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Cai S, Shi Z, Zhou S, Liang Y, Wang L, Wang K, Zhang L. Cerebrovascular Dysregulation in Patients with Glioma Assessed with Time-shifted BOLD fMRI. Radiology 2022; 304:155-163. [PMID: 35380491 DOI: 10.1148/radiol.212192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Microscopic vascular events, such as neovascularization and neurovascular uncoupling, are common in cerebral glioma. Mapping the cerebrovascular network remodeling at the macroscopic level may provide an alternative approach to assess hemodynamic dysregulation in patients with glioma. Purpose To investigate cerebrovascular dynamics and their relevance to tumor aggressiveness by using time-shift analysis (TSA) of the systemic low-frequency oscillation (sLFO) of the resting-state blood oxygenation level-dependent signal and a decision tree model. Materials and Methods In this retrospective study, 96 patients with histologically confirmed cerebral glioma were consecutively included (March 2012 to February 2017). TSA was performed to quantify the temporal properties of sLFO signals. Alteration in the time-shift properties was assessed in the tumor region and the contralesional hemisphere relative to the brains of healthy controls by using the Mann-Whitney U test. A decision tree model based on time-shift features was developed to predict the World Health Organization (WHO) glioma grade. Results A total of 88 patients with glioma (WHO grade II, 45; grade III, 21; grade IV, 22; mean age, 42 years; age range, 20-73 years; 51 men) and 40 healthy individuals from the 1000 Functional Connectomes Project (mean age, 32 years; age range, 24-49 years; 19 men) were included. The sLFO of the brain tissues was characterized by increased time shift in the tumor region and enhanced correlation with the global reference signal in the contralesional hemisphere compared with healthy brains. The proportion of tumor voxels with negative correlation to the reference signal significantly increased with the glioma malignancy grade. The decision tree model achieved an accuracy of 91% (80 of 88 patients) in predicting the glioma malignancy grade at the individual level (P = .004) based on the time-shift features. Conclusion Gliomas induced grade-specific cerebrovascular dysregulation in the entire brain, with altered time-shift features of systemic low-frequency oscillation signals. © RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
- Siqi Cai
- From the Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Blvd, Shenzhen 518055, China (S.C., S.Z., L.Z.); University of the Chinese Academy of Sciences, Beijing, China (S.C., S.Z.); Department of Neurosurgery, Huashan Hospital of Fudan University, Shanghai, China (Z.S.); and Departments of Neurosurgery (Y.L., L.W.) and Radiology (K.W.), Beijing Tiantan Hospital of Capital Medical University, Beijing, China
| | - Zhifeng Shi
- From the Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Blvd, Shenzhen 518055, China (S.C., S.Z., L.Z.); University of the Chinese Academy of Sciences, Beijing, China (S.C., S.Z.); Department of Neurosurgery, Huashan Hospital of Fudan University, Shanghai, China (Z.S.); and Departments of Neurosurgery (Y.L., L.W.) and Radiology (K.W.), Beijing Tiantan Hospital of Capital Medical University, Beijing, China
| | - Shihui Zhou
- From the Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Blvd, Shenzhen 518055, China (S.C., S.Z., L.Z.); University of the Chinese Academy of Sciences, Beijing, China (S.C., S.Z.); Department of Neurosurgery, Huashan Hospital of Fudan University, Shanghai, China (Z.S.); and Departments of Neurosurgery (Y.L., L.W.) and Radiology (K.W.), Beijing Tiantan Hospital of Capital Medical University, Beijing, China
| | - Yuchao Liang
- From the Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Blvd, Shenzhen 518055, China (S.C., S.Z., L.Z.); University of the Chinese Academy of Sciences, Beijing, China (S.C., S.Z.); Department of Neurosurgery, Huashan Hospital of Fudan University, Shanghai, China (Z.S.); and Departments of Neurosurgery (Y.L., L.W.) and Radiology (K.W.), Beijing Tiantan Hospital of Capital Medical University, Beijing, China
| | - Lei Wang
- From the Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Blvd, Shenzhen 518055, China (S.C., S.Z., L.Z.); University of the Chinese Academy of Sciences, Beijing, China (S.C., S.Z.); Department of Neurosurgery, Huashan Hospital of Fudan University, Shanghai, China (Z.S.); and Departments of Neurosurgery (Y.L., L.W.) and Radiology (K.W.), Beijing Tiantan Hospital of Capital Medical University, Beijing, China
| | - Kai Wang
- From the Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Blvd, Shenzhen 518055, China (S.C., S.Z., L.Z.); University of the Chinese Academy of Sciences, Beijing, China (S.C., S.Z.); Department of Neurosurgery, Huashan Hospital of Fudan University, Shanghai, China (Z.S.); and Departments of Neurosurgery (Y.L., L.W.) and Radiology (K.W.), Beijing Tiantan Hospital of Capital Medical University, Beijing, China
| | - Lijuan Zhang
- From the Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Blvd, Shenzhen 518055, China (S.C., S.Z., L.Z.); University of the Chinese Academy of Sciences, Beijing, China (S.C., S.Z.); Department of Neurosurgery, Huashan Hospital of Fudan University, Shanghai, China (Z.S.); and Departments of Neurosurgery (Y.L., L.W.) and Radiology (K.W.), Beijing Tiantan Hospital of Capital Medical University, Beijing, China
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Gould L, Kress S, Neudorf J, Gibb K, Persad A, Meguro K, Norton J, Borowsky R. An fMRI, DTI and Neurophysiological Examination of Atypical Organization of Motor Cortex in Ipsilesional Hemisphere Following Post-Stroke Recovery. J Stroke Cerebrovasc Dis 2021; 30:105593. [PMID: 33434816 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/17/2020] [Accepted: 12/27/2020] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES We report a 61-year-old woman who developed left hemiparesis following a right frontal stroke. She underwent rehabilitation and regained function of the left side of her body. Three years after her first stroke, she developed a large left subdural hematoma and again presented with left hemiparesis. MATERIALS AND METHODS Prior to the cranioplasty, an fMRI scan involving left and right hand movement, arm movement, and foot peddling were conducted in order to determine whether the patient showed ipsilateral activation for the motor tasks, thus explaining the left hemiparesis following the left subdural hematoma. Diffusion tensor imaging (DTI) tractography was also collected to visualize the motor and sensory tracts. RESULTS The fMRI results revealed activation in the expected contralateral left primary motor cortex (M1) for the right-sided motor tasks, and bilateral M1 activation for the left-sided motor tasks. Intraoperative neurophysiology confirmed these findings, whereby electromyography revealed left-sided (i.e., ipsilateral) responses for four of the five electrode locations. The DTI results indicated that the corticospinal tracts and spinothalamic tracts were within normal limits and showed no displacement or disorganization. CONCLUSIONS These results suggest that there may have been reorganization of the M1 following her initial stroke, and that the left hemisphere may have become involved in moving the left side of the body thereby leading to left hemiparesis following the left subdural hematoma. The findings suggest that cortical reorganization may occur in stroke patients recovering from hemiparesis, and specifically, that components of motor processing subserved by M1 may be taken over by ipsilateral regions.
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Affiliation(s)
- Layla Gould
- Division of Neurosurgery, Royal University Hospital, 103 Hospital Drive, Saskatoon, SK S7N 0W8, Canada.
| | - Shaylyn Kress
- Department of Psychology, University of Saskatchewan, 9 Campus Drive, Saskatoon, SK S7N 5A5, Canada.
| | - Josh Neudorf
- Department of Psychology, University of Saskatchewan, 9 Campus Drive, Saskatoon, SK S7N 5A5, Canada.
| | - Katherine Gibb
- Department of Psychology, University of Saskatchewan, 9 Campus Drive, Saskatoon, SK S7N 5A5, Canada.
| | - Amit Persad
- Division of Neurosurgery, Royal University Hospital, 103 Hospital Drive, Saskatoon, SK S7N 0W8, Canada.
| | - Kotoo Meguro
- Division of Neurosurgery, Royal University Hospital, 103 Hospital Drive, Saskatoon, SK S7N 0W8, Canada.
| | - Jonathan Norton
- Division of Neurosurgery, Royal University Hospital, 103 Hospital Drive, Saskatoon, SK S7N 0W8, Canada.
| | - Ron Borowsky
- Department of Psychology, University of Saskatchewan, 9 Campus Drive, Saskatoon, SK S7N 5A5, Canada.
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Gould L, Wu A, Tellez-Zenteno JF, Neudorf J, Kress S, Gibb K, Ekstrand C, Dabirzadeh H, Ahmed SU, Borowsky R. Atypical language localization in right temporal lobe epilepsy: An fMRI case report. Epilepsy Behav Rep 2020; 14:100364. [PMID: 32462137 PMCID: PMC7243043 DOI: 10.1016/j.ebr.2020.100364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 03/03/2020] [Accepted: 03/06/2020] [Indexed: 11/25/2022] Open
Abstract
We report a 41- year-old, left-handed patient with drug-resistant right temporal lobe epilepsy (TLE). Presurgical fMRI was conducted to examine whether the patient had language functioning in the right hemisphere given that left-handedness is associated with a higher prevalence of right hemisphere dominance for language. The fMRI results revealed bilateral activation in Broca's and Wernicke's areas and activation of eloquent cortex near the region of planned resection in the right temporal lobe. Due to right temporal language-related activation, the patient underwent an awake right-sided temporal lobectomy with intraoperative language mapping. Intraoperative direct cortical stimulation (DCS) was conducted in the regions corresponding to the fMRI activation, and the patient showed language abnormalities, such as paraphasic errors, and speech arrest. The decision was made to abort the planned anterior temporal lobe procedure, and the patient instead underwent a selective amygdalohippocampectomy via the Sylvian fissure at a later date. Post-operatively the patient was seizure-free with no neurological deficits. Taken together, the results support previous findings of right hemisphere language activation in left-handed individuals, and should be considered in cases in which presurgical localization is conducted for left-hand dominant patients undergoing neurosurgical procedures. The report evaluates evidence for the possibility of right hemisphere language activation in a left-handed right TLE patient The results of the fMRI tasks showed bilateral speech regions, such as left and right Broca's area and Wernicke's area The results support previous findings of right hemisphere language activation in left-handed individuals The report discusses the value of fMRI of language tasks for presurgical planning in epilepsy cases Report highlights how fMRI findings can alter surgical strategy and how intraoperative brain mapping validates these findings
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Affiliation(s)
- Layla Gould
- Department of Surgery, Division of Neurosurgery, Royal University Hospital, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada
- Correspondence to: L. Gould, Department of Surgery, University of Saskatchewan, SK S7N 5A5, Canada.
| | - Adam Wu
- Department of Surgery, Division of Neurosurgery, Royal University Hospital, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada
| | - Jose F. Tellez-Zenteno
- Department of Medicine, Division of Neurology, Royal University Hospital, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada
| | - Josh Neudorf
- Department of Psychology, University of Saskatchewan, 9 Campus Drive, Saskatoon, SK S7N 5A5, Canada
| | - Shaylyn Kress
- Department of Psychology, University of Saskatchewan, 9 Campus Drive, Saskatoon, SK S7N 5A5, Canada
| | - Katherine Gibb
- Department of Psychology, University of Saskatchewan, 9 Campus Drive, Saskatoon, SK S7N 5A5, Canada
| | - Chelsea Ekstrand
- Department of Psychology, University of Saskatchewan, 9 Campus Drive, Saskatoon, SK S7N 5A5, Canada
| | - Hamid Dabirzadeh
- Department of Medical Imaging, Royal University Hospital, 103 Hospital Drive, Saskatoon, SK S7N 0W8, Canada
| | - Syed Uzair Ahmed
- Department of Surgery, Division of Neurosurgery, Royal University Hospital, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada
| | - Ron Borowsky
- Department of Psychology, University of Saskatchewan, 9 Campus Drive, Saskatoon, SK S7N 5A5, Canada
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