2
|
Fang S, Liang J, Qian T, Wang Y, Liu X, Fan X, Li S, Wang Y, Jiang T. Anatomic Location of Tumor Predicts the Accuracy of Motor Function Localization in Diffuse Lower-Grade Gliomas Involving the Hand Knob Area. AJNR Am J Neuroradiol 2017; 38:1990-1997. [PMID: 28838912 DOI: 10.3174/ajnr.a5342] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 06/04/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The accuracy of preoperative blood oxygen level-dependent fMRI remains controversial. This study assessed the association between the anatomic location of a tumor and the accuracy of fMRI-based motor function mapping in diffuse lower-grade gliomas. MATERIALS AND METHODS Thirty-five patients with lower-grade gliomas involving motor areas underwent preoperative blood oxygen level-dependent fMRI scans with grasping tasks and received intraoperative direct cortical stimulation. Patients were classified into an overlapping group and a nonoverlapping group, depending on the extent to which blood oxygen level-dependent fMRI and direct cortical stimulation results concurred. Tumor location was quantitatively measured, including the shortest distance from the tumor to the hand knob and the deviation distance of the midpoint of the hand knob in the lesion hemisphere relative to the midline compared with the normal contralateral hemisphere. RESULTS A 4-mm shortest distance from the tumor to the hand knob value was identified as optimal for differentiating the overlapping and nonoverlapping group with the receiver operating characteristic curve (sensitivity, 84.6%; specificity, 77.8%). The shortest distances from the tumor to the hand knob of ≤4 mm were associated with inaccurate fMRI-based localizations of the hand motor cortex. The shortest distances from the tumor to the hand knob were larger (P = .002), and the deviation distances for the midpoint of the hand knob in the lesion hemisphere were smaller (P = .003) in the overlapping group than in the nonoverlapping group. CONCLUSIONS This study suggests that the shortest distance from the tumor to the hand knob and the deviation distance for the midpoint of the hand knob on the lesion hemisphere are predictive of the accuracy of blood oxygen level-dependent fMRI results. Smaller shortest distances from the tumor to the hand knob and larger deviation distances for the midpoint of hand knob on the lesion hemisphere are associated with less accuracy of motor cortex localization with blood oxygen level-dependent fMRI. Preoperative fMRI data for surgical planning should be used cautiously when the shortest distance from the tumor to the hand knob is ≤4 mm, especially for lower-grade gliomas anterior to the central sulcus.
Collapse
Affiliation(s)
- S Fang
- From the Department of Neurosurgery (S.F., Y.W., T.J.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Neurosurgical Institute (S.F., J.L., Y.W., X.L., X.F., Y.W., T.J.), Capital Medical University, Beijing, China
| | - J Liang
- Beijing Neurosurgical Institute (S.F., J.L., Y.W., X.L., X.F., Y.W., T.J.), Capital Medical University, Beijing, China
| | - T Qian
- MR Collaborations NE Asia (T.Q.), Siemens Healthcare, Beijing, China
| | - Y Wang
- From the Department of Neurosurgery (S.F., Y.W., T.J.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Neurosurgical Institute (S.F., J.L., Y.W., X.L., X.F., Y.W., T.J.), Capital Medical University, Beijing, China
| | - X Liu
- Beijing Neurosurgical Institute (S.F., J.L., Y.W., X.L., X.F., Y.W., T.J.), Capital Medical University, Beijing, China
| | - X Fan
- Beijing Neurosurgical Institute (S.F., J.L., Y.W., X.L., X.F., Y.W., T.J.), Capital Medical University, Beijing, China
| | - S Li
- Functional Neuroradiology Center (S.L.), Beijing Neurosurgical Institute, Beijing, China
| | - Y Wang
- Beijing Neurosurgical Institute (S.F., J.L., Y.W., X.L., X.F., Y.W., T.J.), Capital Medical University, Beijing, China
| | - T Jiang
- From the Department of Neurosurgery (S.F., Y.W., T.J.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China .,Beijing Neurosurgical Institute (S.F., J.L., Y.W., X.L., X.F., Y.W., T.J.), Capital Medical University, Beijing, China.,Beijing Institute for Brain Disorders Brain Tumor Center (T.J.), Beijing, China
| |
Collapse
|
3
|
Choudhri AF, Patel RM, Siddiqui A, Whitehead MT, Wheless JW. Cortical Activation Through Passive-Motion Functional MRI. AJNR Am J Neuroradiol 2015; 36:1675-81. [PMID: 26228890 DOI: 10.3174/ajnr.a4345] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 02/13/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE Functional brain mapping is an important technique for neurosurgical planning, particularly for patients with tumors or epilepsy; however, mapping has traditionally involved invasive techniques. Existing noninvasive techniques require patient compliance and may not be suitable for young children. We performed a retrospective review of our experience with passive-motion functional MR imaging in anesthetized patients to determine the diagnostic yield of this technique. MATERIALS AND METHODS A retrospective review of patients undergoing passive-motion fMRI under general anesthesia at a single institution over a 2.5-year period was performed. Clinical records were evaluated to determine the indication for fMRI, the ability to detect cortical activation, and, if present, the location of cortical activation. RESULTS We identified 62 studies in 56 patients in this time period. The most common indication for fMRI was epilepsy/seizures. Passive-motion fMRI identified upper-extremity cortical activation in 105 of 119 (88%) limbs evaluated, of which 90 (86%) activations were in an orthotopic location. Lower-extremity cortical activation was identified in 86 of 118 (73%) limbs evaluated, of which 73 (85%) activations were in an orthotopic location. CONCLUSIONS Passive-motion fMRI was successful in identifying cortical activation in most of the patients. This tool can be implemented easily and can aid in surgical planning for children with tumors or candidates for epilepsy surgery, particularly those who may be too young to comply with existing noninvasive functional measures.
Collapse
Affiliation(s)
- A F Choudhri
- From the Departments of Radiology (A.F.C., A.S., M.T.W.) Neurosurgery (A.F.C.) Le Bonheur Neuroscience Institute (A.F.C., A.S., M.T.W., J.W.W.), Le Bonheur Children's Hospital, Memphis, Tennessee
| | - R M Patel
- College of Medicine (R.M.P.), University of Tennessee Health Science Center, Memphis, Tennessee
| | - A Siddiqui
- From the Departments of Radiology (A.F.C., A.S., M.T.W.) Le Bonheur Neuroscience Institute (A.F.C., A.S., M.T.W., J.W.W.), Le Bonheur Children's Hospital, Memphis, Tennessee
| | - M T Whitehead
- From the Departments of Radiology (A.F.C., A.S., M.T.W.) Le Bonheur Neuroscience Institute (A.F.C., A.S., M.T.W., J.W.W.), Le Bonheur Children's Hospital, Memphis, Tennessee Department of Radiology (M.T.W.), Children's National Medical Center, Washington, DC
| | - J W Wheless
- Pediatrics (J.W.W.) Le Bonheur Neuroscience Institute (A.F.C., A.S., M.T.W., J.W.W.), Le Bonheur Children's Hospital, Memphis, Tennessee
| |
Collapse
|
4
|
Gabriel M, Brennan NP, Peck KK, Holodny AI. Blood oxygen level dependent functional magnetic resonance imaging for presurgical planning. Neuroimaging Clin N Am 2014; 24:557-71. [PMID: 25441500 DOI: 10.1016/j.nic.2014.07.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Functional magnetic resonance imaging (fMRI) has become a common tool for presurgical sensorimotor mapping, and is a significant preoperative asset for tumors located adjacent to the central sulcus. fMRI has changed surgical options for many patients. This noninvasive tool allows for easy display and integration with other neuroimaging techniques. Although fMRI is a useful preoperative tool, it is not perfect. Tumors that affect the normal vascular coupling of neuronal activity will affect fMRI measurements. This article discusses the usefulness of blood oxygen level dependent (BOLD) fMRI with regard to preoperative motor mapping.
Collapse
Affiliation(s)
- Meredith Gabriel
- Functional MRI Laboratory, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Nicole P Brennan
- Functional MRI Laboratory, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Kyung K Peck
- Functional MRI Laboratory, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Andrei I Holodny
- Functional MRI Laboratory, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
| |
Collapse
|
6
|
Orringer DA, Golby A, Jolesz F. Neuronavigation in the surgical management of brain tumors: current and future trends. Expert Rev Med Devices 2013; 9:491-500. [PMID: 23116076 DOI: 10.1586/erd.12.42] [Citation(s) in RCA: 142] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Neuronavigation has become an ubiquitous tool in the surgical management of brain tumors. This review describes the use and limitations of current neuronavigational systems for brain tumor biopsy and resection. Methods for integrating intraoperative imaging into neuronavigational datasets developed to address the diminishing accuracy of positional information that occurs over the course of brain tumor resection are discussed. In addition, the process of integration of functional MRI and tractography into navigational models is reviewed. Finally, emerging concepts and future challenges relating to the development and implementation of experimental imaging technologies in the navigational environment are explored.
Collapse
Affiliation(s)
- Daniel A Orringer
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | | | | |
Collapse
|
7
|
Pillai JJ, Zaca D, Choudhri A. Clinical impact of integrated physiologic brain tumor imaging. Technol Cancer Res Treat 2010; 9:359-80. [PMID: 20626202 DOI: 10.1177/153303461000900406] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The development of new MRI techniques in the last two decades has provided neuroradiologists and neurosurgeons with additional noninvasive imaging tools for management and treatment of brain tumors. When coupled with standard structural MR sequences in imaging brain tumors, Blood Oxygenation Level Dependent (BOLD) functional MRI (fMRI), Perfusion Weighted Imaging (PWI) and Diffusion Tensor Imaging (DTI) provide additional physiologic information that is very useful for differential diagnosis, presurgical planning and prognosis. In this review after a brief technical description of BOLD fMRI, PWI and DTI, studies are described from the literature that have extensively validated these imaging techniques in comparison with invasive "gold standard" techniques such as intraoperative electrical cortical and subcortical stimulation mapping or biopsy. Additional studies are mentioned that demonstrate the positive impact of BOLD fMRI, PWI and DTI on brain tumor treatment and clinical outcome. In the final section an interesting clinical case treated at our institution is presented that highlights the clinical utility of this integrated physiologic brain tumor imaging approach.
Collapse
Affiliation(s)
- Jay J Pillai
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Univ. School of Medicine, Baltimore, MD 21287, USA.
| | | | | |
Collapse
|
8
|
Pillai JJ. The evolution of clinical functional imaging during the past 2 decades and its current impact on neurosurgical planning. AJNR Am J Neuroradiol 2010; 31:219-25. [PMID: 20150316 DOI: 10.3174/ajnr.a1845] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BOLD fMRI has, during the past decade, made a major transition from a purely research imaging technique to a viable clinical technique used primarily for presurgical planning in patients with brain tumors and other resectable brain lesions. This review article briefly examines the history and evolution of clinical functional imaging, with particular emphasis on how the use of BOLD fMRI for neurosurgical planning has changed during the past 2 decades. Even more important, this article describes the many published studies during that same period that have examined the overall clinical impact that BOLD and DTI have made on surgical planning.
Collapse
Affiliation(s)
- J J Pillai
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.
| |
Collapse
|