Preoperative blood oxygen level-dependent functional magnetic resonance imaging in patients with primary brain tumors: clinical application and outcome.
OBJECTIVE
This study sought to evaluate the ability of blood oxygen level-dependent (BOLD) functional magnetic resonance imaging (fMRI) to successfully identify functional cortical areas in patients with primary brain tumors, to evaluate the use of the fMRI results in presurgical planning, and to assess the functional outcome of the patients with respect to the functional maps obtained with fMRI.


METHODS
The study included 25 consecutive preoperative fMRI sessions in patients with primary brain tumors in or near sensorimotor and/or language cortices. All fMRI paradigms were analyzed and rated according to the degree of success. Several distances between tumor and functional cortex as delineated with BOLD fMRI were measured to assess the topographic relationship between these two structures. Pre- and postoperative neurological statuses were obtained from the patients' journals.


RESULTS
Acquisition of BOLD fMRI images was successful in 80% of the cases. The primary cause of unsuccessful fMRI was echo-planar imaging signal voids that were the result of previous craniotomy; the secondary cause was excessive motion. The neurosurgeons used the fMRI results for preoperative planning in 75% of the cases in which fMRI was successful. The risk of postoperative loss of function tested with fMRI was significantly lower when the distance between tumor periphery and BOLD activity was 10 mm or more.


CONCLUSIONS
The majority of patients with primary brain tumors were capable of satisfactorily performing the fMRI paradigms, and the information obtained was used in the preoperative planning. A distance of 10 mm or more between the functional cortex, as delineated with fMRI, and the tumor significantly reduced the risk of postoperative loss of function.
Håberg
Asta
A
Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway. astah@mr.ntnu.no
Kvistad
Kjell Arne
KA
Unsgård
Geirmund
G
Haraldseth
Olav
O
D000328:Adult; D000368:Aged; D001254:Astrocytoma / Q000473:pathology / Q000601:surgery*; D001925:Brain Damage, Chronic / Q000097:blood / Q000517:prevention & control; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery*; D002540:Cerebral Cortex / Q000473:pathology / Q000601:surgery*; D004292:Dominance, Cerebral / Q000502:physiology*; D005260:Female; D005909:Glioblastoma / Q000473:pathology / Q000601:surgery*; D005910:Glioma / Q000473:pathology / Q000601:surgery*; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009367:Neoplasm Staging; D010100:Oxygen / Q000097:blood*; D010101:Oxygen Consumption / Q000502:physiology; D010108:Oxyhemoglobins / Q000378:metabolism; D011183:Postoperative Complications / Q000097:blood / Q000517:prevention & control; D011300:Preoperative Care; D012016:Reference Values; D012307:Risk Factors; D016896:Treatment Outcome
D006454:Hemoglobins; D010108:Oxyhemoglobins; C100003:deoxyhemoglobin; D010100:Oxygen