title: [Function magnetic resonance imaging and diffusion tensor tractography in patients with brain gliomas involving motor areas: clinical application and outcome].
abstract: OBJECTIVE
  To explore the role of preoperative blood oxygen level dependent (BOLD) functional magnetic resonance imaging (fMRI) and diffusion tensor tractography (DTT) to identify the relationship between motor cortical area, pyramidal tracts with brain gliomas in neurosurgical treatment of intraoperative electrical stimulation for gliomas involving motor areas at 3T.
  
  
  METHODS
  Twenty-eight patients with brain gliomas involving motor areas were included. They underwent MRI examination, which included conventional T1WI, T2WI, BOLD-fMRI of bilateral hands movement paradigm and diffusion tensor imaging (DTI). The data of BOLD-fMRI and DTI were transferred to the workstation (Leonardo syngo 2003A, Siemens) and analyzed. Activation mapping of hands movement, fractional Anisotropy (FA) Color and three dimensional pyramidal tracts were produced. The relationship between motor cortical area, pyramidal tracts and brain gliomas was demonstrated, which was used to optimize the pre-surgical planning. With guidance of the result of BOLD-fMRI and DTT, all patients received microsurgery under anaesthesia retaining consciousness using intraoperative motor functional brain mapping with the method of direct electrical stimulations. The brain lesions were removed as far as possible in the case of eloquent areas and sub-cortical important white matters preservation. The preoperative and postoperative KPS of all patients were operated to evaluate the state of patients.
  
  
  RESULTS
  BOLD-fMRI, DTI were performed successfully in 28 patients. The relationship between the primary motor cortex, premotor area, supplementary motor area, pyramidal tracts and brain gliomas localized by preoperative fMRI and DTI. Under anaesthesia retaining consciousness, the primary motor area was monitored by the method of direct electrical stimulations with the guidance of preoperative BOLD-fMRI. There was good correlation between preoperative fMRI and intraoperative cortical stimulation. Furthermore, the preoperative mappings and DTT could make up for the un-monitored motor areas and pyramidal tracts during operative cortical stimulation. Comparing the preoperative KPS, the postoperative KPS was advanced.
  
  
  CONCLUSIONS
  BOLD-fMRI and DTT could non-invasively localize the relationship between brain motor cortex, pyramidal tracts and brain gliomas in vivo to optimize the surgical planning, guide the microsurgery under anaesthesia retaining consciousness using intraoperative motor functional brain mapping with the method of direct electrical stimulations and remove brain tumors as far as possible in the case of eloquent areas and sub-cortical important white matters preservation.
authors.affiliation: Neuroradiology Center of the Capital University of Medical Sciences, Affiliated Beijing Neurosurgery Institute, Beijing 100050, China.
authors.forename: Zi-xiao
authors.initials: ZX
authors.lastname: Li
authors.forename: Jian-ping
authors.initials: JP
authors.lastname: Dai
authors.forename: Tao
authors.initials: T
authors.lastname: Jiang
authors.forename: Shao-wu
authors.initials: SW
authors.lastname: Li
authors.forename: Yi-lin
authors.initials: YL
authors.lastname: Sun
authors.forename: Xiong-li
authors.initials: XL
authors.lastname: Liang
authors.forename: Pei-yi
authors.initials: PY
authors.lastname: Gao
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D017352:Echo-Planar Imaging / Q000379:methods*; D005260:Female; D005910:Glioma / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D038361:Neuronavigation / Q000379:methods*; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods