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Campbell JM, Kundu B, Lee JN, Miranda M, Arain A, Taussky P, Grandhi R, Rolston JD. Evaluating the concordance of functional MRI-based language lateralization and Wada testing in epilepsy patients: A single-center analysis. Interv Neuroradiol 2023; 29:599-604. [PMID: 35979608 PMCID: PMC10549711 DOI: 10.1177/15910199221121384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/20/2022] [Accepted: 08/03/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND For patients with drug-resistant epilepsy, surgery may be effective in controlling their disease. Surgical evaluation may involve localization of the language areas using functional magnetic resonance imaging (fMRI) or Wada testing. We evaluated the accuracy of task-based fMRI versus Wada-based language lateralization in a cohort of our epilepsy patients. METHODS In a single-center, retrospective analysis, we identified patients with medically intractable epilepsy who participated in presurgical language mapping (n = 35) with fMRI and Wada testing. Demographic variables and imaging metrics were obtained. We calculated the laterality index (LI) from task-evoked fMRI activation maps across language areas during auditory and reading tasks to determine lateralization. Possible scores for LI range from -1 (strongly left-hemisphere dominant) to 1 (strongly right-hemisphere dominant). Concordance between fMRI and Wada was estimated using Cohen's Kappa coefficient. Association between the LI scores from the auditory and reading tasks was tested using Spearman's rank correlation coefficient. RESULTS The fMRI-based laterality indices were concordant with results from Wada testing in 91.4% of patients during the reading task (κ = .55) and 96.9% of patients during the auditory task (κ = .79). The mean LIs for the reading and auditory tasks were -0.52 ± 0.43 and -0.68 ± 0.42, respectively. The LI scores for the language and reading tasks were strongly correlated, r(30) = 0.57 (p = 0.001). CONCLUSION Our findings suggest that fMRI is generally an accurate, low-risk alternative to Wada testing for language lateralization. However, when fMRI indicates atypical language lateralization (e.g., bilateral dominance), patients may benefit from subsequent Wada testing or intraoperative language mapping.
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Affiliation(s)
- Justin M Campbell
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
- Interdepartmental Program in Neuroscience, University of Utah, Salt Lake City, Utah, USA
| | - Bornali Kundu
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - James N Lee
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Michelle Miranda
- Department of Neurology, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Amir Arain
- Department of Neurology, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Philipp Taussky
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Ramesh Grandhi
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, USA
| | - John D Rolston
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
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Clinical Speech fMRI in Children and Adolescents : Development of an Optimal Protocol and Analysis Algorithm. Clin Neuroradiol 2021; 32:185-196. [PMID: 34613421 PMCID: PMC8894226 DOI: 10.1007/s00062-021-01097-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 08/31/2021] [Indexed: 11/28/2022]
Abstract
Purpose In patients with drug-resistant focal epilepsy, surgical resection is often the only treatment option to achieve long-term seizure control. Prior to brain surgery involving potential language areas, identification of hemispheric language dominance is crucial. Our group developed and validated a functional magnetic resonance imaging (fMRI) battery of four pediatric language tasks. The present study aimed at optimizing fMRI data acquisition and analysis using these tasks. Methods We retrospectively analyzed speech fMRI examinations of 114 neuropediatric patients (age range 5.8–17.8 years) who were examined prior to possible epilepsy surgery. In order to evaluate hemispheric language dominance, 1–4 language tasks (vowel identification task VIT, word-chain task WCT, beep-story task BST, synonym task SYT) were measured. Results Language dominance was classified using fMRI activation in the 13 validly lateralizing ROIs (VLR) in frontal, temporal and parietal lobes and cerebellum of the recent validation study from our group: 47/114 patients were classified as left-dominant, 34/114 as bilateral and 6/114 as right-dominant. In an attempt to enlarge the set of VLR, we then compared for each task agreement of these ROI activations with the classified language dominance. We found four additional task-specific ROIs showing concordant activation and activation in ≥ 10 sessions, which we termed validly lateralizing (VLRnew). The new VLRs were: for VIT the temporal language area and for SYT the middle frontal gyrus, the intraparietal sulcus and cerebellum. Finally, in order to find the optimal sequence of measuring the different tasks, we analyzed the success rates of single tasks and all possible task combinations. The sequence 1) VIT 2) WCT 3) BST 4) SYT was identified as the optimal sequence, yielding the highest chance to obtain reliable results even when the fMRI examination has to be stopped, e.g., due to lack of cooperation. Conclusion Our suggested task order together with the enlarged set of VLRnew may contribute to optimize pediatric speech fMRI in a clinical setting. Supplementary Information The online version of this article (10.1007/s00062-021-01097-z) contains supplementary material, which is available to authorized users.
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Thakkar I, Arraño-Carrasco L, Cortes-Rivera B, Zunino-Pesce R, Mery-Muñoz F, Rodriguez-Fernández M, Smits M, Mendez-Orellana C. Alternative language paradigms for functional magnetic resonance imaging as presurgical tools for inducing crossed cerebro-cerebellar language activations in brain tumor patients. Eur Radiol 2021; 32:300-307. [PMID: 34189601 DOI: 10.1007/s00330-021-08137-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/11/2021] [Accepted: 06/02/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Crossed cerebro-cerebellar BOLD activations have recently come to light as additional diagnostic features for patients with brain tumors. The covert verb generation (VG) task is a widely used language paradigm to determine these language-related crossed activations. Here we demonstrate these crossed activations in two additional language paradigms, the semantic and phonological association tasks. We propose the merit of these tasks to language lateralization determination in the clinic as they are easy to monitor and suitable for patients with aphasia. METHODS Patients with brain tumors localized at different cortical sites (n = 71) performed three language paradigms, namely the VG task as well as the semantic (SA) and phonological (PA) association tasks with button-press responses. Respective language activations in disparate cortical regions and the cerebellum were assigned laterality. Agreements in laterality between the two new tasks and the verb generation task were tested using Cohen's kappa. RESULTS Both tasks significantly agreed in cortical and cerebellar lateralization with the verb generation task in patients. Additionally, a McNemar test confirmed the presence of crossed activations in the cortex and the cerebellum in the entire subject population. CONCLUSION We demonstrated that the semantic and phonological association tasks resulted in crossed cerebro-cerebellar language lateralization activations as those observed due to the covert verb generation task. This may suggest the possibility of these tasks being used conjointly with the traditional verb generation task, especially for subjects that may be unable to perform the latter. KEY POINTS • The semantic and phonological association tasks can be useful as additional presurgical fMRI language lateralization paradigms for brain tumor patients along with the standard verb generation task. • All three tasks also confirm the presence of crossed cerebro-cerebellar language activations in the current subject population.
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Affiliation(s)
- Ishani Thakkar
- Interdisciplinary Center for Neuroscience, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Leonardo Arraño-Carrasco
- Department of Radiology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Barbara Cortes-Rivera
- School of Speech and Language Pathology, Faculty of Health, Universidad Santo Tomás, Santiago, Chile
| | - Romina Zunino-Pesce
- Department of Radiology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisco Mery-Muñoz
- Department of Neurosurgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - María Rodriguez-Fernández
- Institute for Biological and Medical Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marion Smits
- Department of Radiology & Nuclear Medicine, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Carolina Mendez-Orellana
- School of Speech and Language Pathology, Health Sciences Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
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Tuohy K, Fernandez A, Hamidi N, Padmanaban V, Mansouri A. Current State of Health Economic Analyses for Low-Grade Glioma Management: A Systematic Review. World Neurosurg 2021; 152:189-197.e1. [PMID: 34087462 DOI: 10.1016/j.wneu.2021.05.112] [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: 03/01/2021] [Revised: 05/23/2021] [Accepted: 05/24/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Health economic analyses help determine the value of a medical intervention by assessing the costs and outcomes associated with it. The objective of this study was to assess the level of evidence in economic evaluations for low-grade glioma (LGG) management. METHODS Following the PRISMA guidelines, we conducted a systematic review of English articles in Medline, Embase, The Central Registration Depository, EconPapers, and EconLit. The results were screened, and data were extracted by 2 independent reviewers for studies reporting economic evaluations for LGG. The quality of each study was evaluated using the CHEERS (Consolidated Health Economic Evaluation Reporting Standards) checklist, the hierarchy scale developed by Cooper et al. (2005), and the Quality of Health Economic Studies instrument. RESULTS Three studies met our inclusion criteria. The adjusted incremental cost-effectiveness ratio (ICER) values for the included studies ranged from $3934 to $9936, but each evaluated a different aspect of LGG management. All had a good quality of reporting per the CHEERS checklist. Based on the Cooper et al. hierarchy scale, the quality of data use was lacking most for utilities. The quality of study design was scored as 82, 92, and 100 for each study using the Quality of Health Economic Studies instrument. CONCLUSIONS Although a limited number of economic evaluations were identified, the studies evaluated here were well designed. The interventions assessed were all considered cost-effective, but pooled analysis was not possible because of heterogeneity in the interventions assessed. Given the importance of value and cost-effectiveness in medical care, more evidence is needed in this area.
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Affiliation(s)
- Kyle Tuohy
- Pennsylvania State College of Medicine, Hershey, Pennsylvania, USA.
| | - Ajay Fernandez
- Doctor of Osteopathic Medicine Program, Arizona College of Osteopathic Medicine, Glendale, Arizona, USA
| | - Nima Hamidi
- Doctor of Osteopathic Medicine Program, Arizona College of Osteopathic Medicine, Glendale, Arizona, USA
| | - Varun Padmanaban
- Penn State Department of Neurosurgery, Hershey, Pennsylvania, USA
| | - Alireza Mansouri
- Penn State Department of Neurosurgery, Hershey, Pennsylvania, USA; Penn State Cancer Institute, Hershey, Pennsylvania, USA
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Brar K, Hachem LD, Badhiwala JH, Mau C, Zacharia BE, de Moraes FY, Pirouzmand F, Mansouri A. Management of Diffuse Low-Grade Glioma: The Renaissance of Robust Evidence. Front Oncol 2020; 10:575658. [PMID: 33117714 PMCID: PMC7560299 DOI: 10.3389/fonc.2020.575658] [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: 06/24/2020] [Accepted: 08/31/2020] [Indexed: 12/20/2022] Open
Abstract
The surgical management of diffuse low-grade gliomas (DLGGs) has undergone a paradigm shift toward striving for maximal safe resection when feasible. While extensive observational data supports this transition, unbiased evidence in the form of high quality randomized-controlled trials (RCTs) is lacking. Furthermore, despite a high volume of molecular, genetic, and imaging data, the field of neuro-oncology lacks personalized care algorithms for individuals with DLGGs based on a robust foundation of evidence. In this manuscript, we (1) discuss the logistical and philosophical challenges hindering the development of surgical RCTs for DLGGs, (2) highlight the potential impact of well-designed international prospective observational registries, (3) discuss ways in which cutting-edge computational techniques can be harnessed to generate maximal insight from high volumes of multi-faceted data, and (4) outline a comprehensive plan of action that will enable a multi-disciplinary approach to future DLGG management, integrating advances in clinical medicine, basic molecular research and large-scale data mining.
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Affiliation(s)
- Karanbir Brar
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Laureen D Hachem
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Jetan H Badhiwala
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Christine Mau
- Department of Neurosurgery, Penn State Health, Hershey, PA, United States
| | - Brad E Zacharia
- Department of Neurosurgery, Penn State Health, Hershey, PA, United States.,Penn State Cancer Institute, Hershey, PA, United States
| | - Fabio Ynoe de Moraes
- Division of Radiation Oncology, Department of Oncology, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Farhad Pirouzmand
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Alireza Mansouri
- Department of Neurosurgery, Penn State Health, Hershey, PA, United States.,Penn State Cancer Institute, Hershey, PA, United States
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Vysotski S, Madura C, Swan B, Holdsworth R, Lin Y, Rio AMD, Wood J, Kundu B, Penwarden A, Voss J, Gallagher T, Nair VA, Field A, Garcia-Ramos C, Meyerand EM, Baskaya M, Prabhakaran V, Kuo JS. Preoperative FMRI Associated with Decreased Mortality and Morbidity in Brain Tumor Patients. INTERDISCIPLINARY NEUROSURGERY-ADVANCED TECHNIQUES AND CASE MANAGEMENT 2018; 13:40-45. [PMID: 31341789 DOI: 10.1016/j.inat.2018.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Functional Magnetic Resonance Imaging (fMRI) is a presurgical planning technique used to localize functional cortex so as to maximize resection of diseased tissue and avoid viable tissue. In this retrospective study, we examined differences in morbidity and mortality of brain tumor patients who received preoperative fMRI in comparison to those who did not. Methods Brain tumor patients (n=206) were selected from a retrospective review of neurosurgical case logs from 2001-2009 at the University of Wisconsin-Madison. Results Univariate analysis showed improved mortality in the fMRI group and the fMRI+Electrical Cortical Stimulation Mapping (ECM) group compared to the No-fMRI group. Multivariate analyses showed improved mortality of the fMRI group and the fMRI+ECM group compared to the No-fMRI group, with age and tumor grade being the most significant influencers. Overall, the fMRI group showed survival benefits at 3 years; twice that of the No-fMRI group. Furthermore, patients with high-grade tumors showed significant survival benefits in the fMRI group, while patients with low-grade tumors did not (controlling for age and ECM). There was also a significant difference in the two groups with respect to morbidity, with patients receiving fMRI showing improved outcomes in the motor and language domains. Conclusions This study analyzing a large retrospective series of brain tumor patients with and without the use of fMRI in the preoperative planning has resulted in improved mortality and morbidity outcomes with the use of fMRI. These results point to the importance of incorporating fMRI in presurgical planning in the clinical management of patients with brain tumors.
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Affiliation(s)
- Siarhei Vysotski
- Department of Radiology, University of Wisconsin-Madison, School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792-3252
| | - Casey Madura
- Neurological Surgery, University of Wisconsin-Madison, School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792-3252
| | - Benjamin Swan
- Department of Radiology, Mount Auburn Hospital, 330 Mount Auburn Street, Cambridge, MA 02138
| | - Ryan Holdsworth
- Department of Radiology, University of Wisconsin-Madison, School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792-3252
| | - Yunzhi Lin
- Department of Statistics, University of Wisconsin Madison, 1300 University Avenue, Madison, WI 53705
| | - Alejandro Munoz Del Rio
- Department of Radiology, University of Wisconsin-Madison, School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792-3252.,Department of Medical Physics, University of Wisconsin-Madison, Wisconsin Institutes for Medical Research (WIMR), 1111 Highland Avenue Rm 1005, Madison, WI 53705
| | - Joel Wood
- Department of General Surgery, UW Hospitals and Clinics, 600 Highland Avenue, Madison, WI 53792-3252
| | - Bornali Kundu
- Medical Scientist Training Program, University of Wisconsin Madison, 6001 Research Park Blvd. Rm 1056, Madison, WI 51719
| | - Amy Penwarden
- Department of Anesthesiology, University of North Carolina -Chapel Hill, 106 Bel Arbor Ln Carrboro, NC 27510
| | - Jed Voss
- Department of Radiology, University of Wisconsin-Madison, School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792-3252
| | - Thomas Gallagher
- Department of Radiology, Northwestern University Feinberg School of Medicine, NMH/Arkes Family Pavilion Suite 800, 676 N Saint Clair, Chicago IL 60611
| | - Veena A Nair
- Department of Radiology, University of Wisconsin-Madison, School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792-3252
| | - Aaron Field
- Department of Radiology, University of Wisconsin-Madison, School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792-3252.,Biomedical Engineering, University of Wisconsin-Madison, 1550 Engineering Dr, Madison, WI 53706, USA
| | - Camille Garcia-Ramos
- Department of Medical Physics, University of Wisconsin-Madison, Wisconsin Institutes for Medical Research (WIMR), 1111 Highland Avenue Rm 1005, Madison, WI 53705
| | - Elizabeth M Meyerand
- Biomedical Engineering, University of Wisconsin-Madison, 1550 Engineering Dr, Madison, WI 53706, USA.,Department of Medical Physics, University of Wisconsin-Madison, Wisconsin Institutes for Medical Research (WIMR), 1111 Highland Avenue Rm 1005, Madison, WI 53705
| | - Mustafa Baskaya
- Neurological Surgery, University of Wisconsin-Madison, School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792-3252
| | - Vivek Prabhakaran
- Department of Radiology, University of Wisconsin-Madison, School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792-3252
| | - John S Kuo
- UW Carbone Cancer Center, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI 53792, USA.,UW Center for Stem Cell and Regenerative Medicine, University of Wisconsin-Madison, School of Medicine and Public Health, K3/803 Clinical Science Center, Mail Code 8660, 600 Highland Avenue, Madison, WI 53792-3252
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Huang H, Ding Z, Mao D, Yuan J, Zhu F, Chen S, Xu Y, Lou L, Feng X, Qi L, Qiu W, Zhang H, Zang YF. PreSurgMapp: a MATLAB Toolbox for Presurgical Mapping of Eloquent Functional Areas Based on Task-Related and Resting-State Functional MRI. Neuroinformatics 2018; 14:421-38. [PMID: 27221107 DOI: 10.1007/s12021-016-9304-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The main goal of brain tumor surgery is to maximize tumor resection while minimizing the risk of irreversible postoperative functional sequelae. Eloquent functional areas should be delineated preoperatively, particularly for patients with tumors near eloquent areas. Functional magnetic resonance imaging (fMRI) is a noninvasive technique that demonstrates great promise for presurgical planning. However, specialized data processing toolkits for presurgical planning remain lacking. Based on several functions in open-source software such as Statistical Parametric Mapping (SPM), Resting-State fMRI Data Analysis Toolkit (REST), Data Processing Assistant for Resting-State fMRI (DPARSF) and Multiple Independent Component Analysis (MICA), here, we introduce an open-source MATLAB toolbox named PreSurgMapp. This toolbox can reveal eloquent areas using comprehensive methods and various complementary fMRI modalities. For example, PreSurgMapp supports both model-based (general linear model, GLM, and seed correlation) and data-driven (independent component analysis, ICA) methods and processes both task-based and resting-state fMRI data. PreSurgMapp is designed for highly automatic and individualized functional mapping with a user-friendly graphical user interface (GUI) for time-saving pipeline processing. For example, sensorimotor and language-related components can be automatically identified without human input interference using an effective, accurate component identification algorithm using discriminability index. All the results generated can be further evaluated and compared by neuro-radiologists or neurosurgeons. This software has substantial value for clinical neuro-radiology and neuro-oncology, including application to patients with low- and high-grade brain tumors and those with epilepsy foci in the dominant language hemisphere who are planning to undergo a temporal lobectomy.
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Affiliation(s)
- Huiyuan Huang
- Center for Cognition and Brain Disorders, Hangzhou Normal University, 58 Haishu Road, Hangzhou, 311121, People's Republic of China.,School of Education Science, Hangzhou Normal University, Hangzhou, Zhejiang, 311121, People's Republic of China.,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, Zhejiang, 310015, People's Republic of China
| | - Zhongxiang Ding
- Department of Radiology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, 310014, People's Republic of China
| | - Dewang Mao
- Department of Radiology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, 310014, People's Republic of China
| | - Jianhua Yuan
- Department of Radiology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, 310014, People's Republic of China
| | - Fangmei Zhu
- Department of Radiology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, 310014, People's Republic of China
| | - Shuda Chen
- Department of Neurosurgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, 310014, People's Republic of China
| | - Yan Xu
- Department of Neurosurgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, 310014, People's Republic of China
| | - Lin Lou
- Department of Neurosurgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, 310014, People's Republic of China
| | - Xiaoyan Feng
- Department of Neurosurgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, 310014, People's Republic of China
| | - Le Qi
- Department of Radiology, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, 310015, People's Republic of China
| | - Wusi Qiu
- Department of Neurosurgery, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, 310015, People's Republic of China
| | - Han Zhang
- Center for Cognition and Brain Disorders, Hangzhou Normal University, 58 Haishu Road, Hangzhou, 311121, People's Republic of China. .,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, Zhejiang, 310015, People's Republic of China.
| | - Yu-Feng Zang
- Center for Cognition and Brain Disorders, Hangzhou Normal University, 58 Haishu Road, Hangzhou, 311121, People's Republic of China.,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, Zhejiang, 310015, People's Republic of China
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8
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Voss J, Meier TB, Freidel R, Kundu B, Nair VA, Holdsworth R, Kuo JS, Prabhakaran V. The role of secondary motor and language cortices in morbidity and mortality: a retrospective functional MRI study of surgical planning for patients with intracranial tumors. Neurosurg Focus 2014; 34:E7. [PMID: 23544413 DOI: 10.3171/2013.2.focus12410] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Functional MRI (fMRI) is commonly used by neurosurgeons preoperatively to identify brain regions associated with essential behaviors, such as language and motor abilities. In this study the authors investigated the relationship between patient morbidity and mortality and the distance from the tumor border area to functional activations in secondary motor and language cortices. METHODS Patients with primary or metastatic brain tumors who underwent preoperative fMRI motor and language mapping were selected from a large database of patients with tumors. The lesion-to-activation distance (LAD) was measured in each patient relative to the supplementary motor area (SMA) for motor tasks and the presupplementary motor area (pSMA) for language tasks. The association between LAD and the incidence of deficits was investigated using the Fisher exact tests of significance. The impact of other variables, including age, handedness, sex, and tumor grade, was also investigated. In a subset of patients, logistic regression was performed to identify the likelihood of deficits based on the LAD to primary and secondary regions. Finally, Mantel-Cox log-rank tests were performed to determine whether survival time was significantly related to the LAD to secondary motor and language areas. RESULTS A significant association was observed between the LAD to the SMA and the incidence of motor deficits, with the percentage of patients with deficits dropping for those in the LAD > 2 cm group. The relationship between the LAD to the pSMA and the incidence of language deficits was not significant. Logistic regression demonstrated that the LAD to primary sensorimotor cortex does affect the incidence of motor deficits, but that the LAD to SMA does not. Finally, the authors observed no relationship between the LAD to secondary regions and patient mortality rates. CONCLUSIONS These results demonstrate that the LAD to SMA structures does affect morbidity, although not to the extent of LAD to primary structures. In addition, motor deficits are significantly associated with LAD to secondary structures, but language deficits are not. This should be considered by neurosurgeons for patient consultation and preoperative planning.
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Affiliation(s)
- Jed Voss
- Departments of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53705, USA
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Gallagher TA, Nair VA, Regner MF, Young BM, Radtke A, Pankratz J, Holdsworth RL, Baniulis D, Kornder NK, Voss J, Austin BP, Moritz C, Meyerand EM, Prabhakaran V. Characterizing the relationship between functional MRI-derived measures and clinical outcomes in patients with vascular lesions. Neurosurg Focus 2014; 34:E8. [PMID: 23544414 DOI: 10.3171/2013.2.focus12417] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Functional MRI (fMRI) has proven to be an effective component of pretreatment planning in patients harboring a variety of different brain lesions. The authors have recently reported significant relationships concerning distances between brain tumor borders and areas of functional activation (lesion-to-activation distance; LAD) with regard to patient morbidity and mortality. This study further examines the relationship between LAD, focusing on a host of vascular lesions and pre- and posttreatment morbidity. METHODS This study included a sample population of patients with vascular lesions (n = 106), primarily arteriovenous malformations (AVMs) and cavernomas. These patients underwent pretreatment fMRI-based motor mapping (n = 72) or language mapping (n = 84). The impact of LAD and other variables derived from the patient medical record were analyzed with respect to functional deficits in terms of morbidity (weakness and/or aphasia). RESULTS In patients with no pretreatment deficits, there was trend for a significant relationship between the Wernicke area LAD and posttreatment language deficits. In patients with or without pretreatment deficits, a trend toward significance was observed between sensorimotor LAD and posttreatment motor deficits. Additionally, lesion type (AVMs or cavernomas) affected posttreatment deficits, with more patients with cavernomas showing posttreatment language deficits than patients with AVMs. However, this difference was not observed for posttreatment motor deficits. CONCLUSIONS These findings suggest that the proximity of a vascular lesion to sensorimotor and language areas is a relevant parameter in estimating patient prognosis in the perioperative period. Additionally, vascular lesion type and existence of pretreatment deficits play a significant role in outcomes.
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Affiliation(s)
- Thomas A Gallagher
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Veena A Nair
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Michael F Regner
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Brittany M Young
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Andrew Radtke
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Joshua Pankratz
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Ryan L Holdsworth
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Dovile Baniulis
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Nicole K Kornder
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Jed Voss
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Benjamin P Austin
- Cardiovascular Research Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Chad Moritz
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Elizabeth M Meyerand
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Vivek Prabhakaran
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Kundu B, Penwarden A, Wood JM, Gallagher TA, Andreoli MJ, Voss J, Meier T, Nair VA, Kuo JS, Field AS, Moritz C, Meyerand ME, Prabhakaran V. Association of functional magnetic resonance imaging indices with postoperative language outcomes in patients with primary brain tumors. Neurosurg Focus 2013; 34:E6. [PMID: 23544412 PMCID: PMC3954579 DOI: 10.3171/2013.2.focus12413] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Functional MRI (fMRI) has the potential to be a useful presurgical planning tool to treat patients with primary brain tumor. In this study the authors retrospectively explored relationships between language-related postoperative outcomes in such patients and multiple factors, including measures estimated from task fMRI maps (proximity of lesion to functional activation area, or lesion-to-activation distance [LAD], and activation-based language lateralization, or lateralization index [LI]) used in the clinical setting for presurgical planning, as well as other factors such as patient age, patient sex, tumor grade, and tumor volume. METHODS Patient information was drawn from a database of patients with brain tumors who had undergone preoperative fMRI-based language mapping of the Broca and Wernicke areas. Patients had performed a battery of tasks, including word-generation tasks and a text-versus-symbols reading task, as part of a clinical fMRI protocol. Individually thresholded task fMRI activation maps had been provided for use in the clinical setting. These clinical imaging maps were used to retrospectively estimate LAD and LI for the Broca and Wernicke areas. RESULTS There was a relationship between postoperative language deficits and the proximity between tumor and Broca area activation (the LAD estimate), where shorter LADs were related to the presence of postoperative aphasia. Stratification by tumor location further showed that for posterior tumors within the temporal and parietal lobes, more bilaterally oriented Broca area activation (LI estimate close to 0) and a shorter Wernicke area LAD were associated with increased postoperative aphasia. Furthermore, decreasing LAD was related to decreasing LI for both Broca and Wernicke areas. Preoperative deficits were related to increasing patient age and a shorter Wernicke area LAD. CONCLUSIONS Overall, LAD and LI, as determined using fMRI in the context of these paradigms, may be useful indicators of postsurgical outcomes. Whereas tumor location may influence postoperative deficits, the results indicated that tumor proximity to an activation area might also interact with how the language network is affected as a whole by the lesion. Although the derivation of LI must be further validated in individual patients by using spatially specific statistical methods, the current results indicated that fMRI is a useful tool for predicting postoperative outcomes in patients with a single brain tumor.
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Affiliation(s)
- Bornali Kundu
- School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA.
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11
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Zacà D, Nickerson JP, Deib G, Pillai JJ. Effectiveness of four different clinical fMRI paradigms for preoperative regional determination of language lateralization in patients with brain tumors. Neuroradiology 2012; 54:1015-25. [PMID: 22744798 DOI: 10.1007/s00234-012-1056-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Accepted: 06/12/2012] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Blood oxygen level-dependent functional magnetic resonance imaging (fMRI) has demonstrated its capability to provide comparable results to gold standard intracarotid sodium amobarbital (Wada) testing for preoperative determination of language hemispheric dominance. However, thus far, no consensus has been established regarding which fMRI paradigms are the most effective for the determination of hemispheric language lateralization in specific categories of patients and specific regions of interest (ROIs). METHODS Forty-one brain tumor patients who performed four different language tasks-rhyming (R), silent word generation (SWG) sentence completion, and sentence listening comprehension (LC)-for presurgical language mapping by fMRI were included in this study. A statistical threshold-independent lateralization index (LI) was calculated and compared among the paradigms in four different ROIs for language activation: functional Broca's (BA) and Wernicke's areas (WA) as well as larger anatomically defined expressive (EA) and receptive (RA) areas. RESULTS The two expressive paradigms evaluated in this study are very good lateralizing tasks in expressive language areas; specifically, a significantly higher mean LI value was noted for SWG (0.36 ± 0.25) compared to LC (0.16 ± 0.24, p = 0.009) and for R (0.40 ± 0.22) compared to LC (0.16 ± 0.24, p = 0.001) in BA. SWG LI (0.28 ± 0.19) was higher than LC LI (0.12 ± 0.16, p = 0.01) also in EA. No significant differences in LI were found among these paradigms in WA or RA. CONCLUSIONS SWG and R are sufficient for the determination of lateralization in expressive language areas, whereas new semantic or receptive paradigms need to be designed for an improved assessment of lateralization in receptive language areas.
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Affiliation(s)
- Domenico Zacà
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine & The Johns Hopkins Hospital, 600 N. Wolfe Street, Phipps B-100, Baltimore, MD 21287, USA
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12
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Wood JM, Kundu B, Utter A, Gallagher TA, Voss J, Nair VA, Kuo JS, Field AS, Moritz CH, Meyerand ME, Prabhakaran V. Impact of brain tumor location on morbidity and mortality: a retrospective functional MR imaging study. AJNR Am J Neuroradiol 2011; 32:1420-5. [PMID: 21885713 DOI: 10.3174/ajnr.a2679] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE fMRI is increasingly used in neurosurgery to preoperatively identify areas of eloquent cortex. Our study evaluated the efficacy of clinical fMRI by analyzing the relationship between the distance from the tumor border to the area of functional activation (LAD) and patient pre- and postoperative morbidity and mortality. MATERIALS AND METHODS The study included patients with diagnosis of primary or metastatic brain tumor who underwent preoperative fMRI-based motor mapping (n=74) and/or language mapping (n=77). The impact of LAD and other variables collected from patient records was analyzed with respect to functional deficits in terms of morbidity (paresis and aphasia) and mortality. RESULTS Significant relationships were found between motor and language LAD and the existence of either pre- or postoperative motor (P < .001) and language deficits (P=.009). Increasing age was associated with motor and language deficits (P=.02 and P=.04 respectively). Right-handedness was related to language deficits (P=.05). Survival analysis revealed that pre- and postoperative deficits, grade, tumor location, and LAD predicted mortality. Motor deficits increased linearly as the distance from the tumor to the primary sensorimotor cortex decreased. Language deficits increased exponentially as the distance from the tumor to the language areas decreased below 1 cm. Postoperative mortality analysis showed an interaction effect between motor or language LAD and mortality predictors (grade and tumor location, respectively). CONCLUSIONS These findings indicate that tumors may affect language and motor function differently depending on tumor LAD. Overall, the data support the use of fMRI as a tool to evaluate patient prognosis and are directly applicable to neurosurgical planning.
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Affiliation(s)
- J M Wood
- Department of Neuroradiology, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, 53705, USA.
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13
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Sakr HM. Language and memory lateralization and localization using different fMRI paradigms in Arabic speaking patients: Initial experience. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2011. [DOI: 10.1016/j.ejrnm.2011.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Chavhan GB, Babyn PS, Thomas B, Shroff MM, Haacke EM. Principles, techniques, and applications of T2*-based MR imaging and its special applications. Radiographics 2009; 29:1433-49. [PMID: 19755604 DOI: 10.1148/rg.295095034] [Citation(s) in RCA: 433] [Impact Index Per Article: 28.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
T2* relaxation refers to decay of transverse magnetization caused by a combination of spin-spin relaxation and magnetic field inhomogeneity. T2* relaxation is seen only with gradient-echo (GRE) imaging because transverse relaxation caused by magnetic field inhomogeneities is eliminated by the 180 degrees pulse at spin-echo imaging. T2* relaxation is one of the main determinants of image contrast with GRE sequences and forms the basis for many magnetic resonance (MR) applications, such as susceptibility-weighted (SW) imaging, perfusion MR imaging, and functional MR imaging. GRE sequences can be made predominantly T2* weighted by using a low flip angle, long echo time, and long repetition time. GRE sequences with T2*-based contrast are used to depict hemorrhage, calcification, and iron deposition in various tissues and lesions. SW imaging uses phase information in addition to T2*-based contrast to exploit the magnetic susceptibility differences of the blood and of iron and calcification in various tissues. Perfusion MR imaging exploits the signal intensity decrease that occurs with the passage of a high concentration of gadopentetate dimeglumine through the microvasculature. Change in oxygen saturation during specific tasks changes the local T2*, which leads to the blood oxygen level-dependent effect seen at functional MR imaging. The basics of T2* relaxation, T2*-weighted sequences, and their clinical applications are presented, followed by the principles, techniques, and clinical uses of four T2*-based applications, including SW imaging, perfusion MR imaging, functional MR imaging, and iron overload imaging.
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Affiliation(s)
- Govind B Chavhan
- Department of Diagnostic Imaging, Hospital for Sick Children, and University of Toronto, 555 University Ave, Toronto, ON, Canada.
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15
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Rumpel H, Chan LL, Tan JSP, Ng IHB, Lim WEH. Clinical Functional Magnetic Resonance Imaging for Pre-surgical Planning – the Singapore General Hospital Experience with the First 30 Patients. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2009. [DOI: 10.47102/annals-acadmedsg.v38n9p782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Introduction: Functional magnetic resonance imaging (fMRI) is a neuroradiological technique for the localisation of cortical function. FMRI made its debut in cognitive neuroscience and then eventually to other clinical applications. We report our experience with pre-surgical fMRI on a high field scanner, based purely on a clinical platform.
Materials and Methods: The protocols included motor, auditory, visual and language fMRI. The choice of protocols was dependant on clinical request and lesion locale.
Results: Retrospective analysis and audit of the first 30 consecutive patients over a 12-month period revealed that about 85% of patients had a successful examination. In a pictorial essay, we demonstrate that patients with weakness in performing a motor task showed abnormal activations of the pre-motor and supplementary motor areas.
Conclusion: FMRI data greatly enhances the pre-surgical planning process and the conduct of surgery when it is incorporated into the surgical navigation system in the operating theatre.
Key words: fMRI, Pre-surgical planning, Task activation
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Ruff IM, Petrovich Brennan NM, Peck KK, Hou BL, Tabar V, Brennan CW, Holodny AI. Assessment of the language laterality index in patients with brain tumor using functional MR imaging: effects of thresholding, task selection, and prior surgery. AJNR Am J Neuroradiol 2008; 29:528-35. [PMID: 18184849 DOI: 10.3174/ajnr.a0841] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Functional MR imaging (fMRI) is used to determine preoperatively the laterality of cortical language representation along with the relationship of language areas to adjacent brain tumors. The purpose of this study was to determine whether changing the statistical threshold for different language tasks influences the language laterality index (LI) for a group of controls, patients with tumor without prior surgery, and patients with tumor and prior surgery. MATERIALS AND METHODS Seven controls, 9 patients with tumor without prior surgery, and 4 patients with tumor and prior surgery performed verb-generation, phonemic fluency, and semantic fluency language tasks during fMRI. Interhemispheric activation differences between the left and right Broca regions of interest were determined by calculating language LIs. LIs were compared within each group, between groups, and between language tasks. Intraoperative electrocortical mapping or the presence of aphasia during postoperative neurology examinations or both were used as ground truth. RESULTS The language LI varied as a result of statistical thresholding, presence of tumor, prior surgery, and language task. Although patients and controls followed a similar shape in the LI curve, there was no optimal P value for determining the LI. Three patients demonstrated a shift in the LI between hemispheres as a function of statistical threshold. Verb generation was the least variable task both between tasks and across groups. CONCLUSION For preoperative patients with tumor, the LI should be examined across a spectrum of P values and a range of tasks to ensure reliability. Our data suggest that the LI may be threshold- and task-dependent, particularly in the presence of adjacent tumor.
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Affiliation(s)
- I M Ruff
- Northwestern University Feinberg School of Medicine, Chicago, Ill., USA
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18
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Smits M, Visch-Brink E, Schraa-Tam CK, Koudstaal PJ, van der Lugt A. Functional MR imaging of language processing: an overview of easy-to-implement paradigms for patient care and clinical research. Radiographics 2007; 26 Suppl 1:S145-58. [PMID: 17050512 DOI: 10.1148/rg.26si065507] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Functional magnetic resonance (MR) imaging is one of the most commonly used functional neuroimaging techniques for studying the cerebral representation of language processing and is increasingly being used for both patient care and clinical research. In patient care, functional MR imaging is primarily used in the preoperative evaluation of (a) the relationship of a lesion to critical language areas and (b) hemispheric dominance. In clinical research, this modality is used to study language disorders due to neurologic disease and is generally aimed at language function recovery. A variety of language paradigms (verbal fluency, passive listening, comprehension) have been developed for the study of language processing and its separate components. All of the tasks are easy to implement, analyze, and perform. Silent gap acquisition is preferable for the imaging of specific language processing components because auditory stimuli are not degraded by imager noise. On the other hand, continuous acquisition allows more data to be acquired in less time, thereby increasing statistical power and decreasing the effects of motion artifacts. Although functional MR imaging cannot yet replace intraoperative electrocortical stimulation in patients undergoing neurosurgery, it may be useful for guiding surgical planning and mapping, thereby reducing the extent and duration of craniotomy.
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Affiliation(s)
- Marion Smits
- Department of Radiology, Erasmus MC-University Medical Center Rotterdam, Dr Molewaterplein 40, 3015 GD Rotterdam, the Netherlands.
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Evans ES, Hahn CA, Kocak Z, Zhou SM, Marks LB. The Role of Functional Imaging in the Diagnosis and Management of Late Normal Tissue Injury. Semin Radiat Oncol 2007; 17:72-80. [PMID: 17395037 DOI: 10.1016/j.semradonc.2006.11.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Normal tissue injury after radiation therapy (RT) can be defined based on either clinical symptoms or laboratory/radiologic tests. In the research setting, functional imaging (eg, single-photon emission computed tomography [SPECT], positron-emission tomography [PET], and magnetic resonance imaging [MRI]) is useful because it provides objective quantitative data such as metabolic activity, perfusion, and soft-tissue contrast within tissues and organs. For RT-induced lung, heart, and parotid gland injury, pre- and post-RT SPECT images can be compared with the dose- and volume-dependent nature of regional injury. In the brain, SPECT can detect changes in perfusion and blood flow post-RT, and PET can detect metabolic changes, particularly to regions of the brain that have received doses above 40 to 50 Gy. On MRI, changes in contrast-enhanced images, T(1) and T(2) relaxation times, and pulmonary vascular resistance at different intervals pre- and post-RT show its ability to detect and distinguish different phases of radiation pneumonitis. Similarly, conventional and diffusion-weighted MRI can be used to differentiate between normal tissue edema, necrosis, and tumor in the irradiated brain, and magnetic resonance spectroscopy can measure changes in compounds, indicative of membrane and neuron disruption. The use of functional imaging is a powerful tool for early detection of RT-induced normal tissue injury, which may be related to long-term clinically significant injury.
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Affiliation(s)
- Elizabeth S Evans
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
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Hakyemez B, Erdogan C, Yildirim N, Bora I, Bekar A, Parlak M. Functional MRI in Patients with Intracranial Lesions near Language Areas. Neuroradiol J 2006; 19:306-12. [PMID: 24351215 DOI: 10.1177/197140090601900306] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2006] [Accepted: 05/11/2006] [Indexed: 11/16/2022] Open
Abstract
We aimed to depict Broca's area and Wernicke's area by word generation and sentence formation paradigms in patients with various intracranial lesions adjacent to language areas using functional MRI technique and to evaluate the ability of functional MRI to lateralize the hemispheric dominance for language. Twenty-three right-handed patients were included in this study. Lesions were classified as low-grade glioma (n=8), high-grade glioma (n=9), metastasis (n=1), meningioma (n=1), arteriovenous malformation (n=2) and mesial temporal sclerosis (n=2). We performed blood-oxygenated-level-dependant functional MRI using a 1.5-T unit. Word generation and sentence formation tasks were used to activate language areas. Language areas were defined as Brodmann 44, 45 (Broca's area) and Brodmann 22 area (Wernicke's area). Laterality index was used to show the dominant hemisphere. Two poorly cooperative patients showed no activation and were excluded from the study. Broca's area was localized in 21 patients (100 %). Wernicke's area, on the other hand, could only be localized in eight of the 21 patients (38 %).The left hemisphere was dominant in 86% of patients while atypical language lateralization (right or bilateral) was demonstrated in 14% of the patients. Bilateral activation areas were shown in 10% of those patients while right cerebral hemisphere was dominant in 4% of the patients. Word generation and sentence formation tasks are especially helpful in localizing Broca's area. Wernicke's area could also be demonstrated in some of the cases. Functional MRI can be used as an important and useful means of demonstrating language areas in patients with lesions adjacent to those areas and depicting the hemispheric dominance.
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Affiliation(s)
- B Hakyemez
- Department of Radiology, Uludag University Medical School; Department of Radiology, Bursa State Hospital; Bursa, Turkey -
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21
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Olsen KI, Schroeder P, Corby R, Vucic I, Bardo DME. Advanced magnetic resonance imaging techniques to evaluate CNS glioma. Expert Rev Neurother 2005; 5:S3-11. [PMID: 16274265 DOI: 10.1586/14737175.5.6.s3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
To make full use of the benefits of magnetic resonance imaging (MRI) in the evaluation of intracranial glioma, a variety of advanced MRI and qualitative and quantitative techniques can be added to the radiologists' diagnostic armamentarium, beyond the standard contrast-enhanced images. These techniques include perfusion MRI, which is useful in the characterization of glioma because a relative quantification of cerebral microcirculatory parameters may be estimated; magnetic resonance spectroscopy, which can provide an estimate of the concentration of normal and abnormal metabolites in the brain and, when supplemented with magnetic resonance perfusion data, can be a useful tool for distinguishing between tumor recurrence and radiation necrosis; and diffusion tensor imaging, which combines physiologic behaviors unique to the cytoarchitecture of brain cells and the interstitial tissues with 2D and 3D anatomic magnetic resonance images, and thereby differentiates intact white matter tracts, displaced by tumor or surrounding edema, from invasion or disruption by a more aggressive neoplasm.
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Affiliation(s)
- Kristina I Olsen
- Department of Neuroradiology, The University of Chicago, 5841 S. Maryland Ave., MC 2026, Chicago, IL 60637, USA.
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Abstract
Once limited to structural imaging modalities such as CT and MRI,radiographic evaluation of the psychiatric patient now includes more sophisticated functional techniques such as fMRI, MR spectroscopy, and PET. With the increased sensitivity that these new tools bring comes greater complexity. As new imaging techniques continue to transition from research to clinical application, the imaging options and associated complexity will increase. Consultation with neuroradiology colleagues will allow the practicing psychiatrist to evaluate their patients optimally. These techniques will continue to provide insight into the pathophysiology, etiology, diagnosis, treatment, and prognosis of these patients.
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Affiliation(s)
- Daniel F Broderick
- Mayo Clinic College of Medicine, Mayo Clinic, Jacksonville, FL 32224, USA.
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Duffau H. Lessons from brain mapping in surgery for low-grade glioma: insights into associations between tumour and brain plasticity. Lancet Neurol 2005; 4:476-86. [PMID: 16033690 DOI: 10.1016/s1474-4422(05)70140-x] [Citation(s) in RCA: 441] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Surgical treatment of low-grade gliomas (LGGs) aims to maximise the amount of tumour tissue resected, while minimising the risk of functional sequelae. In this review I address the issue of how to reconcile these two conflicting goals. First, I review the natural history of LGG-growth, invasion, and anaplastic transformation. Second, I discuss the contribution of new techniques, such as functional mapping, to our understanding of brain reorganisation in response to progressive growth of LGG. Third, I consider the clinical implications of interactions between tumour progression and brain plasticity. In particular, I show how longitudinal studies (preoperative, intraoperative, and postoperative) could allow us to optimise the surgical risk-to-benefit ratios. I will also discuss controversial issues such as defining surgical indications for LGGs, predicting the risk of postoperative deficit, aspects of operative surgical neuro-oncology (eg, preoperative planning and preservation of functional areas and tracts), and postoperative functional recovery.
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Affiliation(s)
- Hugues Duffau
- Department of Neurosurgery, INSERM U678, Hôpital Salpêtrière, Paris, France.
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Petrovich N, Holodny AI, Tabar V, Correa DD, Hirsch J, Gutin PH, Brennan CW. Discordance between functional magnetic resonance imaging during silent speech tasks and intraoperative speech arrest. J Neurosurg 2005; 103:267-74. [PMID: 16175856 DOI: 10.3171/jns.2005.103.2.0267] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object. The goal of this study was to investigate discordance between the location of speech arrest during awake cortical mapping, a common intraoperative indicator of hemispheric dominance, and silent speech functional magnetic resonance (fMR) imaging maps of frontal language function.
Methods. Twenty-one cases were reviewed retrospectively. Images of silent speech fMR imaging activation were coregistered to anatomical MR images obtained for neuronavigation. These were compared with the intraoperative cortical photographs and the behavioral results of electrocorticography during awake craniotomy. An fMR imaging control study of three healthy volunteers was then conducted to characterize the differences between silent and vocalized speech fMR imaging protocols used for neurosurgical planning.
Conclusions. Results of fMR imaging showed consistent and predominant activation of the inferior frontal gyrus (IFG) during silent speech tasks. During intraoperative mapping, however, 16 patients arrested in the precentral gyrus (PRG), well posterior to the fMR imaging activity. Of those 16, 14 arrested only in the PRG and not in the IFG as silent speech fMR imaging predicted. The control fMR imaging study showed that vocalized speech fMR imaging shifts the location of the fMR imaging prediction to include the motor strip and may be more appropriate for neurosurgical planning.
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Affiliation(s)
- Nicole Petrovich
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA
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Abstract
This paper discusses the modern neurosurgeon's use of advanced magnetic resonance imaging in pre-operative and perioperative planning. The effect of advanced imaging on the risk and benefit analysis of surgery is discussed in particular.
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Affiliation(s)
- John G Golfinos
- Department of Neurosurgery, NYU School of Medicine, New York, NY 10016, USA.
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