title: Multimodal Imaging in Malignant Brain Tumors: Enhancing the Preoperative Risk Evaluation for Motor Deficits with a Combined Hybrid MRI-PET and Navigated Transcranial Magnetic Stimulation Approach.
abstract: OBJECTIVE
  Motor deficits in patients with brain tumors are caused mainly by irreversible infiltration of the motor network or by indirect mass effects; these deficits are potentially reversible on tumor removal. Here we used a novel multimodal imaging approach consisting of structural, functional, and metabolic neuroimaging to better distinguish these underlying causes in a preoperative setting and determine the predictive value of this approach.
  
  
  METHODS
  Thirty patients with malignant brain tumors involving the central region underwent a hybrid O-(2-[(18)F]fluoroethyl)-L-tyrosine-PET-MR imaging and motor mapping by neuronavigated transcranial magnetic stimulation. The functional maps served as localizers for DTI tractography of the corticospinal tract. The spatial relationship between functional tissue (motor cortex and corticospinal tract) and lesion volumes as depicted by structural and metabolic imaging was analyzed.
  
  
  RESULTS
  Motor impairment was found in nearly all patients in whom the contrast-enhanced T1WI or PET lesion overlapped functional tissue. All patients who functionally deteriorated after the operation showed such overlap on presurgical maps, while the absence of overlap predicted a favorable motor outcome. PET was superior to contrast-enhanced T1WI for revealing a motor deficit before the operation. However, the best correlation with clinical impairment was found for T2WI lesion overlap with functional tissue maps, but the prognostic value for motor recovery was not significant.
  
  
  CONCLUSIONS
  Overlapping contrast-enhanced T1WI or PET-positive signals with motor functional tissue were highly indicative of motor impairment and predictive for surgery-associated functional outcome. Such a multimodal diagnostic approach may contribute to the risk evaluation of operation-associated motor deficits in patients with brain tumors.
authors.affiliation: From the Departments of Neurosurgery (V.N., C.W.L., R.G.) Department of Radiology (V.N., H.L.), Memorial Sloan Kettering Cancer Center, New York, New York volker.neuschmelting@uk-koeln.de.
authors.forename: V
authors.identifier: http://orcid.org/0000-0001-7527-6990
authors.initials: V
authors.lastname: Neuschmelting
authors.affiliation: From the Departments of Neurosurgery (V.N., C.W.L., R.G.).
authors.forename: C
authors.identifier: http://orcid.org/0000-0001-6463-0034
authors.initials: C
authors.lastname: Weiss Lucas
authors.affiliation: Institute for Neuroscience and Medicine (G.S., A.-M.O.-P., N.J.S., K.-J.L., C.G.), Forschungszentrum Jülich, (Institute for Neuroscience and Medicine [INM]-2, INM-3, INM-4), Juelich, Germany.
authors.forename: G
authors.identifier: http://orcid.org/0000-0001-7114-1941
authors.initials: G
authors.lastname: Stoffels
authors.affiliation: Institute for Neuroscience and Medicine (G.S., A.-M.O.-P., N.J.S., K.-J.L., C.G.), Forschungszentrum Jülich, (Institute for Neuroscience and Medicine [INM]-2, INM-3, INM-4), Juelich, Germany.
authors.forename: A-M
authors.identifier: http://orcid.org/0000-0002-8536-8044
authors.initials: AM
authors.lastname: Oros-Peusquens
authors.affiliation: Radiology (H.L.) Department of Radiology (V.N., H.L.), Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: H
authors.identifier: http://orcid.org/0000-0002-3610-3074
authors.initials: H
authors.lastname: Lockau
authors.affiliation: Institute for Neuroscience and Medicine (G.S., A.-M.O.-P., N.J.S., K.-J.L., C.G.), Forschungszentrum Jülich, (Institute for Neuroscience and Medicine [INM]-2, INM-3, INM-4), Juelich, Germany Departments of Neurology (N.J.S.).
authors.forename: N J
authors.identifier: http://orcid.org/0000-0002-8151-6169
authors.initials: NJ
authors.lastname: Shah
authors.affiliation: Institute for Neuroscience and Medicine (G.S., A.-M.O.-P., N.J.S., K.-J.L., C.G.), Forschungszentrum Jülich, (Institute for Neuroscience and Medicine [INM]-2, INM-3, INM-4), Juelich, Germany Nuclear Medicine (K.-J.L.), Rheinisch-Westfälische Technische Hochschule Aachen University, Aachen, Germany.
authors.forename: K-J
authors.identifier: http://orcid.org/0000-0003-1101-5075
authors.initials: KJ
authors.lastname: Langen
authors.affiliation: From the Departments of Neurosurgery (V.N., C.W.L., R.G.).
authors.forename: R
authors.identifier: http://orcid.org/0000-0002-1927-0022
authors.initials: R
authors.lastname: Goldbrunner
authors.affiliation: Neurology (C.G.), University of Cologne, Cologne, Germany Institute for Neuroscience and Medicine (G.S., A.-M.O.-P., N.J.S., K.-J.L., C.G.), Forschungszentrum Jülich, (Institute for Neuroscience and Medicine [INM]-2, INM-3, INM-4), Juelich, Germany.
authors.forename: C
authors.identifier: http://orcid.org/0000-0002-1656-720X
authors.initials: C
authors.lastname: Grefkes
mesh_terms: D000328:Adult; D001931:Brain Mapping / Q000379:methods*; D001932:Brain Neoplasms / Q000150:complications / Q000473:pathology*; D005260:Female; D059907:Functional Neuroimaging / Q000379:methods*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D000068079:Motor Disorders / Q000175:diagnosis* / Q000209:etiology; D064847:Multimodal Imaging / Q000379:methods*; D049268:Positron-Emission Tomography; D011712:Pyramidal Tracts / Q000473:pathology; D050781:Transcranial Magnetic Stimulation; D055815:Young Adult