superior longitudinal fasciculus (SLF). Functional MRI had a sensitivity and specificity of 100% and 71%, respectively, for motor function in HCP area 4. Sensitivity and specificity were different according to the area and fMRI protocol; i.e., semantic protocols performed better in Brodmann area (BA) 55b/peri-sylvian language areas with 100% sensitivity and 20% specificity, and word production protocols in BAs 44 and 45 with 70% sensitivity and 80% specificity. Some compensation patterns could be observed, such as motor activation of the postcentral gyrus in precentral gliomas. CONCLUSIONS HCP areas can be detected in clinical scenarios of glioma surgery. These areas appear relatively stable across patients, but compensation patterns seem to differ, allowing occasional resection of activating areas. Newly described areas such as 55b and SLF can act as critical areas in language networks. Surgical planning should account for these parcellations.
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Affiliation(s)
- Carlos Bennett
- 1Department of Neurosurgery, Hospital Carlos van Buren, Valparaíso.,2School of Medicine, Universidad de Valparaíso
| | - Matías González
- 1Department of Neurosurgery, Hospital Carlos van Buren, Valparaíso.,2School of Medicine, Universidad de Valparaíso
| | - Gisella Tapia
- 2School of Medicine, Universidad de Valparaíso.,3Department of Neurology, Hospital Carlos van Buren, Valparaíso
| | - Rodrigo Riveros
- 2School of Medicine, Universidad de Valparaíso.,4Department of Radiology, Hospital Carlos van Buren, Valparaíso
| | - Francisco Torres
- 2School of Medicine, Universidad de Valparaíso.,4Department of Radiology, Hospital Carlos van Buren, Valparaíso
| | - Nicole Loyola
- 1Department of Neurosurgery, Hospital Carlos van Buren, Valparaíso.,2School of Medicine, Universidad de Valparaíso
| | - Alejandro Veloz
- 5School of Biomedical Engineering, Universidad de Valparaíso.,6Centro de Investigación y Desarrollo en Ingeniería en Salud CINGS, Universidad de Valparaíso
| | - Stéren Chabert
- 5School of Biomedical Engineering, Universidad de Valparaíso.,8Instituto Milenio Intelligent Healthcare Engineering, Santiago, Chile
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Holloway T, Leach JL, Tenney JR, Byars AW, Horn PS, Greiner HM, Mangano FT, Holland KD, Arya R. Functional MRI and electrical stimulation mapping for language localization: A comparative meta-analysis. Clin Neurol Neurosurg 2022; 222:107417. [DOI: 10.1016/j.clineuro.2022.107417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/13/2022] [Accepted: 08/17/2022] [Indexed: 11/15/2022]
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What Can Resting-State fMRI Data Analysis Explain about the Functional Brain Connectivity in Glioma Patients? Tomography 2022; 8:267-280. [PMID: 35202187 PMCID: PMC8878995 DOI: 10.3390/tomography8010021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/12/2022] [Accepted: 01/14/2022] [Indexed: 11/24/2022] Open
Abstract
Resting-state functional MRI has been increasingly implemented in imaging protocols for the study of functional connectivity in glioma patients as a sequence able to capture the activity of brain networks and to investigate their properties without requiring the patients’ cooperation. The present review aims at describing the most recent results obtained through the analysis of resting-state fMRI data in different contexts of interest for brain gliomas: the identification and localization of functional networks, the characterization of altered functional connectivity, and the evaluation of functional plasticity in relation to the resection of the glioma. An analysis of the literature showed that significant and promising results could be achieved through this technique in all the aspects under investigation. Nevertheless, there is room for improvement, especially in terms of stability and generalizability of the outcomes. Further research should be conducted on homogeneous samples of glioma patients and at fixed time points to reduce the considerable variability in the results obtained across and within studies. Future works should also aim at establishing robust metrics for the assessment of the disruption of functional connectivity and its recovery at the single-subject level.
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Dmitriev AY, Dashyan VG. [Functional magnetic resonance imaging in neurosurgery]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:138-143. [PMID: 34874669 DOI: 10.17116/jnevro2021121101138] [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: 11/18/2022]
Abstract
The study is a short review of articles concerning functional magnetic resonance imaging (fMRI) and its practical application in neurosurgery. Advantages and disadvantages of the methods are considered, the results of surgical treatment of patients using functional navigation are presented. Separate attention is paid to fMRI precision, a new resting-state method of visualization. Practical advices of fMRI application in neurooncology and surgery of arteriovenous malformations are given.
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Affiliation(s)
- A Yu Dmitriev
- Sklifosovsky Research Institute for Emergency, Moscow, Russia.,Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - V G Dashyan
- Sklifosovsky Research Institute for Emergency, Moscow, Russia.,Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
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Morales H. Current and Future Challenges of Functional MRI and Diffusion Tractography in the Surgical Setting: From Eloquent Brain Mapping to Neural Plasticity. Semin Ultrasound CT MR 2021; 42:474-489. [PMID: 34537116 DOI: 10.1053/j.sult.2021.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Decades ago, Spetzler (1986) and Sawaya (1998) provided a rough brain segmentation of the eloquent areas of the brain, aimed to help surgical decisions in cases of vascular malformations and tumors, respectively. Currently in clinical use, their criteria are in need of revision. Defining functions (eg, sensorimotor, language and visual) that should be preserved during surgery seems a straightforward task. In practice, locating the specific areas that could cause a permanent vs transient deficit is not an easy task. This is particularly true for the associative cortex and cognitive domains such as language. The old model, with Broca's and Wernicke's areas at the forefront, has been superseded by a dual-stream model of parallel language processing; named ventral and dorsal pathways. This complicated network of cortical hubs and subcortical white matter pathways needing preservation during surgery is a work in progress. Preserving not only cortical regions but most importantly preserving the connections, or white matter fiber bundles, of core regions in the brain is the new paradigm. For instance, the arcuate fascicululs and inferior fronto-occipital fasciculus are key components of the dorsal and ventral language pathways, respectively; and their damage result in permanent language deficits. Interestedly, the damage of the temporal portions of these bundles -where there is a crossroad with other multiple bundles-, appears to be more important (permanent) than the damage of the frontal portions - where plasticity and contralateral activation could help. Although intraoperative direct cortical and subcortical stimulation have contributed largely, advanced MR techniques such as functional MRI (fMRI) and diffusion tractography (DT), are at the epi-center of our current understanding. Nevertheless, these techniques posse important challenges: such as neurovascular uncoupling or venous bias on fMRI; and appropriate anatomical validation or accurate representation of crossing fibers on DT. These limitations should be well understood and taken into account in clinical practice. Unifying multidisciplinary research and clinical efforts is desirable, so these techniques could contribute more efficiently not only to locate eloquent areas but to improve outcomes and our understanding of neural plasticity. Finally, although there are constant anatomical and functional regions at the individual level, there is a known variability at the inter-individual level. This concept should strengthen the importance of a personalized approach when evaluating these regions on fMRI and DT. It should strengthen the importance of personalized treatments as well, aimed to meet tailored needs and expectations.
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Affiliation(s)
- Humberto Morales
- Section of Neuroradiology, University of Cincinnati Medical Center, Cincinnati, OH.
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12
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Dmitriev AY, Dashyan VG. [Functional magnetic resonance imaging in neurosurgery]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:118-123. [PMID: 34460167 DOI: 10.17116/jnevro2021121071118] [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: 11/17/2022]
Abstract
The review of publications on functional magnetic resonance imaging (fMRI) and its practical application in neurosurgery is presented. Advantages and disadvantages are selected taking pathogenesis into account. Results of surgical treatment with use of functional navigation are described. Separate attention is paid to fMRI precision by its comparing with direct cortical stimulation. New resting-state method of visualization is observed. Practical advices are given of fMRI application in neurooncology and surgery of arteriovenous malformations.
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Affiliation(s)
- A Yu Dmitriev
- Sklifosovsky Research Institute for Emergency, Moscow, Russia.,Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - V G Dashyan
- Sklifosovsky Research Institute for Emergency, Moscow, Russia.,Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
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13
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Ciavarro M, Grande E, Pavone L, Bevacqua G, De Angelis M, di Russo P, Morace R, Committeri G, Grillea G, Bartolo M, Paolini S, Esposito V. Pre-surgical fMRI Localization of the Hand Motor Cortex in Brain Tumors: Comparison Between Finger Tapping Task and a New Visual-Triggered Finger Movement Task. Front Neurol 2021; 12:658025. [PMID: 34054699 PMCID: PMC8160093 DOI: 10.3389/fneur.2021.658025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 03/17/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Pre-surgical mapping is clinically essential in the surgical management of brain tumors to preserve functions. A common technique to localize eloquent areas is functional magnetic resonance imaging (fMRI). In tumors involving the peri-rolandic regions, the finger tapping task (FTT) is typically administered to delineate the functional activation of hand-knob area. However, its selectivity may be limited. Thus, here, a novel cue-induced fMRI task was tested, the visual-triggered finger movement task (VFMT), aimed at eliciting a more accurate functional cortical mapping of the hand region as compared with FTT. Method: Twenty patients with glioma in the peri-rolandic regions underwent pre-operative mapping performing both FTT and VFMT. The fMRI data were analyzed for surgical procedures. When the craniotomy allowed to expose the motor cortex, the correspondence with intraoperative direct electrical stimulation (DES) was evaluated through sensitivity and specificity (mean sites = 11) calculated as percentage of true-positive and true-negative rates, respectively. Results: Both at group level and at single-subject level, differences among the tasks emerged in the functional representation of the hand-knob. Compared with FTT, VFMT showed a well-localized activation within the hand motor area and a less widespread activation in associative regions. Intraoperative DES confirmed the greater specificity (97%) and sensitivity (100%) of the VFMT in determining motor eloquent areas. Conclusion: The study provides a novel, external-triggered fMRI task for pre-surgical motor mapping. Compared with the traditional FTT, the new VFMT may have potential implications in clinical fMRI and surgical management due to its focal identification of the hand-knob region and good correspondence to intraoperative DES.
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Affiliation(s)
- Marco Ciavarro
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Pozzilli, Italy
| | - Eleonora Grande
- Department of Neuroscience, Imaging and Clinical Sciences, University "Gabriele d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Luigi Pavone
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Pozzilli, Italy
| | - Giuseppina Bevacqua
- Department of Human Neurosciences, University of Rome "La Sapienza", Rome, Italy
| | | | - Paolo di Russo
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Pozzilli, Italy
| | - Roberta Morace
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Pozzilli, Italy
| | - Giorgia Committeri
- Department of Neuroscience, Imaging and Clinical Sciences, University "Gabriele d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Giovanni Grillea
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Pozzilli, Italy
| | - Marcello Bartolo
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Pozzilli, Italy
| | - Sergio Paolini
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Pozzilli, Italy.,Department of Human Neurosciences, University of Rome "La Sapienza", Rome, Italy
| | - Vincenzo Esposito
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Pozzilli, Italy.,Department of Human Neurosciences, University of Rome "La Sapienza", Rome, Italy
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14
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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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15
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Ellis DG, White ML, Hayasaka S, Warren DE, Wilson TW, Aizenberg MR. Accuracy analysis of fMRI and MEG activations determined by intraoperative mapping. Neurosurg Focus 2021; 48:E13. [PMID: 32006951 DOI: 10.3171/2019.11.focus19784] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 11/13/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE By looking at how the accuracy of preoperative brain mapping methods vary according to differences in the distance from the activation clusters used for the analysis, the present study aimed to elucidate how preoperative functional neuroimaging may be used in such a way that maximizes the mapping accuracy. METHODS The eloquent function of 19 patients with a brain tumor or cavernoma was mapped prior to resection with both functional MRI (fMRI) and magnetoencephalography (MEG). The mapping results were then validated using direct cortical stimulation mapping performed immediately after craniotomy and prior to resection. The subset of patients with equivalent MEG and fMRI tasks performed for motor (n = 14) and language (n = 12) were evaluated as both individual and combined predictions. Furthermore, the distance resulting in the maximum accuracy, as evaluated by the J statistic, was determined by plotting the sensitivities and specificities against a linearly increasing distance threshold. RESULTS fMRI showed a maximum mapping accuracy at 5 mm for both motor and language mapping. MEG showed a maximum mapping accuracy at 40 mm for motor and 15 mm for language mapping. At the standard 10-mm distance used in the literature, MEG showed a greater specificity than fMRI for both motor and language mapping but a lower sensitivity for motor mapping. Combining MEG and fMRI showed a maximum accuracy at 15 mm and 5 mm-MEG and fMRI distances, respectively-for motor mapping and at a 10-mm distance for both MEG and fMRI for language mapping. For motor mapping, combining MEG and fMRI at the optimal distances resulted in a greater accuracy than the maximum accuracy of the individual predictions. CONCLUSIONS This study demonstrates that the accuracy of language and motor mapping for both fMRI and MEG is heavily dependent on the distance threshold used in the analysis. Furthermore, combining MEG and fMRI showed the potential for increased motor mapping accuracy compared to when using the modalities separately.Clinical trial registration no.: NCT01535430 (clinicaltrials.gov).
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Affiliation(s)
| | - Matthew L White
- 2Radiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Satoru Hayasaka
- 3Department of Psychology, University of Texas at Austin, Texas; and
| | - David E Warren
- 4Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska
| | - Tony W Wilson
- 4Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska
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16
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Qiu T, Hameed NUF, Lin CP, Biswal BB, Wu J. Hemodynamic Scaling of Task-Induced Signal Changes in Tumor Subjects. Front Hum Neurosci 2020; 14:569463. [PMID: 33132884 PMCID: PMC7566414 DOI: 10.3389/fnhum.2020.569463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 08/24/2020] [Indexed: 11/24/2022] Open
Abstract
Background: FMRI signal amplitude can change during stimulus presentation due to underlying neural function and hemodynamic responses limiting the accuracy of fMRI in pre-surgical planning. To account for these changes in fMRI activation signal, we used breath-hold tasks to mimic hemodynamic changes in brain tumor subjects and scaled the activation response. Methods: Motor and/or language fMRI was performed in 21 subjects with brain tumor. A breath-hold task was also performed in these subjects to obtain the hemodynamic response changes independent of neural changes. The task activation signals were calibrated on a voxel wise basis for all the subjects. Direct cortical stimulation was used to verify the scaled results of task-based fMRI. Results: After scaling for the hemodynamic response function (HRF) on a voxel wise basis, the spatial extent of the scaled activation was more clustered together and appeared to minimize false positives. Similarly, accounting for the underlying canonical HRF, the percentage increase of active voxels after scaling had lower standard non-deviation suggesting that the activation response across voxels were more similar. Conclusion: Although preliminary in nature, this study suggests that the variation in hemodynamic changes can be calibrated using breath-hold in brain tumor subjects and can also be used for other clinical cases where the underlying HRF has been altered.
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Affiliation(s)
- Tianming Qiu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China
| | - N. U. Farrukh Hameed
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ching-Po Lin
- Institute of Neuroscience, National Yang-Ming University, Taipei, China
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Bharat B. Biswal
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, United States
- *Correspondence: Jinsong Wu
| | - Jinsong Wu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China
- Bharat B. Biswal
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17
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Metwali H, Raemaekers M, Ibrahim T, Samii A. The Fluctuations of Blood Oxygen Level-Dependent Signals as a Method of Brain Tumor Characterization: A Preliminary Report. World Neurosurg 2020; 142:e10-e17. [PMID: 32360673 DOI: 10.1016/j.wneu.2020.04.134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 04/17/2020] [Accepted: 04/18/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE In this study we present the nature and characteristic of the fluctuation of blood oxygen level-dependent (BOLD) signals measured from brain tumors. METHODS Supratentorial astrocytomas, which were neither operated nor previously managed with chemotherapy or radiotherapy, were segmented, and the time series of the BOLD signal fluctuations were extracted. The mean (across patients) power spectra were plotted for the different World Health Organization tumor grades. One-way analysis of variance (ANOVA) was performed to identify significant differences between the power spectra of different tumor grades. Results were considered significant at P < 0.05. RESULTS A total of 58 patients were included in the study. This group of patients included 1 patient with grade I glioma; 15 with grade II; 12 with grade III; and 30 with grade IV. The power spectra of the tumor time series were individually inspected, and all tumors exhibited high peaks at the lower frequency signals, but these were more pronounced in high-grade tumors. ANOVA showed a significant difference in power spectra between groups (P = 0.000). Post hoc analysis with Bonferroni correction showed a significant difference between grade II and grade III (P = 0.012) and grade IV (P = 0.000). There was no significant power spectra difference between grade III and IV tumors (P = 1). CONCLUSIONS The power spectra of BOLD signals from tumor tissue showed fluctuations in the low-frequency signals and were significantly correlated with tumor grade. These signals could have a misleading effect when analyzing resting state functional magnetic resonance imaging and could be also viewed as a potential method of tumor characterization.
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Affiliation(s)
- Hussam Metwali
- Kliniken Nordoberpfalz AG, Klinikum Weiden, Department of Neurosurgery, Weiden, Germany.
| | - Mathijs Raemaekers
- Brain Center Rudolf Magnus, University Medical Center, Utrecht, The Netherlands
| | - Tamer Ibrahim
- Department of Neurosurgery, University of Alexandria, Alexandria, Egypt
| | - Amir Samii
- Department of Neurosurgery, International Neuroscience Institute, Hannover, Germany
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18
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Yang X, Zhang K. Navigated transcranial magnetic stimulation brain mapping: Achievements, opportunities, and prospects. GLIOMA 2020. [DOI: 10.4103/glioma.glioma_13_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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19
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Utilization of functional MRI language paradigms for pre-operative mapping: a systematic review. Neuroradiology 2019; 62:353-367. [DOI: 10.1007/s00234-019-02322-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 11/08/2019] [Indexed: 12/18/2022]
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20
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Vakamudi K, Posse S, Jung R, Cushnyr B, Chohan MO. Real-time presurgical resting-state fMRI in patients with brain tumors: Quality control and comparison with task-fMRI and intraoperative mapping. Hum Brain Mapp 2019; 41:797-814. [PMID: 31692177 PMCID: PMC7268088 DOI: 10.1002/hbm.24840] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 12/11/2022] Open
Abstract
Resting-state functional magnetic resonance imaging (rsfMRI) is a promising task-free functional imaging approach, which may complement or replace task-based fMRI (tfMRI) in patients who have difficulties performing required tasks. However, rsfMRI is highly sensitive to head movement and physiological noise, and validation relative to tfMRI and intraoperative electrocortical mapping is still necessary. In this study, we investigate (a) the feasibility of real-time rsfMRI for presurgical mapping of eloquent networks with monitoring of data quality in patients with brain tumors and (b) rsfMRI localization of eloquent cortex compared with tfMRI and intraoperative electrocortical stimulation (ECS) in retrospective analysis. Five brain tumor patients were studied with rsfMRI and tfMRI on a clinical 3T scanner using MultiBand(8)-echo planar imaging (EPI) with repetition time: 400 ms. Moving-averaged sliding-window correlation analysis with regression of motion parameters and signals from white matter and cerebrospinal fluid was used to map sensorimotor and language resting-state networks. Data quality monitoring enabled rapid optimization of scan protocols, early identification of task noncompliance, and head movement-related false-positive connectivity to determine scan continuation or repetition. Sensorimotor and language resting-state networks were identifiable within 1 min of scan time. The Euclidean distance between ECS and rsfMRI connectivity and task-activation in motor cortex, Broca's, and Wernicke's areas was 5-10 mm, with the exception of discordant rsfMRI and ECS localization of Wernicke's area in one patient due to possible cortical reorganization and/or altered neurovascular coupling. This study demonstrates the potential of real-time high-speed rsfMRI for presurgical mapping of eloquent cortex with real-time data quality control, and clinically acceptable concordance of rsfMRI with tfMRI and ECS localization.
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Affiliation(s)
- Kishore Vakamudi
- Department of Neurology, University of New Mexico, Albuquerque, New Mexico
| | - Stefan Posse
- Department of Neurology, University of New Mexico, Albuquerque, New Mexico.,Department of Physics and Astronomy, University of New Mexico, Albuquerque, New Mexico
| | - Rex Jung
- Department of Neurosurgery, University of New Mexico, Albuquerque, New Mexico
| | - Brad Cushnyr
- Department of Radiology, University of New Mexico, Albuquerque, New Mexico
| | - Muhammad O Chohan
- Department of Neurosurgery, University of New Mexico, Albuquerque, New Mexico
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21
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Agarwal S, Sair HI, Gujar S, Pillai JJ. Language Mapping With fMRI: Current Standards and Reproducibility. Top Magn Reson Imaging 2019; 28:225-233. [PMID: 31385902 DOI: 10.1097/rmr.0000000000000216] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Clinical use of blood oxygen level dependent (BOLD) functional magnetic resonance imaging (fMRI) is a relatively new phenomenon, with only about 3 decades of collective experience. Nevertheless, task-based BOLD fMRI has been widely accepted for presurgical planning, over traditional methods, which are invasive and at times perilous. Many studies have demonstrated the ability of BOLD fMRI to make substantial clinical impact with respect to surgical planning and preoperative risk assessment, especially to localize the eloquent motor and visual areas. Reproducibility and repeatability of language fMRI are important in the assessment of its clinical usefulness. There are national efforts currently underway to standardize language fMRI. The American Society of Functional Neuroradiology (ASFNR) has recently provided guidelines on fMRI paradigm algorithms for presurgical language assessment for language lateralization and localization. In this review article, we provide a comprehensive overview of current standards of language fMRI mapping and its reproducibility.
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Affiliation(s)
- Shruti Agarwal
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Haris I Sair
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sachin Gujar
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jay J Pillai
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
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22
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Yamamoto AK, Magerkurth J, Mancini L, White MJ, Miserocchi A, McEvoy AW, Appleby I, Micallef C, Thornton JS, Price CJ, Weiskopf N, Yousry TA. Acquisition of sensorimotor fMRI under general anaesthesia: Assessment of feasibility, the BOLD response and clinical utility. NEUROIMAGE-CLINICAL 2019; 23:101923. [PMID: 31491826 PMCID: PMC6699415 DOI: 10.1016/j.nicl.2019.101923] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 05/28/2019] [Accepted: 06/30/2019] [Indexed: 11/17/2022]
Abstract
We evaluated whether task-related fMRI (functional magnetic resonance imaging) BOLD (blood oxygenation level dependent) activation could be acquired under conventional anaesthesia at a depth enabling neurosurgery in five patients with supratentorial gliomas. Within a 1.5 T MRI operating room immediately prior to neurosurgery, a passive finger flexion sensorimotor paradigm was performed on each hand with the patients awake, and then immediately after the induction and maintenance of combined sevoflurane and propofol general anaesthesia. The depth of surgical anaesthesia was measured and confirmed with an EEG-derived technique, the Bispectral Index (BIS). The magnitude of the task-related BOLD response and BOLD sensitivity under anaesthesia were determined. The fMRI data were assessed by three fMRI expert observers who rated each activation map for somatotopy and usefulness for radiological neurosurgical guidance. The mean magnitudes of the task-related BOLD response under a BIS measured depth of surgical general anaesthesia were 25% (tumour affected hemisphere) and 22% (tumour free hemisphere) of the respective awake values. BOLD sensitivity under anaesthesia ranged from 7% to 83% compared to the awake state. Despite these reductions, somatotopic BOLD activation was observed in the sensorimotor cortex in all ten data acquisitions surpassing statistical thresholds of at least p < 0.001uncorr. All ten fMRI activation datasets were scored to be useful for radiological neurosurgical guidance. Passive task-related sensorimotor fMRI acquired in neurosurgical patients under multi-pharmacological general anaesthesia is reproducible and yields clinically useful activation maps. These results demonstrate the feasibility of the technique and its potential value if applied intra-operatively. Additionally these methods may enable fMRI investigations in patients unable to perform or lie still for awake paradigms, such as young children, claustrophobic patients and those with movement disorders.
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Affiliation(s)
- Adam Kenji Yamamoto
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom; Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, United Kingdom.
| | - Joerg Magerkurth
- UCL Psychology and Language Sciences, Birkbeck-UCL Centre for Neuroimaging, London, United Kingdom.
| | - Laura Mancini
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom; Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, United Kingdom.
| | - Mark J White
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom; Medical Physics and Biomedical Engineering, University College London Hospital, London, United Kingdom.
| | - Anna Miserocchi
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom.
| | - Andrew W McEvoy
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom.
| | - Ian Appleby
- Department of Neuroanaesthesia, National Hospital for Neurology and Neurosurgery, London, United Kingdom.
| | - Caroline Micallef
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, United Kingdom.
| | - John S Thornton
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom; Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, United Kingdom.
| | - Cathy J Price
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom.
| | - Nikolaus Weiskopf
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom; Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.
| | - Tarek A Yousry
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom; Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, United Kingdom.
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23
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Reliability of Functional Magnetic Resonance Imaging in Patients with Brain Tumors: A Critical Review and Meta-Analysis. World Neurosurg 2019; 125:183-190. [DOI: 10.1016/j.wneu.2019.01.194] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/19/2019] [Accepted: 01/21/2019] [Indexed: 11/20/2022]
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24
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Rolinski R, Austermuehle A, Wiggs E, Agrawal S, Sepeta L, Gaillard WD, Zaghloul K, Inati SK, Theodore WH. Functional MRI and direct cortical stimulation: Prediction of postoperative language decline. Epilepsia 2019; 60:560-570. [PMID: 30740700 PMCID: PMC6467056 DOI: 10.1111/epi.14666] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/16/2019] [Accepted: 01/16/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the ability of functional MRI (fMRI) to predict postoperative language decline compared to direct cortical stimulation (DCS) in epilepsy surgery patients. METHODS In this prospective case series, 17 patients with drug-resistant epilepsy had intracranial monitoring and resection from 2012 to 2016 with 1-year follow-up. All patients completed preoperative language fMRI, mapping with DCS of subdural electrodes, pre- and postoperative neuropsychological testing for language function, and resection. Changes in language function before and after surgery were assessed. fMRI activation and DCS electrodes in the resection were evaluated as potential predictors of language decline. RESULTS Four of 17 patients (12 female; median [range] age, 43 [23-59] years) experienced postoperative language decline 1 year after surgery. Two of 4 patients had overlap of fMRI activation, language-positive electrodes in basal temporal regions (within 1 cm), and resection. Two had overlap between resection volume and fMRI activation, but not DCS. fMRI demonstrated 100% sensitivity and 46% specificity for outcome compared to DCS (50% and 85%, respectively). When fMRI and DCS language findings were concordant, the combined tests showed 100% sensitivity and 75% specificity for language outcome. Seizure-onset age, resection side, type, volume, or 1 year seizure outcome did not predict language decline. SIGNIFICANCE Language localization overlap of fMRI and direct cortical stimulation in the resection influences postoperative language performance. Our preliminary study suggests that fMRI may be more sensitive and less specific than direct cortical stimulation. Together they may predict outcome better than either test alone.
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Affiliation(s)
- Rachel Rolinski
- Clinical Epilepsy Section, National Institute of
Neurological Disorders and Stroke, Bethesda, MD
| | - Alison Austermuehle
- Clinical Epilepsy Section, National Institute of
Neurological Disorders and Stroke, Bethesda, MD
| | - Edythe Wiggs
- Clinical Epilepsy Section, National Institute of
Neurological Disorders and Stroke, Bethesda, MD
| | - Shubhi Agrawal
- Clinical Epilepsy Section, National Institute of
Neurological Disorders and Stroke, Bethesda, MD
- Berman Brain & Spine Institute, Baltimore, MD
| | - Leigh Sepeta
- Clinical Epilepsy Section, National Institute of
Neurological Disorders and Stroke, Bethesda, MD
- Department of Neurology Children’s National Medical
Center, Washington, D.C
| | - William D Gaillard
- Clinical Epilepsy Section, National Institute of
Neurological Disorders and Stroke, Bethesda, MD
- Department of Neurology Children’s National Medical
Center, Washington, D.C
| | - Kareem Zaghloul
- Surgical Neurology Branch, National Institute of
Neurological Disorders and Stroke, Bethesda, MD
| | - Sara K Inati
- Electroencephalography Section, National Institute of
Neurological Disorders and Stroke, Bethesda, MD
| | - William H Theodore
- Clinical Epilepsy Section, National Institute of
Neurological Disorders and Stroke, Bethesda, MD
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25
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Visualization of Brain Shift Corrected Functional Magnetic Resonance Imaging Data for Intraoperative Brain Mapping. World Neurosurg X 2019; 2:100021. [PMID: 31218295 PMCID: PMC6580887 DOI: 10.1016/j.wnsx.2019.100021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 02/06/2019] [Indexed: 11/22/2022] Open
Abstract
Background Brain tumor surgery requires careful balance between maximizing tumor excision and preserving eloquent cortex. In some cases, the surgeon may opt to perform an awake craniotomy including intraoperative mapping of brain function by direct cortical stimulation (DCS) to assist in surgical decision-making. Preoperatively, functional magnetic resonance imaging (fMRI) facilitates planning by identification of eloquent brain areas, helping to guide DCS and other aspects of the surgical plan. However, brain deformation (shift) limits the usefulness of preoperative fMRI during surgery. To address this, an integrated visualization method for fMRI and DCS results is developed that is intuitive for the surgeon. Methods An image registration pipeline was constructed to display preoperative fMRI data corrected for brain shift overlaid on images of the exposed cortical surface at the beginning and completion of DCS mapping. Preoperative fMRI and DCS data were registered for a range of misalignments, and the residual registration errors were calculated. The pipeline was validated on imaging data from five brain tumor patients who underwent awake craniotomy. Results Registration errors were well under 5 mm (the approximate spatial resolution of DCS) for misalignments of up to 25 mm and approximately 10–15°. For rotational misalignments up to 20°, the success rate was 95% for an error tolerance of 5 mm. Failures were negligible for rotational misalignments up to 10°. Good quality registrations were observed for all five patients. Conclusions A proof-of-concept image registration pipeline is presented with acceptable accuracy for intraoperative use, providing multimodality visualization with potential benefits for intraoperative brain mapping.
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Key Words
- 2D, 2-dimensional
- 3D, 3-Dimensional
- Awake craniotomy
- Brain mapping
- Brain tumor resection
- CT, Computed tomography
- DCS, Direct cortical stimulation
- Electric stimulation
- FOV, Field of view
- Functional mapping
- MRI, Magnetic resonance imaging
- Multimodal imaging
- RE, Registration error
- Surgical planning
- TE, Echo time
- TR, Repetition time
- fMRI, Functional magnetic resonance imaging
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Conti Nibali M, Rossi M, Sciortino T, Riva M, Gay LG, Pessina F, Bello L. Preoperative surgical planning of glioma: limitations and reliability of fMRI and DTI tractography. J Neurosurg Sci 2018; 63:127-134. [PMID: 30290696 DOI: 10.23736/s0390-5616.18.04597-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Brain mapping techniques (intraoperative neurophysiology and neuropsychology) represent the gold standard in glioma surgery, and particularly in glioma resection. Since the introduction of MRI in the clinical practice, several advanced applications have been developed, like functional MRI (fMRI) and diffusion imaging-based tractography (DTI), which both have an application in glioma surgery. fMRI allows to identify cortical areas related to a specific function, DTI allows to reconstruct a model of the sub-cortical connectivity. This paper describes the clinical application of fMRI and DTI, enlightening sensitivity and specificity in comparison to gold standard and underlining their limitations in surgical decision making.
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Affiliation(s)
- Marco Conti Nibali
- Unit of Neurosurgical Oncology, Department of Oncology and Hemato-Oncology, Humanitas Research Hospital, IRCCS, University of Milan, Milan, Italy -
| | - Marco Rossi
- Unit of Neurosurgical Oncology, Department of Oncology and Hemato-Oncology, Humanitas Research Hospital, IRCCS, University of Milan, Milan, Italy
| | - Tommaso Sciortino
- Unit of Neurosurgical Oncology, Department of Oncology and Hemato-Oncology, Humanitas Research Hospital, IRCCS, University of Milan, Milan, Italy
| | - Marco Riva
- Unit of Neurosurgical Oncology, Department of Oncology and Hemato-Oncology, Humanitas Research Hospital, IRCCS, University of Milan, Milan, Italy.,Department of Medical Biotechnology and Translational Medicine, Humanitas Research Hospital, IRCCS, University of Milan, Milan, Italy
| | - Lorenzo G Gay
- Unit of Neurosurgical Oncology, Department of Oncology and Hemato-Oncology, Humanitas Research Hospital, IRCCS, University of Milan, Milan, Italy
| | - Federico Pessina
- Unit of Neurosurgical Oncology, Department of Oncology and Hemato-Oncology, Humanitas Research Hospital, IRCCS, University of Milan, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Lorenzo Bello
- Unit of Neurosurgical Oncology, Department of Oncology and Hemato-Oncology, Humanitas Research Hospital, IRCCS, University of Milan, Milan, Italy
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27
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Cochereau J, Deverdun J, Herbet G, Charroud C, Boyer A, Moritz-Gasser S, Le Bars E, Molino F, Bonafé A, Menjot de Champfleur N, Duffau H. Comparison between resting state fMRI networks and responsive cortical stimulations in glioma patients. Hum Brain Mapp 2018; 37:3721-3732. [PMID: 27246771 DOI: 10.1002/hbm.23270] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 05/01/2016] [Accepted: 05/17/2016] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES To validate the functional relevance of resting state networks (RSNs) by means of a comparison of resting state connectivity (RSC) between language regions elicited by direct cortical stimulation versus RSC between random regions; and to evaluate the accuracy of resting state fMRI in surgical planning by assessing the overlap between RSNs and intraoperative functional mapping results. METHODS Sensorimotor and language eloquent sites were identified by direct electrical cortical stimulation in 98 patients with a diffuse low-grade glioma. A seed to voxel analysis with inter-language stimulation point connectivity versus inter-random ROIs connectivity was performed (19 patients). An independant component analysis (ICA) was also applied to rsfMRI data. Language and sensorimotor components were selected over 20 independent components and compared to the corresponding stimulation points and resected cortex masks (31 and 90 patients, respectively). RESULTS Mean connectivity value between language seeds was significantly higher than the one between random seeds (0.68 ± 0.39 and 0.12 ± 0.21 respectively, P < 10-10 ). 96 ± 11% of sensorimotor stimulation points were located within 10 mm from sensorimotor ICA maps versus 92 ± 21% for language. 3.1 and 15% of resected cortex overlapped sensorimotor and language networks, respectively. Mean sensorimotor stimulation points and resected cortex z-scores were 2.0 ± 1.2 and -0.050 ± 0.60, respectively (P < 10-10 ). Mean language stimulation points and resected cortex z-scores were 1.6 ± 1.9 and 0.68 ± 0.91, respectively, P < 0.005. CONCLUSION The significantly higher RSC between language seeds than between random seeds validated the functional relevance of RSC. ICA partly succeeded to distinguish eloquent versus surgically removable areas and may be possibly used as a complementary tool to intraoperative mapping. Hum Brain Mapp 37:3721-3732, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Jérôme Cochereau
- Department of Neurosurgery, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France.,Unité I2FH, Institut d'Imagerie Fonctionnelle Humaine, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France.,Team "Plasticity of Central Nervous System, Stem Cells and Glial Tumors", INSERM U1051, Institute of Neurosciences of Montpellier, Montpellier, France.,Department of Neuroradiology, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France
| | - Jérémy Deverdun
- Unité I2FH, Institut d'Imagerie Fonctionnelle Humaine, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France.,Department of Neuroradiology, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France.,Institut de Génomique Fonctionnelle, Unité UMR 5203 - INSERM U661 - Université Montpellier II - Université Montpellier I, France.,Laboratoire Charles Coulomb, Unité CNRS UMR 5221 - Université Montpellier II, Montpellier, France
| | - Guillaume Herbet
- Department of Neurosurgery, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France.,Team "Plasticity of Central Nervous System, Stem Cells and Glial Tumors", INSERM U1051, Institute of Neurosciences of Montpellier, Montpellier, France
| | - Céline Charroud
- Unité I2FH, Institut d'Imagerie Fonctionnelle Humaine, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France.,Department of Neuroradiology, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France
| | - Anthony Boyer
- Unité I2FH, Institut d'Imagerie Fonctionnelle Humaine, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France.,University of Montpellier 2, LIRMM laboratory, DEMAR Team, CNRS, INRIA, Montpellier, 34095, France
| | - Sylvie Moritz-Gasser
- Department of Neurosurgery, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France.,Team "Plasticity of Central Nervous System, Stem Cells and Glial Tumors", INSERM U1051, Institute of Neurosciences of Montpellier, Montpellier, France
| | - Emmanuelle Le Bars
- Unité I2FH, Institut d'Imagerie Fonctionnelle Humaine, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France.,Department of Neuroradiology, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France.,Laboratoire Charles Coulomb, Unité CNRS UMR 5221 - Université Montpellier II, Montpellier, France
| | - François Molino
- Institut de Génomique Fonctionnelle, Unité UMR 5203 - INSERM U661 - Université Montpellier II - Université Montpellier I, France.,Laboratoire Charles Coulomb, Unité CNRS UMR 5221 - Université Montpellier II, Montpellier, France
| | - Alain Bonafé
- Unité I2FH, Institut d'Imagerie Fonctionnelle Humaine, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France.,Team "Plasticity of Central Nervous System, Stem Cells and Glial Tumors", INSERM U1051, Institute of Neurosciences of Montpellier, Montpellier, France.,Department of Neuroradiology, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France
| | - Nicolas Menjot de Champfleur
- Unité I2FH, Institut d'Imagerie Fonctionnelle Humaine, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France.,Team "Plasticity of Central Nervous System, Stem Cells and Glial Tumors", INSERM U1051, Institute of Neurosciences of Montpellier, Montpellier, France.,Department of Neuroradiology, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France.,Laboratoire Charles Coulomb, Unité CNRS UMR 5221 - Université Montpellier II, Montpellier, France
| | - Hugues Duffau
- Department of Neurosurgery, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France.,Team "Plasticity of Central Nervous System, Stem Cells and Glial Tumors", INSERM U1051, Institute of Neurosciences of Montpellier, Montpellier, France
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28
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Lu J, Zhang H, Hameed NUF, Zhang J, Yuan S, Qiu T, Shen D, Wu J. An automated method for identifying an independent component analysis-based language-related resting-state network in brain tumor subjects for surgical planning. Sci Rep 2017; 7:13769. [PMID: 29062010 PMCID: PMC5653800 DOI: 10.1038/s41598-017-14248-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 10/09/2017] [Indexed: 02/08/2023] Open
Abstract
As a noninvasive and “task-free” technique, resting-state functional magnetic resonance imaging (rs-fMRI) has been gradually applied to pre-surgical functional mapping. Independent component analysis (ICA)-based mapping has shown advantage, as no a priori information is required. We developed an automated method for identifying language network in brain tumor subjects using ICA on rs-fMRI. In addition to standard processing strategies, we applied a discriminability-index-based component identification algorithm to identify language networks in three different groups. The results from the training group were validated in an independent group of healthy human subjects. For the testing group, ICA and seed-based correlation were separately computed and the detected language networks were assessed by intra-operative stimulation mapping to verify reliability of application in the clinical setting. Individualized language network mapping could be automatically achieved for all subjects from the two healthy groups except one (19/20, success rate = 95.0%). In the testing group (brain tumor patients), the sensitivity of the language mapping result was 60.9%, which increased to 87.0% (superior to that of conventional seed-based correlation [47.8%]) after extending to a radius of 1 cm. We established an automatic and practical component identification method for rs-fMRI-based pre-surgical mapping and successfully applied it to brain tumor patients.
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Affiliation(s)
- Junfeng Lu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Han Zhang
- Department of Radiology and Biomedical Research Imaging Center (BRIC), University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - N U Farrukh Hameed
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Jie Zhang
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Shiwen Yuan
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Tianming Qiu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Dinggang Shen
- Department of Radiology and Biomedical Research Imaging Center (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.
| | - Jinsong Wu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China.
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29
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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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30
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Castellano A, Cirillo S, Bello L, Riva M, Falini A. Functional MRI for Surgery of Gliomas. Curr Treat Options Neurol 2017; 19:34. [PMID: 28831723 DOI: 10.1007/s11940-017-0469-y] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW Advanced neuroimaging techniques such as functional MRI (fMRI) and diffusion MR tractography have been increasingly used at every stage of the surgical management of brain gliomas, as a means to improve tumor resection while preserving brain functions. This review provides an overview of the last advancements in the field of functional MRI techniques, with a particular focus on their current clinical use and reliability in the preoperative and intraoperative setting, as well as their future perspectives for personalized multimodal management of patients with gliomas. RECENT FINDINGS fMRI and diffusion MR tractography give relevant insights on the anatomo-functional organization of eloquent cortical areas and subcortical connections near or inside a tumor. Task-based fMRI and diffusion tensor imaging (DTI) tractography have proven to be valid and highly sensitive tools for localizing the distinct eloquent cortical and subcortical areas before surgery in glioma patients; they also show good accuracy when compared with intraoperative stimulation mapping data. Resting-state fMRI functional connectivity as well as new advanced HARDI (high angular resolution diffusion imaging) tractography methods are improving and reshaping the role of functional MRI for surgery of gliomas, with potential benefit for personalized treatment strategies. Noninvasive functional MRI techniques may offer the opportunity to perform a multimodal assessment in brain tumors, to be integrated with intraoperative mapping and clinical data for improving surgical management and oncological and functional outcome in patients affected by gliomas.
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Affiliation(s)
- Antonella Castellano
- Neuroradiology Unit and CERMAC, Vita-Salute San Raffaele University and IRCCS San Raffaele Scientific Institute, Via Olgettina 58-60, 20132, Milan, Italy.
| | - Sara Cirillo
- Neuroradiology Unit and CERMAC, Vita-Salute San Raffaele University and IRCCS San Raffaele Scientific Institute, Via Olgettina 58-60, 20132, Milan, Italy
| | - Lorenzo Bello
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy.,Unit of Oncological Neurosurgery, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Marco Riva
- Unit of Oncological Neurosurgery, Humanitas Research Hospital, Rozzano, Milan, Italy.,Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Milan, Italy
| | - Andrea Falini
- Neuroradiology Unit and CERMAC, Vita-Salute San Raffaele University and IRCCS San Raffaele Scientific Institute, Via Olgettina 58-60, 20132, Milan, Italy
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31
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Mellerio C, Charron S, Lion S, Roca P, Kuchcinski G, Legrand L, Edjlali M, Naggara O, Meder JF, Pallud J, Oppenheim C. Perioperative functional neuroimaging of gliomas in eloquent brain areas. Neurochirurgie 2017; 63:129-134. [DOI: 10.1016/j.neuchi.2016.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 10/10/2016] [Accepted: 10/31/2016] [Indexed: 11/25/2022]
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Austermuehle A, Cocjin J, Reynolds R, Agrawal S, Sepeta L, Gaillard WD, Zaghloul K, Inati S, Theodore WH. Language functional MRI and direct cortical stimulation in epilepsy preoperative planning. Ann Neurol 2017; 81:526-537. [PMID: 28220524 PMCID: PMC5401636 DOI: 10.1002/ana.24899] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 02/13/2017] [Accepted: 02/13/2017] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Presurgical language assessment can help minimize damage to eloquent cortex during resective epilepsy surgery. Two methods for presurgical language mapping are functional MRI (fMRI) and direct cortical stimulation (DCS) of implanted subdural electrodes. We compared fMRI results to DCS to help optimize noninvasive language localization and assess its validity. METHODS We studied 19 patients referred for presurgical evaluation of drug-resistant epilepsy. Patients completed four language tasks during preoperative fMRI. After subdural electrode implantation, we used DCS to localize language areas. For each stimulation site, we determined whether language positive electrode pairs intersected with significant fMRI activity clusters for language tasks. RESULTS Sensitivity and specificity depended on electrode region of interest radii and statistical thresholding. For patients with at least one language positive stimulation site, an auditory description decision task provided the best trade-off between sensitivity and specificity. For patients with no language positive stimulation sites, fMRI was a dependable method of excluding eloquent language processing. INTERPRETATION Language fMRI is an effective tool for determining language lateralization before electrode implantation and is especially useful for excluding unexpected critical language areas. It can help guide subdural electrode implantation and narrow the search for eloquent cortical areas by DCS. Ann Neurol 2017;81:526-537.
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Affiliation(s)
- Alison Austermuehle
- Clinical Epilepsy Section, National Institute of Neurological Disorders and Stroke
| | - John Cocjin
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke
| | - Richard Reynolds
- Scientific and Statistical Computing Core, National Institute of Mental Health
| | - Shubhi Agrawal
- Clinical Epilepsy Section, National Institute of Neurological Disorders and Stroke
| | - Leigh Sepeta
- Clinical Epilepsy Section, National Institute of Neurological Disorders and Stroke
| | - William D. Gaillard
- Clinical Epilepsy Section, National Institute of Neurological Disorders and Stroke
| | - Kareem Zaghloul
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke
| | - Sara Inati
- Electroencephalography Section, National Institute of Neurological Disorders and Stroke
| | - William H. Theodore
- Clinical Epilepsy Section, National Institute of Neurological Disorders and Stroke
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Morrison MA, Tam F, Garavaglia MM, Hare GMT, Cusimano MD, Schweizer TA, Das S, Graham SJ. Sources of Variation Influencing Concordance between Functional MRI and Direct Cortical Stimulation in Brain Tumor Surgery. Front Neurosci 2016; 10:461. [PMID: 27803645 PMCID: PMC5067437 DOI: 10.3389/fnins.2016.00461] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 09/26/2016] [Indexed: 11/13/2022] Open
Abstract
Object: Preoperative functional magnetic resonance imaging (fMRI) remains a promising method to aid in the surgical management of patients diagnosed with brain tumors. For patients that are candidates for awake craniotomies, surgical decisions can potentially be improved by fMRI but this depends on the level of concordance between preoperative brain maps and the maps provided by the gold standard intraoperative method, direct cortical stimulation (DCS). There have been numerous studies of the concordance between fMRI and DCS using sensitivity and specificity measures, however the results are variable across studies and the key factors influencing variability are not well understood. Thus, the present work addresses the influence of technical factors on fMRI and DCS concordance. Methods: Motor and language mapping data were collected for a group of glioma patients (n = 14) who underwent both preoperative fMRI and intraoperative DCS in an awake craniotomy procedure for tumor removal. Normative fMRI data were also acquired in a healthy control group (n = 12). The fMRI and DCS mapping data were co-registered; true positive (TP), true negative (TN), false positive (FP), and false negative (FN) occurrences were tabulated over the exposed brain surface. Sensitivity and specificity were measured for the total group, and for the motor and language sub-groups. The influence of grid placement, fMRI statistical thresholding, and task standardization were assessed. Correlations between proportions of agreement and error were also carefully scrutinized to evaluate concordance in more detail. Results: Concordance was significantly better for motor vs. language mapping. There was an inverse relationship between TP and TN with increasing statistical threshold, and FP dominated the total error. Sensitivity and specificity were reduced when tasks were not standardized across fMRI and DCS. Conclusions: Although the agreement between fMRI and DCS is good, variability is introduced by technical factors that can diminish the quality of patient data. Neurosurgeons should evaluate the usefulness of fMRI data while considering that (a) discordance arises primarily from FP fMRI results; (b) there is an inherent trade-off between sensitivity and specificity with fMRI statistical threshold; and
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Affiliation(s)
- Melanie A. Morrison
- Physical Sciences Platform, Sunnybrook Research InstituteToronto, ON, Canada
- Department of Medical Biophysics, University of TorontoToronto, ON, Canada
| | - Fred Tam
- Physical Sciences Platform, Sunnybrook Research InstituteToronto, ON, Canada
| | - Marco M. Garavaglia
- Department of Anaesthesia, University of TorontoToronto, ON, Canada
- Department of Anaesthesia, Toronto Western HospitalToronto, ON, Canada
| | - Gregory M. T. Hare
- Department of Anaesthesia, University of TorontoToronto, ON, Canada
- Keenan Research Centre, St. Michael's HospitalToronto, ON, Canada
- Department of Anaesthesia, St. Michael's HospitalToronto, ON, Canada
| | - Michael D. Cusimano
- Keenan Research Centre, St. Michael's HospitalToronto, ON, Canada
- Division of Neurosurgery, St. Michael's HospitalToronto, ON, Canada
- Department of Surgery, University of TorontoToronto, ON, Canada
| | - Tom A. Schweizer
- Keenan Research Centre, St. Michael's HospitalToronto, ON, Canada
- Department of Surgery, University of TorontoToronto, ON, Canada
| | - Sunit Das
- Keenan Research Centre, St. Michael's HospitalToronto, ON, Canada
- Division of Neurosurgery, St. Michael's HospitalToronto, ON, Canada
- Department of Surgery, University of TorontoToronto, ON, Canada
| | - Simon J. Graham
- Physical Sciences Platform, Sunnybrook Research InstituteToronto, ON, Canada
- Department of Medical Biophysics, University of TorontoToronto, ON, Canada
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Babajani-Feremi A, Narayana S, Rezaie R, Choudhri AF, Fulton SP, Boop FA, Wheless JW, Papanicolaou AC. Language mapping using high gamma electrocorticography, fMRI, and TMS versus electrocortical stimulation. Clin Neurophysiol 2015; 127:1822-36. [PMID: 26679420 DOI: 10.1016/j.clinph.2015.11.017] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 10/30/2015] [Accepted: 11/19/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of the present study was to compare localization of the language cortex using cortical stimulation mapping (CSM), high gamma electrocorticography (hgECoG), functional magnetic resonance imaging (fMRI), and transcranial magnetic stimulation (TMS). METHODS Language mapping using CSM, hgECoG, fMRI, and TMS were compared in nine patients with epilepsy. Considering CSM as reference, we compared language mapping approaches based on hgECoG, fMRI, and TMS using their sensitivity, specificity, and the results of receiver operating characteristic (ROC) analyses. RESULTS Our results show that areas involved in language processing can be identified by hgECoG, fMRI, and TMS. The average sensitivity/specificity of hgECoG, fMRI, and TMS across all patients was 100%/85%, 50%/80%, and 67%/66%, respectively. The average area under the ROC curve of hgECoG, fMRI, and TMS across CSM-positive patients was 0.98, 0.76, and 0.68, respectively. CONCLUSIONS There is considerable concordance between CSM, hgECoG, fMRI, and TMS language mapping. Our results reveal that hgECoG, fMRI, and TMS are valuable tools for presurgical language mapping. SIGNIFICANCE Language mapping on the basis of hgECoG, fMRI, and TMS can provide important additional information, therefore, these methods can be used in conjunction with CSM or as an alternative, when the latter is deemed impractical.
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Affiliation(s)
- Abbas Babajani-Feremi
- Department of Pediatrics, Division of Clinical Neurosciences, University of Tennessee Health Science Center, Memphis, TN, USA; Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA; Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis, TN, USA.
| | - Shalini Narayana
- Department of Pediatrics, Division of Clinical Neurosciences, University of Tennessee Health Science Center, Memphis, TN, USA; Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA; Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Roozbeh Rezaie
- Department of Pediatrics, Division of Clinical Neurosciences, University of Tennessee Health Science Center, Memphis, TN, USA; Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Asim F Choudhri
- Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA; Department of Radiology, University of Tennessee Health Science Center, Memphis, TN, USA; Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Stephen P Fulton
- Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA; Department of Pediatrics, Division of Pediatric Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Frederick A Boop
- Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA; Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - James W Wheless
- Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA; Department of Pediatrics, Division of Pediatric Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Andrew C Papanicolaou
- Department of Pediatrics, Division of Clinical Neurosciences, University of Tennessee Health Science Center, Memphis, TN, USA; Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA; Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis, TN, USA
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35
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Morrison MA, Tam F, Garavaglia MM, Golestanirad L, Hare GMT, Cusimano MD, Schweizer TA, Das S, Graham SJ. A novel tablet computer platform for advanced language mapping during awake craniotomy procedures. J Neurosurg 2015; 124:938-44. [PMID: 26473779 DOI: 10.3171/2015.4.jns15312] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A computerized platform has been developed to enhance behavioral testing during intraoperative language mapping in awake craniotomy procedures. The system is uniquely compatible with the environmental demands of both the operating room and preoperative functional MRI (fMRI), thus providing standardized testing toward improving spatial agreement between the 2 brain mapping techniques. Details of the platform architecture, its advantages over traditional testing methods, and its use for language mapping are described. Four illustrative cases demonstrate the efficacy of using the testing platform to administer sophisticated language paradigms, and the spatial agreement between intraoperative mapping and preoperative fMRI results. The testing platform substantially improved the ability of the surgeon to detect and characterize language deficits. Use of a written word generation task to assess language production helped confirm areas of speech apraxia and speech arrest that were inadequately characterized or missed with the use of traditional paradigms, respectively. Preoperative fMRI of the analogous writing task was also assistive, displaying excellent spatial agreement with intraoperative mapping in all 4 cases. Sole use of traditional testing paradigms can be limiting during awake craniotomy procedures. Comprehensive assessment of language function will require additional use of more sophisticated and ecologically valid testing paradigms. The platform presented here provides a means to do so.
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Affiliation(s)
- Melanie A Morrison
- Physical Sciences, Sunnybrook Research Institute, Toronto;,Department of Medical Biophysics, University of Toronto
| | - Fred Tam
- Physical Sciences, Sunnybrook Research Institute, Toronto
| | - Marco M Garavaglia
- Department of Anesthesia, St. Michael's Hospital, Toronto, Ontario, Canada; and
| | - Laleh Golestanirad
- Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, Boston, Massachusetts
| | - Gregory M T Hare
- Keenan Research Centre.,Department of Anesthesia, St. Michael's Hospital, Toronto, Ontario, Canada; and
| | | | | | - Sunit Das
- Keenan Research Centre.,Division of Neurosurgery, and
| | - Simon J Graham
- Physical Sciences, Sunnybrook Research Institute, Toronto;,Department of Medical Biophysics, University of Toronto
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36
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Solesio‐Jofre E, Serbruyns L, Woolley DG, Mantini D, Beets IAM, Swinnen SP. Aging effects on the resting state motor network and interlimb coordination. Hum Brain Mapp 2014; 35:3945-61. [PMID: 24453170 PMCID: PMC6869293 DOI: 10.1002/hbm.22450] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 11/29/2013] [Accepted: 12/02/2013] [Indexed: 01/14/2023] Open
Abstract
Both increases and decreases in resting state functional connectivity have been previously observed within the motor network during aging. Moreover, the relationship between altered functional connectivity and age-related declines in bimanual coordination remains unclear. Here, we explored the developmental dynamics of the resting brain within a task-specific motor network in a sample of 128 healthy participants, aged 18-80 years. We found that age-related increases in functional connectivity between interhemispheric dorsal and ventral premotor areas were associated with poorer performance on a novel bimanual visuomotor task. Additionally, a control analysis performed on the default mode network confirmed that our age-related increases in functional connectivity were specific to the motor system. Our findings suggest that increases in functional connectivity within the resting state motor network with aging reflect a loss of functional specialization that may not only occur in the active brain but also in the resting brain.
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Affiliation(s)
- Elena Solesio‐Jofre
- Motor Control LaboratoryMovement Control and Neuroplasticity Research GroupKU Leuven, Tervuurse Vest 1013001LeuvenBelgium
| | - Leen Serbruyns
- Motor Control LaboratoryMovement Control and Neuroplasticity Research GroupKU Leuven, Tervuurse Vest 1013001LeuvenBelgium
| | - Daniel G. Woolley
- Motor Control LaboratoryMovement Control and Neuroplasticity Research GroupKU Leuven, Tervuurse Vest 1013001LeuvenBelgium
| | - Dante Mantini
- Department of Health Sciences and TechnologyETH ZurichWinterthurerstrasse 1908057ZurichSwitzerland
- Department of Experimental PsychologyUniversity of Oxford9 South Parks Road, OX1 3UD OxfordUnited Kingdom
- Laboratory for Neuro‐ and PsychophysiologyDepartment of NeurosciencesKU Leuven, Herestraat 493000LeuvenBelgium
| | - Iseult A. M. Beets
- Motor Control LaboratoryMovement Control and Neuroplasticity Research GroupKU Leuven, Tervuurse Vest 1013001LeuvenBelgium
| | - Stephan P. Swinnen
- Motor Control LaboratoryMovement Control and Neuroplasticity Research GroupKU Leuven, Tervuurse Vest 1013001LeuvenBelgium
- Leuven Research Institute for Neuroscience & Disease (LIND)KU LeuvenBelgium
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