title: Presurgical fMRI and DTI for the Prediction of Perioperative Motor and Language Deficits in Primary or Metastatic Brain Lesions.
abstract: OBJECTIVE
  To determine whether lesion to activation distance (LAD) on presurgical blood-oxygen-level-dependent functional magnetic resonance imaging (fMRI) and degree of white matter involvement by primary or metastatic brain lesions predict perioperative motor and language deficits.
  
  
  METHODS
  We retrospectively evaluated 76 patients with intra-axial brain lesions referred for presurgical fMRI and diffusion tensor imaging (DTI). We measured expressive, receptive, global language and motor LAD and assessed degree of involvement of the corticospinal tract (CST) and the superior longitudinal fasciculus (SLF). We performed a Wilcoxon rank-sum test to determine whether the LAD and the degree of CST/SLF involvement were statistically significantly different between patients with and without preoperative or postoperative neurological deficits.
  
  
  RESULTS
  In preoperatively symptomatic patients, motor and expressive language LAD were significantly lower (z = -3.78, P = .0002, and z = -2.51, P = .01, respectively) than in asymptomatic patients. No significant difference was noted in LAD between postoperative symptomatic and asymptomatic patients, except for a trend level effect for motor LAD (P = .07). The degree of CST involvement was significantly different between symptomatic and asymptomatic patients (z = 3.40, P = .0007 and z = 2.97, P = .003, respectively, for pre- and postoperative motor deficits).The degree of SLF involvement was significantly different between preoperatively (but not postoperatively) symptomatic and asymptomatic patients (z = 2.85, P = .004).
  
  
  CONCLUSIONS
  Presurgical motor and expressive language LAD as well as degree of tract involvement on DTI are predictive of preoperative but not postoperative deficits, except for CST DTI and (trend level) motor LAD; inability of language LAD to predict postoperative deficits suggests that preoperative fMRI is valuable to neurosurgeons in avoiding resection of eloquent cortex.
authors.affiliation: Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital & The Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Bailey
authors.affiliation: Center for Mind/Brain Sciences, University of Trento, Trento, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Zacà
authors.affiliation: Department of Radiology, University of Washington, Seattle, WA.
authors.forename: Mahmud Mossa
authors.initials: MM
authors.lastname: Basha
authors.affiliation: Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital & The Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Shruti
authors.initials: S
authors.lastname: Agarwal
authors.affiliation: Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital & The Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Sachin K
authors.initials: SK
authors.lastname: Gujar
authors.affiliation: Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital & The Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Haris I
authors.initials: HI
authors.lastname: Sair
authors.affiliation: Division of General and Diagnostic Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital & The Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: John
authors.initials: J
authors.lastname: Eng
authors.affiliation: Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital & The Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Jay J
authors.initials: JJ
authors.lastname: Pillai
mesh_terms: D000328:Adult; D000368:Aged; D001931:Brain Mapping / Q000379:methods; D001932:Brain Neoplasms / Q000175:diagnosis / Q000601:surgery*; D056324:Diffusion Tensor Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D007806:Language Disorders / Q000175:diagnosis / Q000209:etiology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000175:diagnosis / Q000209:etiology*; D064847:Multimodal Imaging / Q000379:methods; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted / Q000379:methods; D016896:Treatment Outcome; D066127:White Matter / Q000473:pathology
keywords: Functional magnetic resonance imaging (fMRI); brain tumor; diffusion tensor imaging (DTI); lesion to activation distance (LAD); neurological deficits; white matter tract involvement