title: Association of functional magnetic resonance imaging indices with postoperative language outcomes in patients with primary brain tumors.
abstract: OBJECTIVE
  Functional MRI (fMRI) has the potential to be a useful presurgical planning tool to treat patients with primary brain tumor. In this study the authors retrospectively explored relationships between language-related postoperative outcomes in such patients and multiple factors, including measures estimated from task fMRI maps (proximity of lesion to functional activation area, or lesion-to-activation distance [LAD], and activation-based language lateralization, or lateralization index [LI]) used in the clinical setting for presurgical planning, as well as other factors such as patient age, patient sex, tumor grade, and tumor volume.
  
  
  METHODS
  Patient information was drawn from a database of patients with brain tumors who had undergone preoperative fMRI-based language mapping of the Broca and Wernicke areas. Patients had performed a battery of tasks, including word-generation tasks and a text-versus-symbols reading task, as part of a clinical fMRI protocol. Individually thresholded task fMRI activation maps had been provided for use in the clinical setting. These clinical imaging maps were used to retrospectively estimate LAD and LI for the Broca and Wernicke areas.
  
  
  RESULTS
  There was a relationship between postoperative language deficits and the proximity between tumor and Broca area activation (the LAD estimate), where shorter LADs were related to the presence of postoperative aphasia. Stratification by tumor location further showed that for posterior tumors within the temporal and parietal lobes, more bilaterally oriented Broca area activation (LI estimate close to 0) and a shorter Wernicke area LAD were associated with increased postoperative aphasia. Furthermore, decreasing LAD was related to decreasing LI for both Broca and Wernicke areas. Preoperative deficits were related to increasing patient age and a shorter Wernicke area LAD.
  
  
  CONCLUSIONS
  Overall, LAD and LI, as determined using fMRI in the context of these paradigms, may be useful indicators of postsurgical outcomes. Whereas tumor location may influence postoperative deficits, the results indicated that tumor proximity to an activation area might also interact with how the language network is affected as a whole by the lesion. Although the derivation of LI must be further validated in individual patients by using spatially specific statistical methods, the current results indicated that fMRI is a useful tool for predicting postoperative outcomes in patients with a single brain tumor.
authors.affiliation: School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA. bkundu@wisc.edu
authors.forename: Bornali
authors.initials: B
authors.lastname: Kundu
authors.forename: Amy
authors.initials: A
authors.lastname: Penwarden
authors.forename: Joel M
authors.initials: JM
authors.lastname: Wood
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Gallagher
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Andreoli
authors.forename: Jed
authors.initials: J
authors.lastname: Voss
authors.forename: Timothy
authors.initials: T
authors.lastname: Meier
authors.forename: Veena A
authors.initials: VA
authors.lastname: Nair
authors.forename: John S
authors.initials: JS
authors.lastname: Kuo
authors.forename: Aaron S
authors.initials: AS
authors.lastname: Field
authors.forename: Chad
authors.initials: C
authors.lastname: Moritz
authors.forename: M Elizabeth
authors.initials: ME
authors.lastname: Meyerand
authors.forename: Vivek
authors.initials: V
authors.lastname: Prabhakaran
mesh_terms: D000328:Adult; D000368:Aged; D001931:Brain Mapping / Q000379:methods; D001932:Brain Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D016208:Databases, Factual / Q000639:trends; D005260:Female; D005625:Frontal Lobe / Q000502:physiology / Q000601:surgery*; D006801:Humans; D007802:Language; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D012189:Retrospective Studies; D013060:Speech / Q000502:physiology; D016896:Treatment Outcome; D055815:Young Adult
references.citation: Neurosurgery. 2007 Nov;61(5):935-48; discussion 948-9
references.pmid: 18091270
references.citation: AJNR Am J Neuroradiol. 2012 Dec;33(11):2151-7
references.pmid: 22595902
references.citation: Epilepsy Behav. 2011 Feb;20(2):214-22
references.pmid: 20850386
references.citation: Nat Neurosci. 2002 Jul;5(7):695-9
references.pmid: 12055632
references.citation: Radiology. 2006 Sep;240(3):793-802
references.pmid: 16857981
references.citation: AJNR Am J Neuroradiol. 2005 Apr;26(4):791-6
references.pmid: 15814922
references.citation: AJNR Am J Neuroradiol. 2001 Oct;22(9):1711-8
references.pmid: 11673166
references.citation: J Clin Oncol. 2010 Aug 20;28(24):3838-43
references.pmid: 20644085
references.citation: J Neurol. 2008 Nov;255(11):1703-11
references.pmid: 18821045
references.citation: AJNR Am J Neuroradiol. 2006 Jun-Jul;27(6):1258-71
references.pmid: 16775277
references.citation: Lancet Neurol. 2005 Aug;4(8):476-86
references.pmid: 16033690
references.citation: Magn Reson Imaging Clin N Am. 2003 Nov;11(4):529-42, v
references.pmid: 15018109
references.citation: J Neurooncol. 2007 Apr;82(2):221-5
references.pmid: 17029014
references.citation: Brain Lang. 2006 Jul;98(1):57-65
references.pmid: 16519926
references.citation: N Engl J Med. 2008 Jan 3;358(1):18-27
references.pmid: 18172171
references.citation: Nat Rev Neurosci. 2006 Sep;7(9):732-44
references.pmid: 16924262
references.citation: Brain. 2000 Dec;123 Pt 12:2512-8
references.pmid: 11099452
references.citation: Radiology. 2008 Aug;248(2):579-89
references.pmid: 18539893
references.citation: Eur Radiol. 2009 Oct;19(10):2523-34
references.pmid: 19430795
references.citation: Neuroradiology. 2012 Sep;54(9):1015-25
references.pmid: 22744798
references.citation: Brain. 1999 Nov;122 ( Pt 11):2033-46
references.pmid: 10545389
references.citation: Epilepsy Behav. 2008 Oct;13(3):551-3
references.pmid: 18590981
references.citation: Neurosurgery. 1994 Apr;34(4):567-76; discussion 576
references.pmid: 7516498
references.citation: Arch Phys Med Rehabil. 2012 Jan;93(1 Suppl):S15-25
references.pmid: 22202187
references.citation: Neurosurgery. 2010 Jan;66(1):113-20
references.pmid: 19935438
references.citation: AJNR Am J Neuroradiol. 2000 Jun-Jul;21(6):1055-63
references.pmid: 10871013
references.citation: J Magn Reson Imaging. 2006 Jun;23(6):887-905
references.pmid: 16649210
references.citation: Neurosurgery. 2004 Sep;55(3):569-79; discussion 580-1
references.pmid: 15335424
references.citation: Ann Neurol. 2001 Nov;50(5):620-9
references.pmid: 11706968
references.citation: Neurosurgery. 2004 Apr;54(4):902-14; discussion 914-5
references.pmid: 15046657
references.citation: J Neurosurg. 1999 Aug;91(2):238-50
references.pmid: 10433312
references.citation: AJNR Am J Neuroradiol. 2011 Sep;32(8):1420-5
references.pmid: 21885713
references.citation: J Neurosurg. 1989 Sep;71(3):316-26
references.pmid: 2769383
references.citation: AJNR Am J Neuroradiol. 2003 Oct;24(9):1837-42
references.pmid: 14561613
references.citation: Neurosurgery. 2006 Jul 1;59(1):60-66
references.pmid: 28180609
references.citation: Neuroimage. 2011 Jan;54 Suppl 1:S136-45
references.pmid: 20380883
references.citation: Neurosurgery. 2004 Oct;55(4):904-14; discusssion 914-5
references.pmid: 15458599