Brain Tumors: The Influence of Tumor Type and Routine MR Imaging Characteristics at BOLD Functional MR Imaging in the Primary Motor Gyrus

Abreu, Vitor Hugo Fraga de; Peck, Kyung K.; Petrovich-Brennan, Nicole M.; Woo, Kaitlin M.; Holodny, Andrei I.

doi:10.1148/radiol.2016151951

Cited by 38 publications

(20 citation statements)

References 29 publications

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“…A previous study verified that gliomas caused a decline in BOLD fMRI activation by neurovascular uncoupling when the glioma was near the primary motor cortex. 40 Our results were consistent with this theory to some extent. However, another study suggested that the distance between the tumor and primary motor cortex was no more likely than tumor type in influencing BOLD fMRI activation.…”

Section: Discussionsupporting

confidence: 90%

Anatomic Location of Tumor Predicts the Accuracy of Motor Function Localization in Diffuse Lower-Grade Gliomas Involving the Hand Knob Area

Sun

Liang

Qian

et al. 2017

AJNR Am J Neuroradiol

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Section: Discussionsupporting

confidence: 90%

Anatomic Location of Tumor Predicts the Accuracy of Motor Function Localization in Diffuse Lower-Grade Gliomas Involving the Hand Knob Area

Sun

Liang

Qian

et al. 2017

AJNR Am J Neuroradiol

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“…This effect is due to affected neovasculature and the presumable uncoupling of the neurovascular response, effects to which patients with HGG are particularly susceptible. 1,13,17 In this context, it has recently been demonstrated that nTMS-based DTI FT, as applied in this study, can overcome the limitations of manual ROI seeding by relying on neurophysiological functional parameters that should not be severely distorted by changed oxygenation levels. 10,15,19,37 Addition- Summary of the findings concerning lesion-to-CST distances, which were compared among patients with HGG regarding the presence of tumor-related edema (no edema/edema).…”

Section: Association Between Ntms and Clinical Outcomementioning

confidence: 98%

Associations between clinical outcome and navigated transcranial magnetic stimulation characteristics in patients with motor-eloquent brain lesions: a combined navigated transcranial magnetic stimulation–diffusion tensor imaging fiber tracking approach

Sollmann

Wildschuetz

Kelm

et al. 2018

Journal of Neurosurgery

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OBJECTIVE Navigated transcranial magnetic stimulation (nTMS) and diffusion tensor imaging fiber tracking (DTI FT) based on nTMS data are increasingly used for preoperative planning and resection guidance in patients suffering from motor-eloquent brain tumors. The present study explores whether nTMS-based DTI FT can also be used for individual preoperative risk assessment regarding surgery-related motor impairment. METHODS Data derived from preoperative nTMS motor mapping and subsequent nTMS-based tractography in 86 patients were analyzed. All patients suffered from high-grade glioma (HGG), low-grade glioma (LGG), or intracranial metastasis (MET). In this context, nTMS-based DTI FT of the corticospinal tract (CST) was performed at a range of fractional anisotropy (FA) levels based on an individualized FA threshold ([FAT]; tracking with 50%, 75%, and 100% FAT), which was defined as the highest FA value allowing for visualization of fibers (100% FAT). Minimum lesion-to-CST distances were measured, and fiber numbers of the reconstructed CST were assessed. These data were then correlated with the preoperative, postoperative, and follow-up status of motor function and the resting motor threshold (rMT). RESULTS At certain FA levels, a statistically significant difference in lesion-to-CST distances was observed between patients with HGG who had no impairment and those who developed surgery-related transient or permanent motor deficits (75% FAT: p = 0.0149; 100% FAT: p = 0.0233). In this context, no patient with a lesion-to-CST distance ≥ 12 mm suffered from any new surgery-related permanent paresis (50% FAT and 75% FAT). Furthermore, comparatively strong negative correlations were observed between the rMT and lesion-to-CST distances of patients with surgery-related transient paresis (Spearman correlation coefficient [r]; 50% FAT: r = -0.8660; 75% FAT: r = -0.8660) or surgery-related permanent paresis (50% FAT: r = -0.7656; 75% FAT: r = -0.6763). CONCLUSIONS This is one of the first studies to show a direct correlation between imaging, clinical status, and neurophysiological markers for the integrity of the motor system in patients with brain tumors. The findings suggest that nTMS-based DTI FT might be suitable for individual risk assessment in patients with HGG, in addition to being a surgery-planning tool. Importantly, necessary data for risk assessment were obtained without significant additional efforts, making this approach potentially valuable for direct clinical use.

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“…Concerning fMRI, it has been demonstrated that the blood oxygenation level-dependent (BOLD) contrast lacks accuracy in patients with changed intracranial oxygen levels, which are regularly present in the vicinity of gliomas due to their glucose and oxygen consumption from surrounding brain tissue. 13,15,22,51 In contrast to BOLD fMRI, preoperative MEG in patients harboring brain tumors is not reported to severely suffer from altered oxygen levels. However, MEG represents a more expensive alternative that is not widely available.…”

Section: Discussion Preoperative Language Mappingmentioning

confidence: 99%

Setup presentation and clinical outcome analysis of treating highly language-eloquent gliomas via preoperative navigated transcranial magnetic stimulation and tractography

Sollmann

Kelm

Ille

et al. 2018

Neurosurgical Focus

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OBJECTIVEAwake surgery combined with intraoperative direct electrical stimulation (DES) and intraoperative neuromonitoring (IONM) is considered the gold standard for the resection of highly language-eloquent brain tumors. Different modalities, such as functional magnetic resonance imaging (fMRI) or magnetoencephalography (MEG), are commonly added as adjuncts for preoperative language mapping but have been shown to have relevant limitations. Thus, this study presents a novel multimodal setup consisting of preoperative navigated transcranial magnetic stimulation (nTMS) and nTMS-based diffusion tensor imaging fiber tracking (DTI FT) as an adjunct to awake surgery.METHODSSixty consecutive patients (63.3% men, mean age 47.6 ± 13.3 years) suffering from highly language-eloquent left-hemispheric low- or high-grade glioma underwent preoperative nTMS language mapping and nTMS-based DTI FT, followed by awake surgery for tumor resection. Both nTMS language mapping and DTI FT data were available for resection planning and intraoperative guidance. Clinical outcome parameters, including craniotomy size, extent of resection (EOR), language deficits at different time points, Karnofsky Performance Scale (KPS) score, duration of surgery, and inpatient stay, were assessed.RESULTSAccording to postoperative evaluation, 28.3% of patients showed tumor residuals, whereas new surgery-related permanent language deficits occurred in 8.3% of patients. KPS scores remained unchanged (median preoperative score 90, median follow-up score 90).CONCLUSIONSThis is the first study to present a clinical outcome analysis of this very modern approach, which is increasingly applied in neurooncological centers worldwide. Although human language function is a highly complex and dynamic cortico-subcortical network, the presented approach offers excellent functional and oncological outcomes in patients undergoing surgery of lesions affecting this network.

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Brain Tumors: The Influence of Tumor Type and Routine MR Imaging Characteristics at BOLD Functional MR Imaging in the Primary Motor Gyrus

Cited by 38 publications

References 29 publications

Anatomic Location of Tumor Predicts the Accuracy of Motor Function Localization in Diffuse Lower-Grade Gliomas Involving the Hand Knob Area

Anatomic Location of Tumor Predicts the Accuracy of Motor Function Localization in Diffuse Lower-Grade Gliomas Involving the Hand Knob Area

Associations between clinical outcome and navigated transcranial magnetic stimulation characteristics in patients with motor-eloquent brain lesions: a combined navigated transcranial magnetic stimulation–diffusion tensor imaging fiber tracking approach

Setup presentation and clinical outcome analysis of treating highly language-eloquent gliomas via preoperative navigated transcranial magnetic stimulation and tractography

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