title: Testing the Reliability of BOLD-fMRI Motor Mapping in Patients with Cerebral Arteriovenous Malformations by Electric Cortical Stimulation and Surgery Outcomes.
abstract: OBJECTIVE
  To test the reliability of blood oxygenation level-dependent functional magnetic resonance imaging (fMRI) in the primary hand motor cortex (M1) among patients with arteriovenous malformations (AVMs) by electric cortical stimulation (ECS) and surgery outcomes.
  
  
  METHODS
  Forty-three patients with AVMs involving/adjacent to M1 underwent blood oxygen level-dependent fMRI (BOLD-fMRI) with repetitive finger-to-thumb opposition movements. The generated image sets were processed on the iPlan 3.0 workstation. A site-by-site comparison between the fMRI and ECS maps was performed with the aid of neuronavigation. Surgical outcomes were analyzed as the change between preoperative and postoperative muscle strength (MS). Finally, fMRI sensitivity was calculated, and correlations of lesion-to-activation distances (LAD) and surgery outcomes were analyzed.
  
  
  RESULTS
  The highest activation location was found in the ipsilateral M1in 40 patients (93%). The highest activation relocated in the contralateral M1area in one patient (2.3%). No motor activation was found in the other 2 (4.7%) patients. ECS results were positive in 34 patients (85%, 34/40). The fMRI sensitivity was calculated as 85%. In total, 18 patients (41.9%) had worsened MS 1 week after surgery. Eight patients (18.6%) suffered from permanent muscle strength deterioration 6 months later. Moreover, an LAD ≤5 mm was significantly associated with permanent MS deterioration (P = 0.039).
  
  
  CONCLUSIONS
  BOLD-fMRI exhibits high sensitivity in motor mapping in patients with AVMs. LAD ≤5 mm may be associated with permanent MS deterioration in patients with AVM close to the motor cortex.
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neurosurgery, Hongqi Hospital, Mudanjiang Medical University, Aimin District, Mudanjiang, China.
authors.forename: Li Jun
authors.initials: LJ
authors.lastname: Wang
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
authors.forename: Fu Xin
authors.initials: FX
authors.lastname: Lin
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
authors.forename: Bing
authors.initials: B
authors.lastname: Zhao
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Wu
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Cao
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. Electronic address: captainwang9858@126.com.
authors.forename: Shuo
authors.initials: S
authors.lastname: Wang
mesh_terms: D000328:Adult; D015901:Angiography, Digital Subtraction; D001931:Brain Mapping; D004558:Electric Stimulation / Q000379:methods*; D004569:Electroencephalography; D019054:Evoked Potentials, Motor / Q000502:physiology; D005260:Female; D007839:Functional Laterality; D006801:Humans; D007091:Image Processing, Computer-Assisted; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D009044:Motor Cortex / Q000098:blood supply* / Q000502:physiology*; D019635:Neurosurgical Procedures / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D015898:Tomography Scanners, X-Ray Computed; D055815:Young Adult
keywords: Arteriovenous malformations; Electric cortical stimulation; Functional magnetic resonance imaging; Neuronavigation; Primary hand motor cortex; Surgery