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Dhakal K, Rosenthal ES, Kulpanowski AM, Dodelson JA, Wang Z, Cudemus-Deseda G, Villien M, Edlow BL, Presciutti AM, Januzzi JL, Ning M, Taylor Kimberly W, Amorim E, Brandon Westover M, Copen WA, Schaefer PW, Giacino JT, Greer DM, Wu O. Increased task-relevant fMRI responsiveness in comatose cardiac arrest patients is associated with improved neurologic outcomes. J Cereb Blood Flow Metab 2024; 44:50-65. [PMID: 37728641 PMCID: PMC10905635 DOI: 10.1177/0271678x231197392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 09/21/2023]
Abstract
Early prediction of the recovery of consciousness in comatose cardiac arrest patients remains challenging. We prospectively studied task-relevant fMRI responses in 19 comatose cardiac arrest patients and five healthy controls to assess the fMRI's utility for neuroprognostication. Tasks involved instrumental music listening, forward and backward language listening, and motor imagery. Task-specific reference images were created from group-level fMRI responses from the healthy controls. Dice scores measured the overlap of individual subject-level fMRI responses with the reference images. Task-relevant responsiveness index (Rindex) was calculated as the maximum Dice score across the four tasks. Correlation analyses showed that increased Dice scores were significantly associated with arousal recovery (P < 0.05) and emergence from the minimally conscious state (EMCS) by one year (P < 0.001) for all tasks except motor imagery. Greater Rindex was significantly correlated with improved arousal recovery (P = 0.002) and consciousness (P = 0.001). For patients who survived to discharge (n = 6), the Rindex's sensitivity was 75% for predicting EMCS (n = 4). Task-based fMRI holds promise for detecting covert consciousness in comatose cardiac arrest patients, but further studies are needed to confirm these findings. Caution is necessary when interpreting the absence of task-relevant fMRI responses as a surrogate for inevitable poor neurological prognosis.
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Affiliation(s)
- Kiran Dhakal
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Eric S Rosenthal
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Annelise M Kulpanowski
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Jacob A Dodelson
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Zihao Wang
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Gaston Cudemus-Deseda
- Department of Cardiac Anesthesiology and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Marjorie Villien
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Brian L Edlow
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Alexander M Presciutti
- Department of Psychiatry, Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital, Boston, MA, USA
| | - James L Januzzi
- Department of Medicine, Cardiology Division, Massachusetts General Hospital and Baim Institute for Clinical Research, Boston, MA, USA
| | - MingMing Ning
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - W Taylor Kimberly
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Edilberto Amorim
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | | | - William A Copen
- Department of Radiology, Neuroradiology Division, Massachusetts General Hospital, Boston, MA, USA
| | - Pamela W Schaefer
- Department of Radiology, Neuroradiology Division, Massachusetts General Hospital, Boston, MA, USA
| | - Joseph T Giacino
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, MA, USA
| | - David M Greer
- Department of Neurology, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Ona Wu
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
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2
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Abstract
Advanced neuroimaging techniques are increasingly being implemented in clinical practice as complementary tools to conventional imaging because they can provide crucial functional information about the pathophysiology of a variety of disorders. Therefore, it is important to understand the basic principles underlying them and their role in diagnosis and management. In this review, we will primarily focus on the basic principles and clinical applications of perfusion imaging, diffusion imaging, magnetic resonance spectroscopy, functional MRI, and dual-energy computerized tomography. Our goal is to provide the reader with a basic understanding of these imaging techniques and when they should be used in clinical practice.
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3
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Agarwal S, Hua J, Sair HI, Gujar S, Bettegowda C, Lu H, Pillai JJ. Repeatability of language fMRI lateralization and localization metrics in brain tumor patients. Hum Brain Mapp 2018; 39:4733-4742. [PMID: 30076768 PMCID: PMC6218318 DOI: 10.1002/hbm.24318] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 06/29/2018] [Accepted: 07/05/2018] [Indexed: 11/12/2022] Open
Abstract
To assess the within-subject intra-scan session repeatability of language functional MRI (fMRI) activation maps in patients with brain tumors who were undergoing presurgical fMRI as part of their preoperative clinical workup. Sentence completion (SC) and silent word generation (SWG) tasks were used for language localization and hemispheric lateralization for identifying the primary language cortex. Within-subject repeatability for each of these paradigms was assessed in right-handed patients-37 for SC and 78 for SWG. Repeatability of activation maps between consecutive runs of the same task within the same scan session was evaluated by comparing lateralization indexes in holohemispheric and regional language areas. Displacement of center of activation between consecutive runs was also used to assess the repeatability of activation maps. Holohemispheric and regional language lateralization results demonstrated high intra-subject intra-scan repeatability when lateralization indices were calculated using threshold-dependent and threshold-independent approaches. The high repeatability is demonstrated both when centers of mass of activation are considered within key eloquent regions of the brain, such as Broca's area and Wernicke's area, as well as in larger more inclusive expressive and receptive language regions. We examined two well-known and widely accepted language tasks that are known to activate eloquent language cortex. We have demonstrated very high degree of repeatability at a single-subject level within single scan sessions of language mapping in a large cohort of brain tumor patients undergoing presurgical fMRI across several years at our institution.
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Affiliation(s)
- Shruti Agarwal
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological ScienceJohns Hopkins University School of MedicineBaltimoreMaryland
| | - Jun Hua
- Division of MR Research, Russell H. Morgan Department of Radiology and Radiological ScienceJohns Hopkins University School of MedicineBaltimoreMaryland
- F. M. Kirby Research Center For Functional Brain ImagingKennedy Krieger InstituteBaltimoreMaryland
| | - Haris I. Sair
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological ScienceJohns Hopkins University School of MedicineBaltimoreMaryland
| | - Sachin Gujar
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological ScienceJohns Hopkins University School of MedicineBaltimoreMaryland
| | - Chetan Bettegowda
- Department of NeurosurgeryJohns Hopkins University School of MedicineBaltimoreMaryland
| | - Hanzhang Lu
- Division of MR Research, Russell H. Morgan Department of Radiology and Radiological ScienceJohns Hopkins University School of MedicineBaltimoreMaryland
- F. M. Kirby Research Center For Functional Brain ImagingKennedy Krieger InstituteBaltimoreMaryland
| | - Jay J. Pillai
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological ScienceJohns Hopkins University School of MedicineBaltimoreMaryland
- Department of NeurosurgeryJohns Hopkins University School of MedicineBaltimoreMaryland
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4
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Rath J, Wurnig M, Fischmeister F, Klinger N, Höllinger I, Geißler A, Aichhorn M, Foki T, Kronbichler M, Nickel J, Siedentopf C, Staffen W, Verius M, Golaszewski S, Koppelstaetter F, Auff E, Felber S, Seitz RJ, Beisteiner R. Between- and within-site variability of fMRI localizations. Hum Brain Mapp 2016; 37:2151-60. [PMID: 26955899 DOI: 10.1002/hbm.23162] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 12/12/2015] [Accepted: 02/17/2016] [Indexed: 11/11/2022] Open
Abstract
This study provides first data about the spatial variability of fMRI sensorimotor localizations when investigating the same subjects at different fMRI sites. Results are comparable to a previous patient study. We found a median between-site variability of about 6 mm independent of task (motor or sensory) and experimental standardization (high or low). An intraclass correlation coefficient analysis using data quality measures indicated a major influence of the fMRI site on variability. In accordance with this, within-site localization variability was considerably lower (about 3 mm). We conclude that the fMRI site is a considerable confound for localization of brain activity. However, when performed by experienced clinical fMRI experts, brain pathology does not seem to have a relevant impact on the reliability of fMRI localizations. Hum Brain Mapp 37:2151-2160, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Jakob Rath
- Department of Neurology and MR Center of Excellence, Medical University of Vienna, Austria
| | - Moritz Wurnig
- Department of Neurology and MR Center of Excellence, Medical University of Vienna, Austria
| | - Florian Fischmeister
- Department of Neurology and MR Center of Excellence, Medical University of Vienna, Austria
| | - Nicolaus Klinger
- Department of Neurology and MR Center of Excellence, Medical University of Vienna, Austria
| | - Ilse Höllinger
- Department of Neurology and MR Center of Excellence, Medical University of Vienna, Austria
| | - Alexander Geißler
- Department of Neurology and MR Center of Excellence, Medical University of Vienna, Austria
| | - Markus Aichhorn
- Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria
| | - Thomas Foki
- Department of Neurology and MR Center of Excellence, Medical University of Vienna, Austria
| | - Martin Kronbichler
- Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria.,Neuroscience Institute, Christian-Doppler-Clinic, Paracelsus Medical University, Salzburg, Austria
| | - Janpeter Nickel
- Department of Neurology, University Hospital Düsseldorf, Germany
| | | | - Wolfgang Staffen
- Department of Neurology, Christian-Doppler-Clinic, Paracelsus Medical University, Salzburg, Austria
| | - Michael Verius
- Department of Radiology, Medical University of Innsbruck, Austria
| | - Stefan Golaszewski
- Department of Neurology, Christian-Doppler-Clinic, Paracelsus Medical University, Salzburg, Austria
| | | | - Eduard Auff
- Department of Neurology, Medical University of Vienna, Austria
| | - Stephan Felber
- Institute for Diagnostic Radiology, Stiftungsklinikum Mittelrhein, Koblenz, Germany
| | - Rüdiger J Seitz
- Department of Neurology, University Hospital Düsseldorf, Germany.,Centre of Neurology and Neuropsychiatry, Heinrich-Heine-University Düsseldorf, LVR-Klinikum Düsseldorf, Germany
| | - Roland Beisteiner
- Department of Neurology and MR Center of Excellence, Medical University of Vienna, Austria
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5
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Morrison MA, Churchill NW, Cusimano MD, Schweizer TA, Das S, Graham SJ. Reliability of Task-Based fMRI for Preoperative Planning: A Test-Retest Study in Brain Tumor Patients and Healthy Controls. PLoS One 2016; 11:e0149547. [PMID: 26894279 PMCID: PMC4760755 DOI: 10.1371/journal.pone.0149547] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 02/02/2016] [Indexed: 11/25/2022] Open
Abstract
Background Functional magnetic resonance imaging (fMRI) continues to develop as a clinical tool for patients with brain cancer, offering data that may directly influence surgical decisions. Unfortunately, routine integration of preoperative fMRI has been limited by concerns about reliability. Many pertinent studies have been undertaken involving healthy controls, but work involving brain tumor patients has been limited. To develop fMRI fully as a clinical tool, it will be critical to examine these reliability issues among patients with brain tumors. The present work is the first to extensively characterize differences in activation map quality between brain tumor patients and healthy controls, including the effects of tumor grade and the chosen behavioral testing paradigm on reliability outcomes. Method Test-retest data were collected for a group of low-grade (n = 6) and high-grade glioma (n = 6) patients, and for matched healthy controls (n = 12), who performed motor and language tasks during a single fMRI session. Reliability was characterized by the spatial overlap and displacement of brain activity clusters, BOLD signal stability, and the laterality index. Significance testing was performed to assess differences in reliability between the patients and controls, and low-grade and high-grade patients; as well as between different fMRI testing paradigms. Results There were few significant differences in fMRI reliability measures between patients and controls. Reliability was significantly lower when comparing high-grade tumor patients to controls, or to low-grade tumor patients. The motor task produced more reliable activation patterns than the language tasks, as did the rhyming task in comparison to the phonemic fluency task. Conclusion In low-grade glioma patients, fMRI data are as reliable as healthy control subjects. For high-grade glioma patients, further investigation is required to determine the underlying causes of reduced reliability. To maximize reliability outcomes, testing paradigms should be carefully selected to generate robust activation patterns.
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Affiliation(s)
- Melanie A. Morrison
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- * E-mail:
| | | | - Michael D. Cusimano
- Keenan Research Centre, St. Michael's Hospital, Toronto, ON, Canada
- Division of Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Tom A. Schweizer
- Keenan Research Centre, St. Michael's Hospital, Toronto, ON, Canada
- Division of Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Sunit Das
- Keenan Research Centre, St. Michael's Hospital, Toronto, ON, Canada
- Division of Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Simon J. Graham
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
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6
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Gee DG, McEwen SC, Forsyth JK, Haut KM, Bearden CE, Addington J, Goodyear B, Cadenhead KS, Mirzakhanian H, Cornblatt BA, Olvet D, Mathalon DH, McGlashan TH, Perkins DO, Belger A, Seidman LJ, Thermenos H, Tsuang MT, van Erp TGM, Walker EF, Hamann S, Woods SW, Constable T, Cannon TD. Reliability of an fMRI paradigm for emotional processing in a multisite longitudinal study. Hum Brain Mapp 2015; 36:2558-79. [PMID: 25821147 DOI: 10.1002/hbm.22791] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 03/03/2015] [Accepted: 03/06/2015] [Indexed: 12/14/2022] Open
Abstract
Multisite neuroimaging studies can facilitate the investigation of brain-related changes in many contexts, including patient groups that are relatively rare in the general population. Though multisite studies have characterized the reliability of brain activation during working memory and motor functional magnetic resonance imaging tasks, emotion processing tasks, pertinent to many clinical populations, remain less explored. A traveling participants study was conducted with eight healthy volunteers scanned twice on consecutive days at each of the eight North American Longitudinal Prodrome Study sites. Tests derived from generalizability theory showed excellent reliability in the amygdala ( Eρ2 = 0.82), inferior frontal gyrus (IFG; Eρ2 = 0.83), anterior cingulate cortex (ACC; Eρ2 = 0.76), insula ( Eρ2 = 0.85), and fusiform gyrus ( Eρ2 = 0.91) for maximum activation and fair to excellent reliability in the amygdala ( Eρ2 = 0.44), IFG ( Eρ2 = 0.48), ACC ( Eρ2 = 0.55), insula ( Eρ2 = 0.42), and fusiform gyrus ( Eρ2 = 0.83) for mean activation across sites and test days. For the amygdala, habituation ( Eρ2 = 0.71) was more stable than mean activation. In a second investigation, data from 111 healthy individuals across sites were aggregated in a voxelwise, quantitative meta-analysis. When compared with a mixed effects model controlling for site, both approaches identified robust activation in regions consistent with expected results based on prior single-site research. Overall, regions central to emotion processing showed strong reliability in the traveling participants study and robust activation in the aggregation study. These results support the reliability of blood oxygen level-dependent signal in emotion processing areas across different sites and scanners and may inform future efforts to increase efficiency and enhance knowledge of rare conditions in the population through multisite neuroimaging paradigms.
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Affiliation(s)
- Dylan G Gee
- Departments of Psychology and Psychiatry, University of California, Los Angeles, California
| | - Sarah C McEwen
- Departments of Psychology and Psychiatry, University of California, Los Angeles, California
| | - Jennifer K Forsyth
- Departments of Psychology and Psychiatry, University of California, Los Angeles, California
| | - Kristen M Haut
- Department of Psychology, Yale University, New Haven, Connecticut
| | - Carrie E Bearden
- Departments of Psychology and Psychiatry, University of California, Los Angeles, California
| | - Jean Addington
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Bradley Goodyear
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Kristin S Cadenhead
- Department of Psychiatry, University of California, San Diego, La Jolla, California
| | - Heline Mirzakhanian
- Department of Psychiatry, University of California, San Diego, La Jolla, California
| | - Barbara A Cornblatt
- Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York
| | - Doreen Olvet
- Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York
| | - Daniel H Mathalon
- Department of Psychiatry, University of California, San Francisco, California
| | | | - Diana O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina
| | - Aysenil Belger
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina
| | - Larry J Seidman
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Heidi Thermenos
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ming T Tsuang
- Department of Psychiatry, University of California, San Diego, La Jolla, California
| | - Theo G M van Erp
- Department of Psychiatry and Human Behavior, University of California, Irvine, California
| | - Elaine F Walker
- Department of Psychology, Emory University, Atlanta, Georgia
| | - Stephan Hamann
- Department of Psychology, Emory University, Atlanta, Georgia
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, Connecticut
| | - Todd Constable
- Department of Psychiatry, Yale University, New Haven, Connecticut
| | - Tyrone D Cannon
- Department of Psychology, Yale University, New Haven, Connecticut.,Department of Psychiatry, Yale University, New Haven, Connecticut
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7
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Foki T, Pirker W, Geißler A, Haubenberger D, Hilbert M, Hoellinger I, Wurnig M, Rath J, Lehrner J, Matt E, Fischmeister F, Trattnig S, Auff E, Beisteiner R. Finger dexterity deficits in Parkinson's disease and somatosensory cortical dysfunction. Parkinsonism Relat Disord 2015; 21:259-65. [DOI: 10.1016/j.parkreldis.2014.12.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 12/22/2014] [Accepted: 12/27/2014] [Indexed: 01/17/2023]
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8
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Milidonis X, Marshall I, Macleod MR, Sena ES. Magnetic resonance imaging in experimental stroke and comparison with histology: systematic review and meta-analysis. Stroke 2015; 46:843-51. [PMID: 25657177 DOI: 10.1161/strokeaha.114.007560] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Because the new era of preclinical stroke research demands improvements in validity and generalizability of findings, moving from single site to multicenter studies could be pivotal. However, the conduct of magnetic resonance imaging (MRI) in stroke remains ill-defined. We sought to assess the variability in the use of MRI for evaluating lesions post stroke and to examine the possibility as an alternative to gold standard histology for measuring the infarct size. METHODS We identified animal studies of ischemic stroke reporting lesion sizes using MRI. We assessed the degree of heterogeneity and reporting of scanning protocols, postprocessing methods, study design characteristics, and study quality. Studies performing histological evaluation of infarct size were further selected to compare with corresponding MRI using meta-regression. RESULTS Fifty-four articles undertaking a total of 78 different MRI scanning protocols met the inclusion criteria. T2-weighted imaging was most frequently used (83% of the studies), followed by diffusion-weighted imaging (43%). Reporting of the imaging parameters was adequate, but heterogeneity between studies was high. Twelve studies assessed the infarct size using both MRI and histology at corresponding time points, with T2-weighted imaging-based treatment effect having a significant positive correlation with histology (; P<0.001). CONCLUSIONS Guidelines for standardized use and reporting of MRI in preclinical stroke are urgently needed. T2-weighted imaging could be used as an effective in vivo alternative to histology for estimating treatment effects based on the extent of infarction; however, additional studies are needed to explore the effect of individual parameters.
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Affiliation(s)
- Xenios Milidonis
- From the Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Ian Marshall
- From the Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Malcolm R Macleod
- From the Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Emily S Sena
- From the Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, United Kingdom.
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9
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Geißler A, Matt E, Fischmeister F, Wurnig M, Dymerska B, Knosp E, Feucht M, Trattnig S, Auff E, Fitch WT, Robinson S, Beisteiner R. Differential functional benefits of ultra highfield MR systems within the language network. Neuroimage 2014; 103:163-170. [PMID: 25255049 PMCID: PMC4263528 DOI: 10.1016/j.neuroimage.2014.09.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 09/03/2014] [Accepted: 09/15/2014] [Indexed: 11/16/2022] Open
Abstract
Several investigations have shown limitations of fMRI reliability with the current standard field strengths. Improvement is expected from ultra highfield systems but studies on possible benefits for cognitive networks are lacking. Here we provide an initial investigation on a prominent and clinically highly-relevant cognitive function: language processing in individual brains. 26 patients evaluated for presurgical language localization were investigated with a standardized overt language fMRI paradigm on both 3T and 7T MR scanners. During data acquisition and analysis we made particular efforts to minimize effects not related to static magnetic field strength differences. Six measures relevant for functional activation showed a large dissociation between essential language network nodes: although in Wernicke's area 5/6 measures indicated a benefit of ultra highfield, in Broca's area no comparison was significant. The most important reason for this discrepancy was identified as being an increase in susceptibility-related artifacts in inferior frontal brain areas at ultra high field. We conclude that functional UHF benefits are evident, however these depend crucially on the brain region investigated and the ability to control local artifacts.
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Affiliation(s)
- A Geißler
- Study Group Clinical fMRI, Department of Neurology, Medical University of Vienna, Austria; High Field MR Center, Medical University of Vienna, Austria; Department of Neurology, Medical University of Vienna, Austria
| | - E Matt
- Study Group Clinical fMRI, Department of Neurology, Medical University of Vienna, Austria; High Field MR Center, Medical University of Vienna, Austria; Department of Neurology, Medical University of Vienna, Austria
| | - F Fischmeister
- Study Group Clinical fMRI, Department of Neurology, Medical University of Vienna, Austria; High Field MR Center, Medical University of Vienna, Austria; Department of Neurology, Medical University of Vienna, Austria
| | - M Wurnig
- Study Group Clinical fMRI, Department of Neurology, Medical University of Vienna, Austria; High Field MR Center, Medical University of Vienna, Austria; Department of Neurology, Medical University of Vienna, Austria
| | - B Dymerska
- High Field MR Center, Medical University of Vienna, Austria; Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - E Knosp
- Department of Neurosurgery, Medical University of Vienna, Austria
| | - M Feucht
- Department of Pediatrics, Medical University of Vienna, Austria
| | - S Trattnig
- High Field MR Center, Medical University of Vienna, Austria; Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - E Auff
- Department of Neurology, Medical University of Vienna, Austria
| | - W T Fitch
- Department of Cognitive Biology, University of Vienna, Vienna, Austria
| | - S Robinson
- High Field MR Center, Medical University of Vienna, Austria; Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - R Beisteiner
- Study Group Clinical fMRI, Department of Neurology, Medical University of Vienna, Austria; High Field MR Center, Medical University of Vienna, Austria; Department of Neurology, Medical University of Vienna, Austria.
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10
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Frey D, Schilt S, Strack V, Zdunczyk A, Rösler J, Niraula B, Vajkoczy P, Picht T. Navigated transcranial magnetic stimulation improves the treatment outcome in patients with brain tumors in motor eloquent locations. Neuro Oncol 2014; 16:1365-72. [PMID: 24923875 DOI: 10.1093/neuonc/nou110] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Neurological and oncological outcomes of motor eloquent brain-tumor patients depend upon the ability to localize functional areas and the respective proposed therapy. We set out to determine whether the use of navigated transcranial magnetic stimulation (nTMS) had an impact on treatment and outcome in patients with brain tumors in motor eloquent locations. METHODS We enrolled 250 consecutive patients and compared their functional and oncological outcomes to a matched pre-nTMS control group (n = 115). RESULTS nTMS mapping results disproved suspected involvement of primary motor cortex in 25.1% of cases, expanded surgical indication in 14.8%, and led to planning of more extensive resection in 35.2% of cases and more restrictive resection in 3.5%. In comparison with the control group, the rate of gross total resections increased significantly from 42% to 59% (P < .05). Progression-free-survival for low grade glioma was significantly better in the nTMS group at 22.4 months than in control group at 15.4 months (P < .05). Integration of nTMS led to a nonsignificant change of postoperative deficits from 8.5% in the control group to 6.1% in the nTMS group. CONCLUSIONS nTMS provides crucial data for preoperative planning and surgical resection of tumors involving essential motor areas. Expanding surgical indications and extent of resection based on nTMS enables more patients to undergo surgery and might lead to better neurological outcomes and higher survival rates in brain tumor patients. The impact of this study should go far beyond the neurosurgical community because it could fundamentally improve treatment and outcome, and its results will likely change clinical practice.
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Affiliation(s)
- Dietmar Frey
- Department of Neurosurgery, Charité University Medicine, Berlin, Germany
| | - Sarah Schilt
- Department of Neurosurgery, Charité University Medicine, Berlin, Germany
| | - Valérie Strack
- Department of Neurosurgery, Charité University Medicine, Berlin, Germany
| | - Anna Zdunczyk
- Department of Neurosurgery, Charité University Medicine, Berlin, Germany
| | - Judith Rösler
- Department of Neurosurgery, Charité University Medicine, Berlin, Germany
| | - Birat Niraula
- Department of Neurosurgery, Charité University Medicine, Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité University Medicine, Berlin, Germany
| | - Thomas Picht
- Department of Neurosurgery, Charité University Medicine, Berlin, Germany
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11
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Beisteiner R. Improving clinical fMRI: better paradigms or higher field strength? AJNR Am J Neuroradiol 2013; 34:1972-3. [PMID: 23928135 PMCID: PMC7965422 DOI: 10.3174/ajnr.a3722] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- R Beisteiner
- Study Group Clinical fMRIDepartment of NeurologyHigh Field MR CenterMedical University of ViennaVienna, Austria
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Hacker CD, Laumann TO, Szrama NP, Baldassarre A, Snyder AZ, Leuthardt EC, Corbetta M. Resting state network estimation in individual subjects. Neuroimage 2013; 82:616-633. [PMID: 23735260 DOI: 10.1016/j.neuroimage.2013.05.108] [Citation(s) in RCA: 184] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 05/21/2013] [Accepted: 05/22/2013] [Indexed: 11/19/2022] Open
Abstract
Resting state functional magnetic resonance imaging (fMRI) has been used to study brain networks associated with both normal and pathological cognitive functions. The objective of this work is to reliably compute resting state network (RSN) topography in single participants. We trained a supervised classifier (multi-layer perceptron; MLP) to associate blood oxygen level dependent (BOLD) correlation maps corresponding to pre-defined seeds with specific RSN identities. Hard classification of maps obtained from a priori seeds was highly reliable across new participants. Interestingly, continuous estimates of RSN membership retained substantial residual error. This result is consistent with the view that RSNs are hierarchically organized, and therefore not fully separable into spatially independent components. After training on a priori seed-based maps, we propagated voxel-wise correlation maps through the MLP to produce estimates of RSN membership throughout the brain. The MLP generated RSN topography estimates in individuals consistent with previous studies, even in brain regions not represented in the training data. This method could be used in future studies to relate RSN topography to other measures of functional brain organization (e.g., task-evoked responses, stimulation mapping, and deficits associated with lesions) in individuals. The multi-layer perceptron was directly compared to two alternative voxel classification procedures, specifically, dual regression and linear discriminant analysis; the perceptron generated more spatially specific RSN maps than either alternative.
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Affiliation(s)
- Carl D Hacker
- Department of Biomedical Engineering, Washington University
| | | | | | - Antonello Baldassarre
- Department of Neurology and Neurosurgery, Washington University
- Department of Neuroscience and Imaging, University of Chieti, "G. d'Annunzio," Italy
| | - Abraham Z Snyder
- Department of Neurology and Neurosurgery, Washington University
- Department of Radiology, Washington University
| | - Eric C Leuthardt
- Department of Biomedical Engineering, Washington University
- Department of Neurology and Neurosurgery, Washington University
| | - Maurizio Corbetta
- Department of Neurology and Neurosurgery, Washington University
- Department of Radiology, Washington University
- Department of Anatomy and Neurobiology, Washington University
- Department of Neuroscience and Imaging, University of Chieti, "G. d'Annunzio," Italy
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