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Angstwurm P, Hense K, Rosengarth K, Strotzer Q, Schmidt NO, Bumes E, Hau P, Pukrop T, Wendl C. Attenuation of the BOLD fMRI Signal and Changes in Functional Connectivity Affecting the Whole Brain in Presence of Brain Metastasis. Cancers (Basel) 2024; 16:2010. [PMID: 38893128 PMCID: PMC11171012 DOI: 10.3390/cancers16112010] [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: 04/26/2024] [Revised: 05/21/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
To date, there are almost no investigations addressing functional connectivity (FC) in patients with brain metastases (BM). In this retrospective study, we investigate the influence of BM on hemodynamic brain signals derived from functional magnetic resonance imaging (fMRI) and FC. Motor-fMRI data of 29 patients with BM and 29 matched healthy controls were analyzed to assess percent signal changes (PSC) in the ROIs motor cortex, premotor cortex, and supplementary motor cortex and FC in the sensorimotor, default mode, and salience networks using Statistical Parametric Mapping (SPM12) and marsbar and CONN toolboxes. In the PSC analysis, an attenuation of the BOLD signal in the metastases-affected hemisphere compared to the contralateral hemisphere was significant only in the supplementary motor cortex during hand movement. In the FC analysis, we found alterations in patients' FC compared to controls in all examined networks, also in the hemisphere contralateral to the metastasis. This indicates a qualitative attenuation of the BOLD signal in the affected hemisphere and also that FC is altered by the presence of BM, similarly to what is known for primary brain tumors. This transformation is not only visible in the infiltrated hemisphere, but also in the contralateral one, suggesting an influence of BM beyond local damage.
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Affiliation(s)
- Pia Angstwurm
- Faculty of Medicine, University of Regensburg, 93053 Regensburg, Germany
- Center for Neuroradiology, Institute for Diagnostic Radiology, University Hospital Regensburg, 93053 Regensburg, Germany; (Q.S.); (C.W.)
| | - Katharina Hense
- Department of Neurosurgery, University Hospital Regensburg, 93053 Regensburg, Germany; (K.H.); (K.R.); (N.O.S.)
| | - Katharina Rosengarth
- Department of Neurosurgery, University Hospital Regensburg, 93053 Regensburg, Germany; (K.H.); (K.R.); (N.O.S.)
| | - Quirin Strotzer
- Center for Neuroradiology, Institute for Diagnostic Radiology, University Hospital Regensburg, 93053 Regensburg, Germany; (Q.S.); (C.W.)
| | - Nils Ole Schmidt
- Department of Neurosurgery, University Hospital Regensburg, 93053 Regensburg, Germany; (K.H.); (K.R.); (N.O.S.)
| | - Elisabeth Bumes
- Department of Neurology, University Hospital Regensburg, 93053 Regensburg, Germany; (E.B.); (P.H.)
| | - Peter Hau
- Department of Neurology, University Hospital Regensburg, 93053 Regensburg, Germany; (E.B.); (P.H.)
| | - Tobias Pukrop
- Department of Haematology and Internal Oncology, University Hospital Regensburg, 93053 Regensburg, Germany;
| | - Christina Wendl
- Center for Neuroradiology, Institute for Diagnostic Radiology, University Hospital Regensburg, 93053 Regensburg, Germany; (Q.S.); (C.W.)
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Hense K, Deuter D, Greenlee MW, Wendl C, Schmidt NO, Stroszczynski C, Doenitz C, Ott C, Rosengarth K. Analysis of Functional Neuroplastic Changes in the Cortical Language System in Relation to Different Growth Patterns of Glioblastoma. Brain Sci 2023; 13:867. [PMID: 37371347 DOI: 10.3390/brainsci13060867] [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: 04/26/2023] [Revised: 05/15/2023] [Accepted: 05/25/2023] [Indexed: 06/29/2023] Open
Abstract
The interpretation of fMRI data in glioblastoma (GB) is challenging as these tumors exhibit specific hemodynamic processes which, together with malignancy, tumor volume and proximity to eloquent cortex areas, may lead to misinterpretations of fMRI signals. The aim of this study was to investigate if different radiologically defined GB tumor growth patterns may also influence the fMRI signal, activation pattern and functional connectivity differently. Sixty-four patients with left-hemispheric glioblastoma were included and stratified according to their radiologically defined tumor growth pattern into groups with a uniform (U-TGP) or diffuse tumor growth pattern (D-TGP). Task-based fMRI data were analyzed using SPM12 with the marsbar, LI and CONN toolboxes. The percent signal change and the laterality index were analyzed, as well as functional connectivity between 23 selected ROIs. Comparisons of both patient groups showed only minor non-significant differences, indicating that the tumor growth pattern is not a relevant influencing factor for fMRI signal. In addition to these results, signal reductions were found in areas that were not affected by the tumor underlining that a GB is not a localized but rather a systemic disease affecting the entire brain.
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Affiliation(s)
- Katharina Hense
- Department of Neurosurgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Daniel Deuter
- Department of Neurosurgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Mark W Greenlee
- Institute for Experimental Psychology, University of Regensburg, 93053 Regensburg, Germany
| | - Christina Wendl
- Department of Radiology, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Nils Ole Schmidt
- Department of Neurosurgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | | | - Christian Doenitz
- Department of Neurosurgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Christian Ott
- Department of Neurosurgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Katharina Rosengarth
- Department of Neurosurgery, University Hospital Regensburg, 93053 Regensburg, Germany
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Yamamoto AK, Sanjuán A, Pope R, Parker Jones O, Hope TMH, Prejawa S, Oberhuber M, Mancini L, Ekert JO, Garjardo-Vidal A, Creasey M, Yousry TA, Green DW, Price CJ. The Effect of Right Temporal Lobe Gliomas on Left and Right Hemisphere Neural Processing During Speech Perception and Production Tasks. Front Hum Neurosci 2022; 16:803163. [PMID: 35652007 PMCID: PMC9148966 DOI: 10.3389/fnhum.2022.803163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 03/28/2022] [Indexed: 11/28/2022] Open
Abstract
Using fMRI, we investigated how right temporal lobe gliomas affecting the posterior superior temporal sulcus alter neural processing observed during speech perception and production tasks. Behavioural language testing showed that three pre-operative neurosurgical patients with grade 2, grade 3 or grade 4 tumours had the same pattern of mild language impairment in the domains of object naming and written word comprehension. When matching heard words for semantic relatedness (a speech perception task), these patients showed under-activation in the tumour infiltrated right superior temporal lobe compared to 61 neurotypical participants and 16 patients with tumours that preserved the right postero-superior temporal lobe, with enhanced activation within the (tumour-free) contralateral left superior temporal lobe. In contrast, when correctly naming objects (a speech production task), the patients with right postero-superior temporal lobe tumours showed higher activation than both control groups in the same right postero-superior temporal lobe region that was under-activated during auditory semantic matching. The task dependent pattern of under-activation during the auditory speech task and over-activation during object naming was also observed in eight stroke patients with right hemisphere infarcts that affected the right postero-superior temporal lobe compared to eight stroke patients with right hemisphere infarcts that spared it. These task-specific and site-specific cross-pathology effects highlight the importance of the right temporal lobe for language processing and motivate further study of how right temporal lobe tumours affect language performance and neural reorganisation. These findings may have important implications for surgical management of these patients, as knowledge of the regions showing functional reorganisation may help to avoid their inadvertent damage during neurosurgery.
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Affiliation(s)
- Adam Kenji Yamamoto
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
- *Correspondence: Adam Kenji Yamamoto,
| | - Ana Sanjuán
- Neuropsychology and Functional Imaging Group, Departamento de Psicología Básica, Clínica y Psicobiología, Universitat Jaume I, Castellón de La Plana, Spain
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Rebecca Pope
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Oiwi Parker Jones
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- FMRIB Centre and Jesus College, University of Oxford, Oxford, United Kingdom
| | - Thomas M. H. Hope
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Susan Prejawa
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- Faculty of Medicine, Collaborative Research Centre 1052 “Obesity Mechanisms”, University Leipzig, Leipzig, Germany
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Marion Oberhuber
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Laura Mancini
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Justyna O. Ekert
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Andrea Garjardo-Vidal
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- Faculty of Health Sciences, Universidad del Desarrollo, Concepcion, Chile
| | - Megan Creasey
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Tarek A. Yousry
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - David W. Green
- Experimental Psychology, University College London, London, United Kingdom
| | - Cathy J. Price
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
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Relationships of Language Lateralization with Diffusion Tensor Imaging Metrics of Corpus Callosum, Tumor Grade, and Tumors Distance to Language-Eloquent Areas in Glial Neoplasms. J Comput Assist Tomogr 2020; 44:956-968. [PMID: 33196603 DOI: 10.1097/rct.0000000000001103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of the study was to search relationships between language lateralization and corpus callosum (CC) connectivity, tumor grade, and tumors distance to language-eloquent areas in glial neoplasms. MATERIALS AND METHODS The functional magnetic resonance imaging and CC diffusion tensor imaging (DTI) metrics of 42 patients with glial neoplasm were evaluated for relationships of language lateralization (left, right, and bilateral) with CC DTI metrics (tracts number, voxel, volume, length, fractional anisotropy [FA], and apparent diffusion coefficient), tumor grade, and tumors distance to language-eloquent areas and relationships of CC DTI metrics with tumor grade. Kruskal-Wallis, Mann-Whitney U, and χ tests were used. All were repeated in 26 patients with left hemispheric masses. RESULTS In glial masses, language bilateralism was more common than normal population and more pronounced in low grade than high grade. In right lateralism and bilateralism, tumor settlement nearby language-eloquent areas was more common. In the left lateralism, highest CC tract number, higher tumor grade, and more remote tumor settlements were noted. There was no relationship between CC DTI metrics and tumor grade but increase in CC tracts number and FA with increasing tumor grade. CONCLUSIONS Increased bilateralism in glial masses than normal population and in low grade tumors than high grade and increased nearby tumor settlement in right lateralism and bilateralism support interhemispheric reorganization and plasticity. This is more pronounced in low grade because of higher life span. Highest CC tract number, higher tumor grade, and more remote tumor settlement in left lateralized group suggest intact CC integrity with limited hemispheric destruction. Increasing CC tracts number and FA with increasing tumor grade support preserved CC integrity in the shorter life span of high-grade tumors.
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Fang S, Bai HX, Fan X, Li S, Zhang Z, Jiang T, Wang Y. A Novel Sequence: ZOOMit-Blood Oxygen Level-Dependent for Motor-Cortex Localization. Neurosurgery 2020; 86:E124-E132. [PMID: 31642505 DOI: 10.1093/neuros/nyz441] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 08/18/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Use of conventional blood oxygen level-dependent functional magnetic resonance imaging (conventional-BOLD-fMRI) presents challenges in accurately identifying the hand-motor cortex when a glioma involves the ipsilateral hand-knob. Zoomed imaging technique with parallel transmission (ZOOMit)-BOLD is a novel sequence allowing high spatial resolution with a relatively small field of view that may solve this problem. OBJECTIVE To compare the accuracy of ZOOMit-BOLD and conventional-BOLD in hand-motor cortex identification. METHODS A total of 20 patients with gliomas involving the sensorimotor cortex were recruited to identify the hand-motor cortex by both ZOOMit-BOLD and conventional-BOLD. Based on whether the entire or partial glioma directly invaded (was located within) the hand-knob or indirectly affected it by proximity, patients were placed into the involved or uninvolved groups, respectively. Direct cortical stimulation was applied intraoperatively to verify the location of the hand-motor cortex. Overlap indices were used to evaluate the accuracy of the hand-motor cortex identification. An overlap index equal to 0, indicating lack of overlap, was classified as inaccurate classification. RESULTS The accuracy of motor-cortex identification with ZOOMit-BOLD was 100% compared to only 65% with conventional-BOLD. The average overlap index yielded by ZOOMit-BOLD was higher than that of conventional-BOLD, regardless of whether gliomas directly invaded the hand-knob (P = .008) or not (P = .004). The overlap index in the involved group was significantly lower than that in the uninvolved group with both ZOOMit-BOLD (P = .002) and conventional-BOLD (P < .001). CONCLUSION ZOOMit-BOLD may potentially replace conventional-BOLD to identify the hand-motor cortex, particularly in cases in which gliomas directly invade the hand-knob.
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Affiliation(s)
- Shengyu Fang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Harrison X Bai
- Department of Diagnostic Imaging, Rhode Island Hospital and Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Xing Fan
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Shaowu Li
- Functional Neuroradiology Center, Beijing Neurosurgical Institute, Beijing, China
| | - Zhong Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tao Jiang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Beijing Institute for Brain Disorders Brain Tumor Center, Beijing, China
| | - Yinyan Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
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6
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Jansma JM, Rutten GJ, Ramsey LE, Snijders TJ, Bizzi A, Rosengarth K, Dodoo-Schittko F, Hattingen E, de la Peña MJ, von Campe G, Jehna M, Ramsey NF. Automatic identification of atypical clinical fMRI results. Neuroradiology 2020; 62:1677-1688. [PMID: 32812070 PMCID: PMC7666675 DOI: 10.1007/s00234-020-02510-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 07/30/2020] [Indexed: 01/03/2023]
Abstract
Purpose Functional MRI is not routinely used for neurosurgical planning despite potential important advantages, due to difficulty of determining quality. We introduce a novel method for objective evaluation of fMRI scan quality, based on activation maps. A template matching analysis (TMA) is presented and tested on data from two clinical fMRI protocols, performed by healthy controls in seven clinical centers. Preliminary clinical utility is tested with data from low-grade glioma patients. Methods Data were collected from 42 healthy subjects from seven centers, with standardized finger tapping (FT) and verb generation (VG) tasks. Copies of these “typical” data were deliberately analyzed incorrectly to assess feasibility of identifying them as “atypical.” Analyses of the VG task administered to 32 tumor patients assessed sensitivity of the TMA method to anatomical abnormalities. Results TMA identified all atypical activity maps for both tasks, at the cost of incorrectly classifying 3.6 (VG)–6.5% (FT) of typical maps as atypical. For patients, the average TMA was significantly higher than atypical healthy scans, despite localized anatomical abnormalities caused by a tumor. Conclusion This study supports feasibility of TMA for objective identification of atypical activation patterns for motor and verb generation fMRI protocols. TMA can facilitate the use and evaluation of clinical fMRI in hospital settings that have limited access to fMRI experts. In a clinical setting, this method could be applied to automatically flag fMRI scans showing atypical activation patterns for further investigation to determine whether atypicality is caused by poor scan data quality or abnormal functional topography.
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Affiliation(s)
- J Martijn Jansma
- Brain Center, Department of Neurology & Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Geert-Jan Rutten
- Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Lenny E Ramsey
- Department of Neurosurgery, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - T J Snijders
- Brain Center, Department of Neurology & Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Alberto Bizzi
- Neuroradiology Unit, Istituto Clinico Humanitas IRCCS, Rozzano, Milan, Italy
| | - Katharina Rosengarth
- Institute for Experimental Psychology, University of Regensburg, Regensburg, Germany
| | - Frank Dodoo-Schittko
- Medical Sociology, Institute for Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Elke Hattingen
- Institute of Neuroradiology, Goethe University, Frankfurt, Germany
| | | | - Gord von Campe
- Department of Neurosurgery, Medical University of Graz, Graz, Austria
| | - Margit Jehna
- Division of Neuroradiology, Vascular and Interventional Radiology, Medical University of Graz, Graz, Austria
| | - Nick F Ramsey
- Brain Center, Department of Neurology & Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands. .,Braincarta BV, Utrecht, The Netherlands.
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Sultana N, Sun C, Katsube T, Wang B. Biomarkers of Brain Damage Induced by Radiotherapy. Dose Response 2020; 18:1559325820938279. [PMID: 32694960 PMCID: PMC7350401 DOI: 10.1177/1559325820938279] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/26/2020] [Accepted: 06/05/2020] [Indexed: 12/18/2022] Open
Abstract
Radiotherapy remains currently a critical component for both primary and metastatic brain tumors either alone or in combination with surgery, chemotherapy, and molecularly targeted agents, while it could cause simultaneously normal brain tissue injury leading to serious health consequences, that is, development of cognitive impairments following cranial radiotherapy is considered as a critical clinical disadvantage especially for the whole brain radiotherapy. Biomarkers can help to detect the accurate physiology or conditions of patients with brain tumor and develop effective treatment procedures for these patients. In the near future, biomarkers will become one of the prime driving forces of cancer treatment. In this minireview, we analyze the documented work on the acute brain damage and late consequences induced by radiotherapy, identify the biomarkers, in particular, the predictive biomarkers for the damage, and summarize the biological significance of the biomarkers. It is expected that translation of these research advance to radiotherapy would assist stratifying patients for optimized treatment and improving therapeutic efficacy and the quality of life.
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Affiliation(s)
- Nahida Sultana
- Institute of Food and Radiation Biology, Atomic Energy Research Establishment, Bangladesh Atomic Energy Commission, Dhaka, People’s Republic of Bangladesh
| | - Chao Sun
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, People’s Republic of China
| | - Takanori Katsube
- National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Bing Wang
- National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
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Leote J, Loução R, Viegas C, Lauterbach M, Perez-Hick A, Monteiro J, Nunes RG, Ferreira HA. Impact of Navigated Task-specific fMRI on Direct Cortical Stimulation. J Neurol Surg A Cent Eur Neurosurg 2020; 81:555-564. [PMID: 32610351 DOI: 10.1055/s-0040-1712496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND STUDY AIMS Cortical mapping (CM) with direct cortical stimulation (DCS) in awake craniotomy is used to preserve cognitive functions such as language. Nevertheless, patient collaboration during this procedure is influenced by previous neurological symptoms and growing discomfort with DCS duration. Our study aimed to evaluate the impact of navigated task-specific functional magnetic resonance imaging (nfMRI) on the practical aspects of DCS. MATERIAL AND METHODS We recruited glioma patients scheduled for awake craniotomy for prior fMRI-based CM, acquired during motor and language tasks (i.e., verb generation, semantic and syntactic decision tasks). Language data was combined to generate a probabilistic map indicating brain regions activated with more than one paradigm. Presurgical neurophysiological language tests (i.e., verb generation, picture naming, and semantic tasks) were also performed. We considered for subsequent study only the patients with a minimum rate of correct responses of 50% in all tests. These patients were then randomized to perform intraoperative language CM either using the multimodal approach (mCM), using nfMRI and DCS combined, or electrical CM (eCM), with DCS alone. DCS was done while the patient performed picture naming and nonverbal semantic decision tasks. Methodological features such as DCS duration, number of stimuli, total delivered stimulus duration per task, and frequency of seizures were analyzed and compared between groups. The correspondence between positive responses obtained with DCS and nfMRI was also evaluated. RESULTS Twenty-one surgeries were included, thirteen of which using mCM (i.e., test group). Patients with lower presurgical neuropsychological performance (correct response rate between 50 and 80% in language tests) showed a decreased DCS duration in comparison with the control group. None of the compared methodological features showed differences between groups. Correspondence between DCS and nfMRI was 100/84% in the identification of the precentral gyrus for motor function/opercular frontal inferior gyrus for language function, respectively. CONCLUSION Navigated fMRI data did not influence DCS in practice. Presurgical language disturbances limited the applicability of DCS mapping in awake surgery.
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Affiliation(s)
- Joao Leote
- Faculdade de Ciências da Universidade de Lisboa, Instituto de Biofísica e Engenharia Biomédica, Lisboa, Portugal.,Department of Neurosurgery and Critical Care, Hospital Garcia de Orta EPE, Almada, Portugal
| | - Ricardo Loução
- Institute of Neurosciences and Medicine, INM 4, Julich, Nordrhein-Westfalen, Germany
| | - Catarina Viegas
- Department of Neurosurgery and Critical Care, Hospital Garcia de Orta EPE, Almada, Portugal
| | - Martin Lauterbach
- Department of Neuroradiology, Sociedade Portuguesa de Ressonância Magnética, Lisboa, Portugal
| | - António Perez-Hick
- Department of Neurosurgery and Critical Care, Hospital Garcia de Orta EPE, Almada, Portugal
| | - Joana Monteiro
- Department of Neurosurgery and Critical Care, Hospital Garcia de Orta EPE, Almada, Portugal
| | - Rita G Nunes
- Department of Bioengineering and Institute for Systems and Robotics (ISR/IST), LARSyS, Universidade de Lisboa Instituto Superior Técnico Campus Alameda, Lisboa, Lisboa, Portugal
| | - Hugo A Ferreira
- Faculdade de Ciências da Universidade de Lisboa, Instituto de Biofísica e Engenharia Biomédica, Lisboa, Portugal
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Thranitz J, Knauth M, Heldmann M, Küchler J, Münte TF, Royl G. Elevation of intracranial pressure affects the relationship between hemoglobin concentration and neuronal activation in human somatosensory cortex. Hum Brain Mapp 2020; 41:2702-2716. [PMID: 32128949 PMCID: PMC7294068 DOI: 10.1002/hbm.24973] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 02/13/2020] [Accepted: 02/18/2020] [Indexed: 11/25/2022] Open
Abstract
During neuronal activation, a local decrease of deoxygenated hemoglobin concentration (deoxy‐Hb) occurs which is the basis of functional brain imaging with blood oxygenation level dependent functional magnetic resonance imaging (BOLD‐fMRI). Elevated intracranial pressure (eICP) has been shown to impair functional deoxy‐Hb changes. This study investigated this effect and its relation to the underlying neuronal activity in the human primary somatosensory cortex (SI). Functional near‐infrared spectroscopy (fNIRS) during somatosensory evoked potentials (SEP) monitoring was performed on 75 subjects during conditions of median nerve stimulation (MNS) and resting state, combined with normal breathing (NB) and eICP by escalating breathing maneuvers (breath holding [BH], Valsalva maneuver with 15 mmHg [V15] and 35 mmHg expiratory pressure [V35]). During NB, fNIRS revealed a typical oxygenated hemoglobin concentration (oxy‐Hb) increase with deoxy‐Hb decrease during MNS enabling SI brain mapping. Breathing maneuvers associated eICP produced a known global change of oxy‐Hb and deoxy‐Hb with and without MNS. When subtracting measurements during resting state from measurements during MNS, neither functional oxy‐Hb nor deoxy‐Hb changes could be recovered while SEPs remained unchanged. In conclusion, Valsalva‐induced eICP prevents oxy‐Hb and deoxy‐Hb changes during neuronal activation in SI. This finding raises questions on the validity of oxy‐Hb‐ and deoxy‐Hb‐based brain imaging (e.g., BOLD‐fMRI) during eICP.
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Affiliation(s)
- Julia Thranitz
- Department of Neurology, Center of Brain, Behavior and Metabolism, University of Lübeck, Lübeck, Germany
| | - Martin Knauth
- Department of Internal Medicine, Schön Klinik Neustadt, Neustadt in Holstein, Germany
| | - Marcus Heldmann
- Department of Neurology, Center of Brain, Behavior and Metabolism, University of Lübeck, Lübeck, Germany
| | - Jan Küchler
- Department of Neurosurgery, University of Lübeck, Lübeck, Germany
| | - Thomas F Münte
- Department of Neurology, Center of Brain, Behavior and Metabolism, University of Lübeck, Lübeck, Germany
| | - Georg Royl
- Department of Neurology, Center of Brain, Behavior and Metabolism, University of Lübeck, Lübeck, Germany
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Yamamoto AK, Magerkurth J, Mancini L, White MJ, Miserocchi A, McEvoy AW, Appleby I, Micallef C, Thornton JS, Price CJ, Weiskopf N, Yousry TA. Acquisition of sensorimotor fMRI under general anaesthesia: Assessment of feasibility, the BOLD response and clinical utility. NEUROIMAGE-CLINICAL 2019; 23:101923. [PMID: 31491826 PMCID: PMC6699415 DOI: 10.1016/j.nicl.2019.101923] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 05/28/2019] [Accepted: 06/30/2019] [Indexed: 11/17/2022]
Abstract
We evaluated whether task-related fMRI (functional magnetic resonance imaging) BOLD (blood oxygenation level dependent) activation could be acquired under conventional anaesthesia at a depth enabling neurosurgery in five patients with supratentorial gliomas. Within a 1.5 T MRI operating room immediately prior to neurosurgery, a passive finger flexion sensorimotor paradigm was performed on each hand with the patients awake, and then immediately after the induction and maintenance of combined sevoflurane and propofol general anaesthesia. The depth of surgical anaesthesia was measured and confirmed with an EEG-derived technique, the Bispectral Index (BIS). The magnitude of the task-related BOLD response and BOLD sensitivity under anaesthesia were determined. The fMRI data were assessed by three fMRI expert observers who rated each activation map for somatotopy and usefulness for radiological neurosurgical guidance. The mean magnitudes of the task-related BOLD response under a BIS measured depth of surgical general anaesthesia were 25% (tumour affected hemisphere) and 22% (tumour free hemisphere) of the respective awake values. BOLD sensitivity under anaesthesia ranged from 7% to 83% compared to the awake state. Despite these reductions, somatotopic BOLD activation was observed in the sensorimotor cortex in all ten data acquisitions surpassing statistical thresholds of at least p < 0.001uncorr. All ten fMRI activation datasets were scored to be useful for radiological neurosurgical guidance. Passive task-related sensorimotor fMRI acquired in neurosurgical patients under multi-pharmacological general anaesthesia is reproducible and yields clinically useful activation maps. These results demonstrate the feasibility of the technique and its potential value if applied intra-operatively. Additionally these methods may enable fMRI investigations in patients unable to perform or lie still for awake paradigms, such as young children, claustrophobic patients and those with movement disorders.
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Affiliation(s)
- Adam Kenji Yamamoto
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom; Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, United Kingdom.
| | - Joerg Magerkurth
- UCL Psychology and Language Sciences, Birkbeck-UCL Centre for Neuroimaging, London, United Kingdom.
| | - Laura Mancini
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom; Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, United Kingdom.
| | - Mark J White
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom; Medical Physics and Biomedical Engineering, University College London Hospital, London, United Kingdom.
| | - Anna Miserocchi
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom.
| | - Andrew W McEvoy
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom.
| | - Ian Appleby
- Department of Neuroanaesthesia, National Hospital for Neurology and Neurosurgery, London, United Kingdom.
| | - Caroline Micallef
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, United Kingdom.
| | - John S Thornton
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom; Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, United Kingdom.
| | - Cathy J Price
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom.
| | - Nikolaus Weiskopf
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom; Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.
| | - Tarek A Yousry
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom; Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, United Kingdom.
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11
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Seynaeve L, Haeck T, Gramer M, Maes F, De Vleeschouwer S, Van Paesschen W. Optimized preoperative motor cortex mapping in brain tumors using advanced processing of transcranial magnetic stimulation data. NEUROIMAGE-CLINICAL 2019; 21:101657. [PMID: 30660662 PMCID: PMC6413351 DOI: 10.1016/j.nicl.2019.101657] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/21/2018] [Accepted: 01/03/2019] [Indexed: 11/18/2022]
Abstract
Background and objective Transcranial magnetic stimulation (TMS) is a useful technique to help localize motor function prior to neurosurgical procedures. Adequate modelling of the effect of TMS on the brain is a prerequisite to obtain reliable data. Methods Twelve patients were included with perirolandic tumors to undergo TMS-based motor mapping. Several models were developed to analyze the mapping data, from a projection to the nearest brain surface to motor evoked potential (MEP) amplitude informed weighted average of the induced electric fields over a multilayer detailed individual head model. The probability maps were compared with direct cortical stimulation (DCS) data in all patients for the hand and in three for the foot. The gold standard was defined as the results of the DCS sampling (with on average 8 DCS-points per surgery) extrapolated over the exposed cortex (of the tailored craniotomy), and the outcome parameters were based on the similarity of the probability maps with this gold standard. Results All models accurately gauge the location of the motor cortex, with point-cloud based mapping algorithms having an accuracy of 83–86%, with similarly high specificity. To delineate the whole area of the motor cortex representation, the model based on the weighted average of the induced electric fields calculated with a realistic head model performs best. The optimal single threshold to visualize the field based maps is 40% of the maximal value for the anisotropic model and 50% for the isotropic model, but dynamic thresholding adds information for clinical practice. Conclusions The method with which TMS mapping data are analyzed clearly affects the predicted area of the primary motor cortex representation. Realistic electric field based modelling is feasible in clinical practice and improves delineation of the motor cortex representation compared to more simple point-cloud based methods. Probability maps of the motor cortex representation were created from a TMS mapping. The MEP-weighted averaged tissue specific induced fields based map performed best. This map can gauge both motor cortex outline and hotspot, by varying the threshold.
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Affiliation(s)
- Laura Seynaeve
- Laboratory for Epilepsy Research, KU Leuven, Herestraat 49, Box 7003, 3000 Leuven, Belgium.
| | - Tom Haeck
- Department ESAT-PSI, KU Leuven, Kasteelpark Arenberg 10, Box 2441, 3001 Leuven, Belgium; Medical Imaging Research Center, UZ Leuven, Herestraat 49, Box 7003, 3000 Leuven, Belgium
| | - Markus Gramer
- Department ESAT-PSI, KU Leuven, Kasteelpark Arenberg 10, Box 2441, 3001 Leuven, Belgium; Medical Imaging Research Center, UZ Leuven, Herestraat 49, Box 7003, 3000 Leuven, Belgium
| | - Frederik Maes
- Department ESAT-PSI, KU Leuven, Kasteelpark Arenberg 10, Box 2441, 3001 Leuven, Belgium; Medical Imaging Research Center, UZ Leuven, Herestraat 49, Box 7003, 3000 Leuven, Belgium.
| | - Steven De Vleeschouwer
- Department of Neurosurgery, UZ Leuven, Laboratory for Experimental Neurosurgery and Neuroanatomy, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Herestraat 49, Box 7003, 3000 Leuven, Belgium.
| | - Wim Van Paesschen
- Laboratory for Epilepsy Research, KU Leuven, Herestraat 49, Box 7003, 3000 Leuven, Belgium; Department of Neurology, UZ Leuven, Belgium.
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12
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Villanueva-Meyer JE, Mabray MC, Cha S. Current Clinical Brain Tumor Imaging. Neurosurgery 2017; 81:397-415. [PMID: 28486641 PMCID: PMC5581219 DOI: 10.1093/neuros/nyx103] [Citation(s) in RCA: 201] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 02/23/2017] [Indexed: 01/12/2023] Open
Abstract
Neuroimaging plays an ever evolving role in the diagnosis, treatment planning, and post-therapy assessment of brain tumors. This review provides an overview of current magnetic resonance imaging (MRI) methods routinely employed in the care of the brain tumor patient. Specifically, we focus on advanced techniques including diffusion, perfusion, spectroscopy, tractography, and functional MRI as they pertain to noninvasive characterization of brain tumors and pretreatment evaluation. The utility of both structural and physiological MRI in the post-therapeutic brain evaluation is also reviewed with special attention to the challenges presented by pseudoprogression and pseudoresponse.
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Affiliation(s)
- Javier E. Villanueva-Meyer
- Department of Radiology and Biomedical Imaging, Neuroradiology Section, University of California San Francisco, San Francisco, California
| | - Marc C. Mabray
- Department of Radiology and Biomedical Imaging, Neuroradiology Section, University of California San Francisco, San Francisco, California
| | - Soonmee Cha
- Department of Radiology and Biomedical Imaging, Neuroradiology Section, University of California San Francisco, San Francisco, California
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13
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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.
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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
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14
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Lima Cardoso P, Fischmeister FPS, Dymerska B, Geißler A, Wurnig M, Trattnig S, Beisteiner R, Robinson SD. Robust presurgical functional MRI at 7 T using response consistency. Hum Brain Mapp 2017; 38:3163-3174. [PMID: 28321965 PMCID: PMC5434844 DOI: 10.1002/hbm.23582] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 03/07/2017] [Accepted: 03/11/2017] [Indexed: 12/31/2022] Open
Abstract
Functional MRI is valuable in presurgical planning due to its non-invasive nature, repeatability, and broad availability. Using ultra-high field MRI increases the specificity and sensitivity, increasing the localization reliability and reducing scan time. Ideally, fMRI analysis for this application should identify unreliable runs and work even if the patient deviates from the prescribed task timing or if there are changes to the hemodynamic response due to pathology. In this study, a model-free analysis method-UNBIASED-based on the consistency of fMRI responses over runs was applied, to ultra-high field fMRI localizations of the hand area. Ten patients with brain tumors and epilepsy underwent 7 Tesla fMRI with multiple runs of a hand motor task in a block design. FMRI data were analyzed with the proposed approach (UNBIASED) and the conventional General Linear Model (GLM) approach. UNBIASED correctly identified and excluded fMRI runs that contained little or no activation. Generally, less motion artifact contamination was present in UNBIASED than in GLM results. Some cortical regions were identified as activated in UNBIASED but not GLM results. These were confirmed to show reproducible delayed or transient activation, which was time-locked to the task. UNBIASED is a robust approach to generating activation maps without the need for assumptions about response timing or shape. In presurgical planning, UNBIASED can complement model-based methods to aid surgeons in making prudent choices about optimal surgical access and resection margins for each patient, even if the hemodynamic response is modified by pathology. Hum Brain Mapp 38:3163-3174, 2017. © 2017 The Authors Human Brain Mapping Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Pedro Lima Cardoso
- High Field Magnetic Resonance Centre, Department of Biomedical Imaging and Image‐guided TherapyMedical University of ViennaLazarettgasse 14, A‐1090ViennaAustria
| | - Florian Ph. S. Fischmeister
- Study Group Clinical fMRI, Department of NeurologyMedical University of ViennaWähringer Gürtel 18‐20, A‐1090ViennaAustria
| | - Barbara Dymerska
- High Field Magnetic Resonance Centre, Department of Biomedical Imaging and Image‐guided TherapyMedical University of ViennaLazarettgasse 14, A‐1090ViennaAustria
| | - Alexander Geißler
- Study Group Clinical fMRI, Department of NeurologyMedical University of ViennaWähringer Gürtel 18‐20, A‐1090ViennaAustria
| | - Moritz Wurnig
- Study Group Clinical fMRI, Department of NeurologyMedical University of ViennaWähringer Gürtel 18‐20, A‐1090ViennaAustria
| | - Siegfried Trattnig
- High Field Magnetic Resonance Centre, Department of Biomedical Imaging and Image‐guided TherapyMedical University of ViennaLazarettgasse 14, A‐1090ViennaAustria
| | - Roland Beisteiner
- Study Group Clinical fMRI, Department of NeurologyMedical University of ViennaWähringer Gürtel 18‐20, A‐1090ViennaAustria
| | - Simon Daniel Robinson
- High Field Magnetic Resonance Centre, Department of Biomedical Imaging and Image‐guided TherapyMedical University of ViennaLazarettgasse 14, A‐1090ViennaAustria
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15
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Teghipco A, Hussain A, Tivarus ME. Disrupted functional connectivity affects resting state based language lateralization. NEUROIMAGE-CLINICAL 2016; 12:910-927. [PMID: 27882297 PMCID: PMC5114586 DOI: 10.1016/j.nicl.2016.10.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 09/10/2016] [Accepted: 10/20/2016] [Indexed: 12/01/2022]
Abstract
Pre-operative assessment of language localization and lateralization is critical to preserving brain function after lesion or epileptogenic tissue resection. Task fMRI (t-fMRI) has been extensively and reliably used to this end, but resting state fMRI (rs-fMRI) is emerging as an alternative pre-operative brain mapping method that is independent of a patient's ability to comply with a task. We sought to evaluate if language lateralization obtained from rs-fMRI can replace standard assessment using t-fMRI. In a group of 43 patients scheduled for pre-operative fMRI brain mapping and 17 healthy controls, we found that existing methods of determining rs-fMRI lateralization by considering interhemispheric and intrahemispheric functional connectivity are inadequate compared to t-fMRI when applied to the language network. We determined that this was attributable to widespread but nuanced disturbances in the functional connectivity of the language network in patients. We found changes in interhemispheric and intrahemispheric functional connectivity that were dependent on lesion location, and particularly impacted patients with lesions in the left temporal lobe. We then tested whether a simpler measure of functional connectivity to the language network has a better relation to t-fMRI based language lateralization. Remarkably, we found that functional connectivity between the language network and the frontal pole, and superior frontal gyrus, as well as the supramarginal gyrus, significantly correlated to task based language lateralization indices in both patients and healthy controls. These findings are consistent with prior work with epilepsy patients, and provide a framework for evaluating language lateralization at rest. Existing methods of determining rs-fMRI lateralization are inadequate for language. Functional connectivity to language network correlates with task lateralization. Lesion location affects functional connectivity. Lesions exhibit some interhemispheric hyperconnectivity within language network.
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Affiliation(s)
- Alex Teghipco
- Rochester Center for Brain Imaging, University of Rochester, USA
| | - Ali Hussain
- Department of Imaging Sciences, University of Rochester, USA
| | - Madalina E Tivarus
- Rochester Center for Brain Imaging, University of Rochester, USA; Department of Imaging Sciences, University of Rochester, USA
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16
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Burks JD, Bonney PA, Conner AK, Glenn CA, Briggs RG, Battiste JD, McCoy T, O'Donoghue DL, Wu DH, Sughrue ME. A method for safely resecting anterior butterfly gliomas: the surgical anatomy of the default mode network and the relevance of its preservation. J Neurosurg 2016; 126:1795-1811. [DOI: 10.3171/2016.5.jns153006] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEGliomas invading the anterior corpus callosum are commonly deemed unresectable due to an unacceptable risk/benefit ratio, including the risk of abulia. In this study, the authors investigated the anatomy of the cingulum and its connectivity within the default mode network (DMN). A technique is described involving awake subcortical mapping with higher attention tasks to preserve the cingulum and reduce the incidence of postoperative abulia for patients with so-called butterfly gliomas.METHODSThe authors reviewed clinical data on all patients undergoing glioma surgery performed by the senior author during a 4-year period at the University of Oklahoma Health Sciences Center. Forty patients were identified who underwent surgery for butterfly gliomas. Each patient was designated as having undergone surgery either with or without the use of awake subcortical mapping and preservation of the cingulum. Data recorded on these patients included the incidence of abulia/akinetic mutism. In the context of the study findings, the authors conducted a detailed anatomical study of the cingulum and its role within the DMN using postmortem fiber tract dissections of 10 cerebral hemispheres and in vivo diffusion tractography of 10 healthy subjects.RESULTSForty patients with butterfly gliomas were treated, 25 (62%) with standard surgical methods and 15 (38%) with awake subcortical mapping and preservation of the cingulum. One patient (1/15, 7%) experienced postoperative abulia following surgery with the cingulum-sparing technique. Greater than 90% resection was achieved in 13/15 (87%) of these patients.CONCLUSIONSThis study presents evidence that anterior butterfly gliomas can be safely removed using a novel, attention-task based, awake brain surgery technique that focuses on preserving the anatomical connectivity of the cingulum and relevant aspects of the cingulate gyrus.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Dee H. Wu
- 4Radiological Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Mallela AN, Peck KK, Petrovich-Brennan NM, Zhang Z, Lou W, Holodny AI. Altered Resting-State Functional Connectivity in the Hand Motor Network in Glioma Patients. Brain Connect 2016; 6:587-595. [PMID: 27457676 DOI: 10.1089/brain.2016.0432] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
To examine the functional connectivity of the primary and supplementary motor areas (SMA) in glioma patients using resting-state functional MRI (rfMRI). To correlate rfMRI data with tumor characteristics and clinical information to characterize functional reorganization of resting-state networks (RSN) and the limitations of this method. This study was IRB approved and in compliance with Health Insurance Portability and Accountability Act. Informed consent was waived in this retrospective study. We analyzed rfMRI in 24 glioma patients and 12 age- and sex-matched controls. We compared global activation, interhemispheric connectivity, and functional connectivity in the hand motor RSNs using hemispheric voxel counts, pairwise Pearson correlation, and pairwise total spectral coherence. We explored the relationship between tumor grade, volume, location, and the patient's clinical status to functional connectivity. Global network activation and interhemispheric connectivity were reduced in gliomas (p < 0.05). Functional connectivity between the bilateral motor cortices and the SMA was reduced in gliomas (p < 0.01). High-grade gliomas had lower functional connectivity than low-grade gliomas (p < 0.05). Tumor volume and distance to ipsilateral motor cortex demonstrated no association with functional connectivity loss. Functional connectivity loss is associated with motor deficits in low-grade gliomas, but not in high-grade gliomas. Global reduction in resting-state connectivity in areas distal to tumor suggests that radiological tumor boundaries underestimate areas affected by glioma. Association between motor deficits and rfMRI suggests that rfMRI may accurately reflect functional changes in low-grade gliomas. Lack of association between rfMRI and clinical motor deficits implies decreased sensitivity of rfMRI in high-grade gliomas, possibly due to neurovascular uncoupling.
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Affiliation(s)
- Arka N Mallela
- 1 Functional MRI Laboratory, Department of Radiology, Memorial Sloan-Kettering Cancer Center , New York, New York.,2 Perelman School of Medicine at the University of Pennsylvania , Philadelphia, Pennsylvania
| | - Kyung K Peck
- 1 Functional MRI Laboratory, Department of Radiology, Memorial Sloan-Kettering Cancer Center , New York, New York.,3 Department of Medical Physics, Memorial Sloan-Kettering Cancer Center , New York, New York
| | - Nicole M Petrovich-Brennan
- 1 Functional MRI Laboratory, Department of Radiology, Memorial Sloan-Kettering Cancer Center , New York, New York
| | - Zhigang Zhang
- 4 Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center , New York, New York
| | - William Lou
- 1 Functional MRI Laboratory, Department of Radiology, Memorial Sloan-Kettering Cancer Center , New York, New York.,5 Weill Cornell Medical College , New York, New York
| | - Andrei I Holodny
- 1 Functional MRI Laboratory, Department of Radiology, Memorial Sloan-Kettering Cancer Center , New York, New York.,6 Brain Tumor Center, Memorial Sloan-Kettering Cancer Center , New York, New York
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18
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Cardoso PL, Fischmeister FPS, Dymerska B, Geißler A, Wurnig M, Trattnig S, Beisteiner R, Robinson SD. Improving the clinical potential of ultra-high field fMRI using a model-free analysis method based on response consistency. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2016; 29:435-49. [PMID: 26965512 PMCID: PMC4891377 DOI: 10.1007/s10334-016-0533-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 01/19/2016] [Accepted: 02/06/2016] [Indexed: 12/16/2022]
Abstract
Objective To develop an analysis method that is sensitive to non-model-conform responses often encountered in ultra-high field presurgical planning fMRI. Using the consistency of time courses over a number of experiment repetitions, it should exclude low quality runs and generate activation maps that reflect the reliability of responses. Materials and methods 7 T fMRI data were acquired from six healthy volunteers: three performing purely motor tasks and three a visuomotor task. These were analysed with the proposed approach (UNBIASED) and the GLM. Results UNBIASED results were generally less affected by false positive results than the GLM. Runs that were identified as being of low quality were confirmed to contain little or no activation. In two cases, regions were identified as activated in UNBIASED but not GLM results. Signal changes in these areas were time-locked to the task, but were delayed or transient. Conclusion UNBIASED is shown to be a reliable means of identifying consistent task-related signal changes regardless of response timing. In presurgical planning, UNBIASED could be used to rapidly generate reliable maps of the consistency with which eloquent brain regions are activated without recourse to task timing and despite modified hemodynamics. Electronic supplementary material The online version of this article (doi:10.1007/s10334-016-0533-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pedro Lima Cardoso
- />Department of Biomedical Imaging and Image-guided Therapy, High Field Magnetic Resonance Centre, Medical University of Vienna, Lazarettgasse 14/BT32, 1090 Vienna, Austria
| | - Florian Ph. S. Fischmeister
- />Study Group Clinical fMRI, Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Barbara Dymerska
- />Department of Biomedical Imaging and Image-guided Therapy, High Field Magnetic Resonance Centre, Medical University of Vienna, Lazarettgasse 14/BT32, 1090 Vienna, Austria
| | - Alexander Geißler
- />Study Group Clinical fMRI, Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Moritz Wurnig
- />Study Group Clinical fMRI, Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Siegfried Trattnig
- />Department of Biomedical Imaging and Image-guided Therapy, High Field Magnetic Resonance Centre, Medical University of Vienna, Lazarettgasse 14/BT32, 1090 Vienna, Austria
| | - Roland Beisteiner
- />Study Group Clinical fMRI, Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Simon Daniel Robinson
- />Department of Biomedical Imaging and Image-guided Therapy, High Field Magnetic Resonance Centre, Medical University of Vienna, Lazarettgasse 14/BT32, 1090 Vienna, Austria
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Liu B, Li Z, Xie P. Angioplasty and stenting for severe vertebral artery orifice stenosis: effects on cerebellar function remodeling verified by blood oxygen level-dependent functional magnetic resonance imaging. Neural Regen Res 2015; 9:2095-101. [PMID: 25657727 PMCID: PMC4316475 DOI: 10.4103/1673-5374.147937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2014] [Indexed: 01/13/2023] Open
Abstract
Vertebral artery orifice stenting may improve blood supply of the posterior circulation of the brain to regions such as the cerebellum and brainstem. However, previous studies have mainly focused on recovery of cerebral blood flow and perfusion in the posterior circulation after interventional therapy. This study examined the effects of functional recovery of local brain tissue on cerebellar function remodeling using blood oxygen level-dependent functional magnetic resonance imaging before and after interventional therapy. A total of 40 Chinese patients with severe unilateral vertebral artery orifice stenosis were enrolled in this study. Patients were equally and randomly assigned to intervention and control groups. The control group received drug treatment only. The intervention group received vertebral artery orifice angioplasty and stenting + identical drug treatment to the control group. At 13 days after treatment, the Dizziness Handicap Inventory score was compared between the intervention and control groups. Cerebellar function remodeling was observed between the two groups using blood oxygen level-dependent functional magnetic resonance imaging. The improvement in dizziness handicap and cerebellar function was more obvious in the intervention group than in the control group. Interventional therapy for severe vertebral artery orifice stenosis may effectively promote cerebellar function remodeling and exert neuroprotective effects.
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Affiliation(s)
- Bo Liu
- Department of Neurology, Yongchuan Hospital, Chongqing Medical University, Chongqing, China ; Institute of Neuroscience, Chongqing Medical University, Chongqing, China ; Chongqing Key Laboratory of Neurobiology, Chongqing Medical University, Chongqing, China
| | - Zhiwei Li
- Department of Neurology, Yongchuan Hospital, Chongqing Medical University, Chongqing, China
| | - Peng Xie
- Department of Neurology, Yongchuan Hospital, Chongqing Medical University, Chongqing, China ; Institute of Neuroscience, Chongqing Medical University, Chongqing, China ; Chongqing Key Laboratory of Neurobiology, Chongqing Medical University, Chongqing, China ; Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Wang L, Chen D, Yang X, Olson JJ, Gopinath K, Fan T, Mao H. Group independent component analysis and functional MRI examination of changes in language areas associated with brain tumors at different locations. PLoS One 2013; 8:e59657. [PMID: 23555736 PMCID: PMC3608667 DOI: 10.1371/journal.pone.0059657] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 02/19/2013] [Indexed: 01/07/2023] Open
Abstract
Object This study investigates the effect of tumor location on alterations of language network by brain tumors at different locations using blood oxygenation level dependent (BOLD) fMRI and group independent component analysis (ICA). Subjects and Methods BOLD fMRI data were obtained from 43 right handed brain tumor patients. Presurgical mapping of language areas was performed on all 43 patients with a picture naming task. All data were retrospectively analyzed using group ICA. Patents were divided into three groups based on tumor locations, i.e., left frontal region, left temporal region or right hemisphere. Laterality index (LI) was used to assess language lateralization in each group. Results The results from BOLD fMRI and ICA revealed the different language activation patterns in patients with brain tumors located in different brain regions. Language areas, such as Broca’s and Wernicke’s areas, were intact in patients with tumors in the right hemisphere. Significant functional changes were observed in patients with tumor in the left frontal and temporal areas. More specifically, the tumors in the left frontal region affect both Broca’s and Wernicke’s areas, while tumors in the left temporal lobe affect mainly Wernicke’s area. The compensated activation increase was observed in the right frontal areas in patients with left hemisphere tumors. Conclusion Group ICA provides a model free alternative approach for mapping functional networks in brain tumor patients. Altered language activation by different tumor locations suggested reorganization of language functions in brain tumor patients and may help better understanding of the language plasticity.
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Affiliation(s)
- Liya Wang
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Center for Systems Imaging, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Department of Radiology, Baoan Hospital, Shenzhen, Guangdong, China
| | - Dandan Chen
- Department of Physics, Emory University, Atlanta, Georgia, United States of America
| | - Xiaofeng Yang
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Center for Systems Imaging, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Jeffrey J. Olson
- Department of Neurosurgery, Emory University School of Medicine, Georgia, United States of America
| | - Kaundinya Gopinath
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Center for Systems Imaging, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Tianning Fan
- Center for Systems Imaging, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Hui Mao
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Center for Systems Imaging, Emory University School of Medicine, Atlanta, Georgia, United States of America
- * E-mail:
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