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Kokkinos V, Chatzisotiriou A, Seimenis I. Functional Magnetic Resonance Imaging and Diffusion Tensor Imaging-Tractography in Resective Brain Surgery: Lesion Coverage Strategies and Patient Outcomes. Brain Sci 2023; 13:1574. [PMID: 38002534 PMCID: PMC10670090 DOI: 10.3390/brainsci13111574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/04/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
Diffusion tensor imaging (DTI)-tractography and functional magnetic resonance imaging (fMRI) have dynamically entered the presurgical evaluation context of brain surgery during the past decades, providing novel perspectives in surgical planning and lesion access approaches. However, their application in the presurgical setting requires significant time and effort and increased costs, thereby raising questions regarding efficiency and best use. In this work, we set out to evaluate DTI-tractography and combined fMRI/DTI-tractography during intra-operative neuronavigation in resective brain surgery using lesion-related preoperative neurological deficit (PND) outcomes as metrics. We retrospectively reviewed medical records of 252 consecutive patients admitted for brain surgery. Standard anatomical neuroimaging protocols were performed in 127 patients, 69 patients had additional DTI-tractography, and 56 had combined DTI-tractography/fMRI. fMRI procedures involved language, motor, somatic sensory, sensorimotor and visual mapping. DTI-tractography involved fiber tracking of the motor, sensory, language and visual pathways. At 1 month postoperatively, DTI-tractography patients were more likely to present either improvement or preservation of PNDs (p = 0.004 and p = 0.007, respectively). At 6 months, combined DTI-tractography/fMRI patients were more likely to experience complete PND resolution (p < 0.001). Low-grade lesion patients (N = 102) with combined DTI-tractography/fMRI were more likely to experience complete resolution of PNDs at 1 and 6 months (p = 0.001 and p < 0.001, respectively). High-grade lesion patients (N = 140) with combined DTI-tractography/fMRI were more likely to have PNDs resolved at 6 months (p = 0.005). Patients with motor symptoms (N = 80) were more likely to experience complete remission of PNDs at 6 months with DTI-tractography or combined DTI-tractography/fMRI (p = 0.008 and p = 0.004, respectively), without significant difference between the two imaging protocols (p = 1). Patients with sensory symptoms (N = 44) were more likely to experience complete PND remission at 6 months with combined DTI-tractography/fMRI (p = 0.004). The intraoperative neuroimaging modality did not have a significant effect in patients with preoperative seizures (N = 47). Lack of PND worsening was observed at 6 month follow-up in patients with combined DTI-tractography/fMRI. Our results strongly support the combined use of DTI-tractography and fMRI in patients undergoing resective brain surgery for improving their postoperative clinical profile.
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Affiliation(s)
- Vasileios Kokkinos
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02215, USA
| | | | - Ioannis Seimenis
- Department of Medicine, School of Health Sciences, Democritus University of Thrace, 387479 Alexandroupolis, Greece;
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2
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Campbell JM, Kundu B, Lee JN, Miranda M, Arain A, Taussky P, Grandhi R, Rolston JD. Evaluating the concordance of functional MRI-based language lateralization and Wada testing in epilepsy patients: A single-center analysis. Interv Neuroradiol 2023; 29:599-604. [PMID: 35979608 PMCID: PMC10549711 DOI: 10.1177/15910199221121384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/20/2022] [Accepted: 08/03/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND For patients with drug-resistant epilepsy, surgery may be effective in controlling their disease. Surgical evaluation may involve localization of the language areas using functional magnetic resonance imaging (fMRI) or Wada testing. We evaluated the accuracy of task-based fMRI versus Wada-based language lateralization in a cohort of our epilepsy patients. METHODS In a single-center, retrospective analysis, we identified patients with medically intractable epilepsy who participated in presurgical language mapping (n = 35) with fMRI and Wada testing. Demographic variables and imaging metrics were obtained. We calculated the laterality index (LI) from task-evoked fMRI activation maps across language areas during auditory and reading tasks to determine lateralization. Possible scores for LI range from -1 (strongly left-hemisphere dominant) to 1 (strongly right-hemisphere dominant). Concordance between fMRI and Wada was estimated using Cohen's Kappa coefficient. Association between the LI scores from the auditory and reading tasks was tested using Spearman's rank correlation coefficient. RESULTS The fMRI-based laterality indices were concordant with results from Wada testing in 91.4% of patients during the reading task (κ = .55) and 96.9% of patients during the auditory task (κ = .79). The mean LIs for the reading and auditory tasks were -0.52 ± 0.43 and -0.68 ± 0.42, respectively. The LI scores for the language and reading tasks were strongly correlated, r(30) = 0.57 (p = 0.001). CONCLUSION Our findings suggest that fMRI is generally an accurate, low-risk alternative to Wada testing for language lateralization. However, when fMRI indicates atypical language lateralization (e.g., bilateral dominance), patients may benefit from subsequent Wada testing or intraoperative language mapping.
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Affiliation(s)
- Justin M Campbell
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
- Interdepartmental Program in Neuroscience, University of Utah, Salt Lake City, Utah, USA
| | - Bornali Kundu
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - James N Lee
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Michelle Miranda
- Department of Neurology, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Amir Arain
- Department of Neurology, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Philipp Taussky
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Ramesh Grandhi
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, USA
| | - John D Rolston
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
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Drakopoulos F, Tsolakis C, Angelopoulos A, Liu Y, Yao C, Kavazidi KR, Foroglou N, Fedorov A, Frisken S, Kikinis R, Golby A, Chrisochoides N. Adaptive Physics-Based Non-Rigid Registration for Immersive Image-Guided Neuronavigation Systems. Front Digit Health 2021; 2:613608. [PMID: 34713074 PMCID: PMC8521897 DOI: 10.3389/fdgth.2020.613608] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/23/2020] [Indexed: 12/21/2022] Open
Abstract
Objective: In image-guided neurosurgery, co-registered preoperative anatomical, functional, and diffusion tensor imaging can be used to facilitate a safe resection of brain tumors in eloquent areas of the brain. However, the brain deforms during surgery, particularly in the presence of tumor resection. Non-Rigid Registration (NRR) of the preoperative image data can be used to create a registered image that captures the deformation in the intraoperative image while maintaining the quality of the preoperative image. Using clinical data, this paper reports the results of a comparison of the accuracy and performance among several non-rigid registration methods for handling brain deformation. A new adaptive method that automatically removes mesh elements in the area of the resected tumor, thereby handling deformation in the presence of resection is presented. To improve the user experience, we also present a new way of using mixed reality with ultrasound, MRI, and CT. Materials and methods: This study focuses on 30 glioma surgeries performed at two different hospitals, many of which involved the resection of significant tumor volumes. An Adaptive Physics-Based Non-Rigid Registration method (A-PBNRR) registers preoperative and intraoperative MRI for each patient. The results are compared with three other readily available registration methods: a rigid registration implemented in 3D Slicer v4.4.0; a B-Spline non-rigid registration implemented in 3D Slicer v4.4.0; and PBNRR implemented in ITKv4.7.0, upon which A-PBNRR was based. Three measures were employed to facilitate a comprehensive evaluation of the registration accuracy: (i) visual assessment, (ii) a Hausdorff Distance-based metric, and (iii) a landmark-based approach using anatomical points identified by a neurosurgeon. Results: The A-PBNRR using multi-tissue mesh adaptation improved the accuracy of deformable registration by more than five times compared to rigid and traditional physics based non-rigid registration, and four times compared to B-Spline interpolation methods which are part of ITK and 3D Slicer. Performance analysis showed that A-PBNRR could be applied, on average, in <2 min, achieving desirable speed for use in a clinical setting. Conclusions: The A-PBNRR method performed significantly better than other readily available registration methods at modeling deformation in the presence of resection. Both the registration accuracy and performance proved sufficient to be of clinical value in the operating room. A-PBNRR, coupled with the mixed reality system, presents a powerful and affordable solution compared to current neuronavigation systems.
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Affiliation(s)
- Fotis Drakopoulos
- Center for Real-Time Computing, Old Dominion University, Norfolk, VA, United States
| | - Christos Tsolakis
- Center for Real-Time Computing, Old Dominion University, Norfolk, VA, United States.,Department of Computer Science, Old Dominion University, Norfolk, VA, United States
| | - Angelos Angelopoulos
- Center for Real-Time Computing, Old Dominion University, Norfolk, VA, United States.,Department of Computer Science, Old Dominion University, Norfolk, VA, United States
| | - Yixun Liu
- Center for Real-Time Computing, Old Dominion University, Norfolk, VA, United States
| | - Chengjun Yao
- Department of Neurosurgery, Huashan Hospital, Shanghai, China
| | | | - Nikolaos Foroglou
- Department of Neurosurgery, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andrey Fedorov
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Sarah Frisken
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Ron Kikinis
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Alexandra Golby
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States.,Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Nikos Chrisochoides
- Center for Real-Time Computing, Old Dominion University, Norfolk, VA, United States.,Department of Computer Science, Old Dominion University, Norfolk, VA, United States
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Morrison MA, Lupo JM. 7-T Magnetic Resonance Imaging in the Management of Brain Tumors. Magn Reson Imaging Clin N Am 2021; 29:83-102. [PMID: 33237018 DOI: 10.1016/j.mric.2020.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This article provides an overview of the current status of ultrahigh-field 7-T magnetic resonance (MR) imaging in neuro-oncology, specifically for the management of patients with brain tumors. It includes a discussion of areas across the pretherapeutic, peritherapeutic, and posttherapeutic stages of patient care where 7-T MR imaging is currently being exploited and holds promise. This discussion includes existing technical challenges, barriers to clinical integration, as well as our impression of the future role of 7-T MR imaging as a clinical tool in neuro-oncology.
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Affiliation(s)
- Melanie A Morrison
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Janine M Lupo
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA.
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5
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Automated eloquent cortex localization in brain tumor patients using multi-task graph neural networks. Med Image Anal 2021; 74:102203. [PMID: 34474216 DOI: 10.1016/j.media.2021.102203] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 06/04/2021] [Accepted: 06/08/2021] [Indexed: 11/20/2022]
Abstract
Localizing the eloquent cortex is a crucial part of presurgical planning. While invasive mapping is the gold standard, there is increasing interest in using noninvasive fMRI to shorten and improve the process. However, many surgical patients cannot adequately perform task-based fMRI protocols. Resting-state fMRI has emerged as an alternative modality, but automated eloquent cortex localization remains an open challenge. In this paper, we develop a novel deep learning architecture to simultaneously identify language and primary motor cortex from rs-fMRI connectivity. Our approach uses the representational power of convolutional neural networks alongside the generalization power of multi-task learning to find a shared representation between the eloquent subnetworks. We validate our method on data from the publicly available Human Connectome Project and on a brain tumor dataset acquired at the Johns Hopkins Hospital. We compare our method against feature-based machine learning approaches and a fully-connected deep learning model that does not account for the shared network organization of the data. Our model achieves significantly better performance than competing baselines. We also assess the generalizability and robustness of our method. Our results clearly demonstrate the advantages of our graph convolution architecture combined with multi-task learning and highlight the promise of using rs-fMRI as a presurgical mapping tool.
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6
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Feasibility, Contrast Sensitivity and Network Specificity of Language fMRI in Presurgical Evaluation for Epilepsy and Brain Tumor Surgery. Brain Topogr 2021; 34:511-524. [PMID: 33837867 DOI: 10.1007/s10548-021-00839-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/30/2021] [Indexed: 02/05/2023]
Abstract
Language fMRI has become an integral part of the planning process in brain surgery. However, fMRI may suffer from confounding factors both on the patient side, as well as on the provider side. In this study, we investigate how patient-related confounds affect the ability of the patient to perform language fMRI tasks (feasibility), the task sensitivity from an image contrast point of view, and the anatomical specificity of expressive and receptive language fMRI protocols. 104 patients were referred for language fMRI in the context of presurgical procedures for epilepsy and brain tumor surgery. Four tasks were used: (1) a verbal fluency (VF) task to map vocabulary use, (2) a semantic description (SD) task to map sentence formation/semantic integration skills, (3) a reading comprehension (RC) task and (4) a listening comprehension (LC) task. Feasibility was excellent in the LC task (100%), but in the acceptable to mediocre range for the rest of the tasks (SD: 87.50%, RC: 85.57%, VF: 67.30%). Feasibility was significantly confounded by age (p = 0.020) and education level (p = 0.003) in VF, by education level (p = 0.004) and lesion laterality (p = 0.019) in SD and by age (p = 0.001), lesion laterality (p = 0.007) and lesion severity (p = 0.048) in RC. All tasks were comparable regarding sensitivity in generating statistically significant image contrast (VF: 90.00%, SD: 92.30%, RC: 93.25%, LC: 88.46%). The lobe of the lesion (p = 0.005) and the age (p = 0.009) confounded contrast sensitivity in the VF and SD tasks respectively. Both VF and LC tasks demonstrated unilateral lateralization of posterior language areas; only the LC task showed unilateral lateralization of anterior language areas. Our study highlights the effects of patient-related confounding factors on language fMRI and proposes LC as the most feasible, less confounded, and efficiently lateralizing task in the clinical presurgical context.
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7
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Mehidine H, Li M, Lendresse JF, Bouvet F, Xie H, Abi Haidar D. A Customized Two Photon Fluorescence Imaging Probe Based on 2D scanning MEMS Mirror Including Electrothermal Two-Level-Ladder Dual S-Shaped Actuators. MICROMACHINES 2020; 11:mi11070704. [PMID: 32708126 PMCID: PMC7408598 DOI: 10.3390/mi11070704] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/21/2020] [Accepted: 07/20/2020] [Indexed: 11/16/2022]
Abstract
We report the design and characterization of a two-photon fluorescence imaging miniature probe. This customized two-axis scanning probe is dedicated for intraoperative two-photon fluorescence imaging endomicroscopic use and is based on a micro-electro-mechanical system (MEMS) mirror with a high reflectivity plate and two-level-ladder double S-shaped electrothermal bimorph actuators. The fully assembled probe has a total outer diameter of 4 mm including all elements. With a two-lens configuration and a small aperture MEMS mirror, this probe can generate a large optical scan angle of 24° with 4 V drive voltage and can achieve a 450 µm FOV with a 2-fps frame rate. A uniform Pixel Dwell Time and a stable scanning speed along a raster pattern were demonstrated while a 57-fs pulse duration of the excitation beam was measured at the exit of the probe head. This miniature imaging probe will be coupled to a two-photon fluorescence endomicroscope oriented towards clinical use.
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Affiliation(s)
- Hussein Mehidine
- Université Paris-Saclay, CNRS/IN2P3, IJCLab, 91405 Orsay, France; (H.M.); (J.-F.L.); (F.B.)
- Université de Paris, IJCLab, 91405 Orsay, France
| | - Min Li
- Suzhou Institute of Biomedical Engineering and Technology (SIBET) Chinese Academy of Sciences (CAS), Suzhou 215163, China;
| | | | - Francoise Bouvet
- Université Paris-Saclay, CNRS/IN2P3, IJCLab, 91405 Orsay, France; (H.M.); (J.-F.L.); (F.B.)
| | - Huikai Xie
- School of Information and Electronics Technology, Beijing Institute of Technology, Beijing 100081, China;
| | - Darine Abi Haidar
- Université Paris-Saclay, CNRS/IN2P3, IJCLab, 91405 Orsay, France; (H.M.); (J.-F.L.); (F.B.)
- Université de Paris, IJCLab, 91405 Orsay, France
- Correspondence:
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8
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Metwali H, Raemaekers M, Ibrahim T, Samii A. The Fluctuations of Blood Oxygen Level-Dependent Signals as a Method of Brain Tumor Characterization: A Preliminary Report. World Neurosurg 2020; 142:e10-e17. [PMID: 32360673 DOI: 10.1016/j.wneu.2020.04.134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 04/17/2020] [Accepted: 04/18/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE In this study we present the nature and characteristic of the fluctuation of blood oxygen level-dependent (BOLD) signals measured from brain tumors. METHODS Supratentorial astrocytomas, which were neither operated nor previously managed with chemotherapy or radiotherapy, were segmented, and the time series of the BOLD signal fluctuations were extracted. The mean (across patients) power spectra were plotted for the different World Health Organization tumor grades. One-way analysis of variance (ANOVA) was performed to identify significant differences between the power spectra of different tumor grades. Results were considered significant at P < 0.05. RESULTS A total of 58 patients were included in the study. This group of patients included 1 patient with grade I glioma; 15 with grade II; 12 with grade III; and 30 with grade IV. The power spectra of the tumor time series were individually inspected, and all tumors exhibited high peaks at the lower frequency signals, but these were more pronounced in high-grade tumors. ANOVA showed a significant difference in power spectra between groups (P = 0.000). Post hoc analysis with Bonferroni correction showed a significant difference between grade II and grade III (P = 0.012) and grade IV (P = 0.000). There was no significant power spectra difference between grade III and IV tumors (P = 1). CONCLUSIONS The power spectra of BOLD signals from tumor tissue showed fluctuations in the low-frequency signals and were significantly correlated with tumor grade. These signals could have a misleading effect when analyzing resting state functional magnetic resonance imaging and could be also viewed as a potential method of tumor characterization.
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Affiliation(s)
- Hussam Metwali
- Kliniken Nordoberpfalz AG, Klinikum Weiden, Department of Neurosurgery, Weiden, Germany.
| | - Mathijs Raemaekers
- Brain Center Rudolf Magnus, University Medical Center, Utrecht, The Netherlands
| | - Tamer Ibrahim
- Department of Neurosurgery, University of Alexandria, Alexandria, Egypt
| | - Amir Samii
- Department of Neurosurgery, International Neuroscience Institute, Hannover, Germany
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Zhang F, Noh T, Juvekar P, Frisken SF, Rigolo L, Norton I, Kapur T, Pujol S, Wells W, Yarmarkovich A, Kindlmann G, Wassermann D, San Jose Estepar R, Rathi Y, Kikinis R, Johnson HJ, Westin CF, Pieper S, Golby AJ, O’Donnell LJ. SlicerDMRI: Diffusion MRI and Tractography Research Software for Brain Cancer Surgery Planning and Visualization. JCO Clin Cancer Inform 2020; 4:299-309. [PMID: 32216636 PMCID: PMC7113081 DOI: 10.1200/cci.19.00141] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2020] [Indexed: 12/27/2022] Open
Abstract
PURPOSE We present SlicerDMRI, an open-source software suite that enables research using diffusion magnetic resonance imaging (dMRI), the only modality that can map the white matter connections of the living human brain. SlicerDMRI enables analysis and visualization of dMRI data and is aimed at the needs of clinical research users. SlicerDMRI is built upon and deeply integrated with 3D Slicer, a National Institutes of Health-supported open-source platform for medical image informatics, image processing, and three-dimensional visualization. Integration with 3D Slicer provides many features of interest to cancer researchers, such as real-time integration with neuronavigation equipment, intraoperative imaging modalities, and multimodal data fusion. One key application of SlicerDMRI is in neurosurgery research, where brain mapping using dMRI can provide patient-specific maps of critical brain connections as well as insight into the tissue microstructure that surrounds brain tumors. PATIENTS AND METHODS In this article, we focus on a demonstration of SlicerDMRI as an informatics tool to enable end-to-end dMRI analyses in two retrospective imaging data sets from patients with high-grade glioma. Analyses demonstrated here include conventional diffusion tensor analysis, advanced multifiber tractography, automated identification of critical fiber tracts, and integration of multimodal imagery with dMRI. RESULTS We illustrate the ability of SlicerDMRI to perform both conventional and advanced dMRI analyses as well as to enable multimodal image analysis and visualization. We provide an overview of the clinical rationale for each analysis along with pointers to the SlicerDMRI tools used in each. CONCLUSION SlicerDMRI provides open-source and clinician-accessible research software tools for dMRI analysis. SlicerDMRI is available for easy automated installation through the 3D Slicer Extension Manager.
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Affiliation(s)
- Fan Zhang
- Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Thomas Noh
- Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | | | - Sarah F. Frisken
- Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Laura Rigolo
- Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Isaiah Norton
- Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Tina Kapur
- Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Sonia Pujol
- Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - William Wells
- Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
- Massachusetts Institute of Technology, Boston, MA
| | | | | | - Demian Wassermann
- Parietal, Inria Saclay-lle de France, Neurospin CEA, Université Paris-Saclay, Palaiseau, France
| | | | - Yogesh Rathi
- Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Ron Kikinis
- Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
- University of Bremen and Fraunhofer MEVIS, Bremen, Germany
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10
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Rigolo L, Essayed WI, Tie Y, Norton I, Mukundan S, Golby A. Intraoperative Use of Functional MRI for Surgical Decision Making after Limited or Infeasible Electrocortical Stimulation Mapping. J Neuroimaging 2019; 30:184-191. [PMID: 31867823 DOI: 10.1111/jon.12683] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/09/2019] [Accepted: 11/11/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND AND PURPOSE Functional magnetic resonance imaging (fMRI) is becoming widely recognized as a key component of preoperative neurosurgical planning, although intraoperative electrocortical stimulation (ECS) is considered the gold standard surgical brain mapping method. However, acquiring and interpreting ECS results can sometimes be challenging. This retrospective study assesses whether intraoperative availability of fMRI impacted surgical decision-making when ECS was problematic or unobtainable. METHODS Records were reviewed for 191 patients who underwent presurgical fMRI with fMRI loaded into the neuronavigation system. Four patients were excluded as a bur-hole biopsy was performed. Imaging was acquired at 3 Tesla and analyzed using the general linear model with significantly activated pixels determined via individually determined thresholds. fMRI maps were displayed intraoperatively via commercial neuronavigation systems. RESULTS Seventy-one cases were planned ECS; however, 18 (25.35%) of these procedures were either not attempted or aborted/limited due to: seizure (10), patient difficulty cooperating with the ECS mapping (4), scarring/limited dural opening (3), or dural bleeding (1). In all aborted/limited ECS cases, the surgeon continued surgery using fMRI to guide surgical decision-making. There was no significant difference in the incidence of postoperative deficits between cases with completed ECS and those with limited/aborted ECS. CONCLUSIONS Preoperative fMRI allowed for continuation of surgery in over one-fourth of patients in which planned ECS was incomplete or impossible, without a significantly different incidence of postoperative deficits compared to the patients with completed ECS. This demonstrates additional value of fMRI beyond presurgical planning, as fMRI data served as a backup method to ECS.
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Affiliation(s)
- Laura Rigolo
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Walid Ibn Essayed
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Yanmei Tie
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Isaiah Norton
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Srinivasan Mukundan
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Alexandra Golby
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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11
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Schult T, Hauser TK, Klose U, Hurth H, Ehricke HH. Fiber visualization for preoperative glioma assessment: Tractography versus local connectivity mapping. PLoS One 2019; 14:e0226153. [PMID: 31830068 PMCID: PMC6907809 DOI: 10.1371/journal.pone.0226153] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 11/20/2019] [Indexed: 11/18/2022] Open
Abstract
In diffusion MRI, the advent of high angular resolution diffusion imaging (HARDI) and HARDI with compressed sensing (HARDI+CS) has led to clinically practical signal acquisition techniques which allow for the assessment of white matter architecture in routine patient studies. However, the reconstruction and visualization of fiber pathways by tractography has not yet been established as a standard methodology which can easily be applied. This is due to various algorithmic problems, such as a lack of robustness, error propagation and the necessity of fine-tuning parameters depending on the clinical question. In the framework of a clinical study of glioma patients, we compare two different whole-brain tracking methods to a local connectivity mapping approach which has recently shown promising results in an adaptation to diffusion MRI. The ability of the three methods to correctly depict fiber affection is analyzed by comparing visualization results to representations of local diffusion profiles provided by orientation distribution functions (ODFs). Our results suggest that methods beyond fiber tractography, which visualize local connectedness rather than global connectivity, should be evaluated further for pre-surgical assessment of fiber affection.
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Affiliation(s)
- Thomas Schult
- Institute for Applied Computer Science, Stralsund University of Applied Sciences, Stralsund, Germany
| | - Till-Karsten Hauser
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, Tübingen, Germany
| | - Uwe Klose
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, Tübingen, Germany
| | - Helene Hurth
- Department of Neurosurgery, University Hospital Tübingen, Tübingen, Germany
| | - Hans-Heino Ehricke
- Institute for Applied Computer Science, Stralsund University of Applied Sciences, Stralsund, Germany
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12
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Reliability of Functional Magnetic Resonance Imaging in Patients with Brain Tumors: A Critical Review and Meta-Analysis. World Neurosurg 2019; 125:183-190. [DOI: 10.1016/j.wneu.2019.01.194] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/19/2019] [Accepted: 01/21/2019] [Indexed: 11/20/2022]
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13
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Liu Z, Bartsch AJ, Berrocal VJ, Johnson TD. A mixed-effects, spatially varying coefficients model with application to multi-resolution functional magnetic resonance imaging data. Stat Methods Med Res 2019; 28:1203-1215. [PMID: 29334860 DOI: 10.1177/0962280217752378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Spatial resolution plays an important role in functional magnetic resonance imaging studies as the signal-to-noise ratio increases linearly with voxel volume. In scientific studies, where functional magnetic resonance imaging is widely used, the standard spatial resolution typically used is relatively low which ensures a relatively high signal-to-noise ratio. However, for pre-surgical functional magnetic resonance imaging analysis, where spatial accuracy is paramount, high-resolution functional magnetic resonance imaging may play an important role with its greater spatial resolution. High spatial resolution comes at the cost of a smaller signal-to-noise ratio. This begs the question as to whether we can leverage the higher signal-to-noise ratio of a standard functional magnetic resonance imaging study with the greater spatial accuracy of a high-resolution functional magnetic resonance imaging study in a pre-operative patient. To answer this question, we propose to regress the statistic image from a high resolution scan onto the statistic image obtained from a standard resolution scan using a mixed-effects model with spatially varying coefficients. We evaluate our model via simulation studies and we compare its performance with a recently proposed model that operates at a single spatial resolution. We apply and compare the two models on data from a patient awaiting tumor resection. Both simulation study results and the real data analysis demonstrate that our newly proposed model indeed leverages the larger signal-to-noise ratio of the standard spatial resolution scan while maintaining the advantages of the high spatial resolution scan.
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Affiliation(s)
- Zhuqing Liu
- 1 Eli Lilly and Company, Indianapolis, IN, USA
| | - Andreas J Bartsch
- 2 Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany.,3 Department of Neuroradiology, University of Wuerzburg, Wuerzburg, Germany.,4 FMRIB Centre, Department of Clinical Neurology, University of Oxford, Oxford, UK
| | - Veronica J Berrocal
- 5 Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Timothy D Johnson
- 5 Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
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14
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Essayed WI, Zhang F, Unadkat P, Cosgrove GR, Golby AJ, O'Donnell LJ. White matter tractography for neurosurgical planning: A topography-based review of the current state of the art. Neuroimage Clin 2017; 15:659-672. [PMID: 28664037 PMCID: PMC5480983 DOI: 10.1016/j.nicl.2017.06.011] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 04/17/2017] [Accepted: 06/08/2017] [Indexed: 12/13/2022]
Abstract
We perform a review of the literature in the field of white matter tractography for neurosurgical planning, focusing on those works where tractography was correlated with clinical information such as patient outcome, clinical functional testing, or electro-cortical stimulation. We organize the review by anatomical location in the brain and by surgical procedure, including both supratentorial and infratentorial pathologies, and excluding spinal cord applications. Where possible, we discuss implications of tractography for clinical care, as well as clinically relevant technical considerations regarding the tractography methods. We find that tractography is a valuable tool in variable situations in modern neurosurgery. Our survey of recent reports demonstrates multiple potentially successful applications of white matter tractography in neurosurgery, with progress towards overcoming clinical challenges of standardization and interpretation.
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Affiliation(s)
- Walid I Essayed
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Fan Zhang
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Prashin Unadkat
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - G Rees Cosgrove
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Alexandra J Golby
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Lauren J O'Donnell
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
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15
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Morrison MA, Tam F, Garavaglia MM, Hare GMT, Cusimano MD, Schweizer TA, Das S, Graham SJ. Sources of Variation Influencing Concordance between Functional MRI and Direct Cortical Stimulation in Brain Tumor Surgery. Front Neurosci 2016; 10:461. [PMID: 27803645 PMCID: PMC5067437 DOI: 10.3389/fnins.2016.00461] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 09/26/2016] [Indexed: 11/13/2022] Open
Abstract
Object: Preoperative functional magnetic resonance imaging (fMRI) remains a promising method to aid in the surgical management of patients diagnosed with brain tumors. For patients that are candidates for awake craniotomies, surgical decisions can potentially be improved by fMRI but this depends on the level of concordance between preoperative brain maps and the maps provided by the gold standard intraoperative method, direct cortical stimulation (DCS). There have been numerous studies of the concordance between fMRI and DCS using sensitivity and specificity measures, however the results are variable across studies and the key factors influencing variability are not well understood. Thus, the present work addresses the influence of technical factors on fMRI and DCS concordance. Methods: Motor and language mapping data were collected for a group of glioma patients (n = 14) who underwent both preoperative fMRI and intraoperative DCS in an awake craniotomy procedure for tumor removal. Normative fMRI data were also acquired in a healthy control group (n = 12). The fMRI and DCS mapping data were co-registered; true positive (TP), true negative (TN), false positive (FP), and false negative (FN) occurrences were tabulated over the exposed brain surface. Sensitivity and specificity were measured for the total group, and for the motor and language sub-groups. The influence of grid placement, fMRI statistical thresholding, and task standardization were assessed. Correlations between proportions of agreement and error were also carefully scrutinized to evaluate concordance in more detail. Results: Concordance was significantly better for motor vs. language mapping. There was an inverse relationship between TP and TN with increasing statistical threshold, and FP dominated the total error. Sensitivity and specificity were reduced when tasks were not standardized across fMRI and DCS. Conclusions: Although the agreement between fMRI and DCS is good, variability is introduced by technical factors that can diminish the quality of patient data. Neurosurgeons should evaluate the usefulness of fMRI data while considering that (a) discordance arises primarily from FP fMRI results; (b) there is an inherent trade-off between sensitivity and specificity with fMRI statistical threshold; and
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Affiliation(s)
- Melanie A. Morrison
- Physical Sciences Platform, Sunnybrook Research InstituteToronto, ON, Canada
- Department of Medical Biophysics, University of TorontoToronto, ON, Canada
| | - Fred Tam
- Physical Sciences Platform, Sunnybrook Research InstituteToronto, ON, Canada
| | - Marco M. Garavaglia
- Department of Anaesthesia, University of TorontoToronto, ON, Canada
- Department of Anaesthesia, Toronto Western HospitalToronto, ON, Canada
| | - Gregory M. T. Hare
- Department of Anaesthesia, University of TorontoToronto, ON, Canada
- Keenan Research Centre, St. Michael's HospitalToronto, ON, Canada
- Department of Anaesthesia, St. Michael's HospitalToronto, ON, Canada
| | - Michael D. Cusimano
- Keenan Research Centre, St. Michael's HospitalToronto, ON, Canada
- Division of Neurosurgery, St. Michael's HospitalToronto, ON, Canada
- Department of Surgery, University of TorontoToronto, ON, Canada
| | - Tom A. Schweizer
- Keenan Research Centre, St. Michael's HospitalToronto, ON, Canada
- Department of Surgery, University of TorontoToronto, ON, Canada
| | - Sunit Das
- Keenan Research Centre, St. Michael's HospitalToronto, ON, Canada
- Division of Neurosurgery, St. Michael's HospitalToronto, ON, Canada
- Department of Surgery, University of TorontoToronto, ON, Canada
| | - Simon J. Graham
- Physical Sciences Platform, Sunnybrook Research InstituteToronto, ON, Canada
- Department of Medical Biophysics, University of TorontoToronto, ON, Canada
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16
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Presurgical motor, somatosensory and language fMRI: Technical feasibility and limitations in 491 patients over 13 years. Eur Radiol 2016; 27:267-278. [PMID: 27193934 DOI: 10.1007/s00330-016-4369-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 04/05/2016] [Accepted: 04/11/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To analyse the long-term feasibility and limitations of presurgical fMRI in a cohort of tumour and epilepsy patients with different MR-scanners at 1.5 and 3.0 T. METHODS Four hundred and ninety-one consecutive patients undergoing presurgical fMRI between 2000 and 2012 on five different MR-scanners using established paradigms and semi-automated data processing were included. Success rates of task performance and BOLD-activation were determined for motor and somatosensory somatotopic mapping and language localisation. Procedural success, failures and imaging artifacts were analysed. MR-field strengths were compared. RESULTS Two thousand three hundred fifteen of 2348 (98.6 %) attempted paradigms (1033 motor, 1220 speech, 95 somatosensory) were successfully performed. 100 paradigms (4.3 %) were repetition runs. 23 speech, 6 motor and 2 sensory paradigms failed for non-compliance and technical issues. Most language paradigm failures were noted in overt sentence generation. Average significant BOLD-activation was higher for motor than language paradigms (95.8 vs. 81.6 %). Most language paradigms showed significantly higher activation rates at 3 T compared to 1.5 T, whereas no significant difference was found for motor paradigms. CONCLUSIONS fMRI proved very robust for the presurgical localisation of the different motor and somatosensory body representations, as well as Broca's and Wernicke's language areas across different MR-scanners at 1.5 and 3.0 T over 13 years. KEY POINTS • Standardised presurgical motor and language fMRI is robust across various MRI platforms. • Motor fMRI is less dependent on field strength than language fMRI. • fMRI task failures are relatively low and are reduced by paradigm repetition.
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17
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Taplin AM, de Pesters A, Brunner P, Hermes D, Dalfino JC, Adamo MA, Ritaccio AL, Schalk G. Intraoperative mapping of expressive language cortex using passive real-time electrocorticography. EPILEPSY & BEHAVIOR CASE REPORTS 2016; 5:46-51. [PMID: 27408802 PMCID: PMC4922734 DOI: 10.1016/j.ebcr.2016.03.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 03/01/2016] [Accepted: 03/04/2016] [Indexed: 12/02/2022]
Abstract
In this case report, we investigated the utility and practicality of passive intraoperative functional mapping of expressive language cortex using high-resolution electrocorticography (ECoG). The patient presented here experienced new-onset seizures caused by a medium-grade tumor in very close proximity to expressive language regions. In preparation of tumor resection, the patient underwent multiple functional language mapping procedures. We examined the relationship of results obtained with intraoperative high-resolution ECoG, extraoperative ECoG utilizing a conventional subdural grid, extraoperative electrical cortical stimulation (ECS) mapping, and functional magnetic resonance imaging (fMRI). Our results demonstrate that intraoperative mapping using high-resolution ECoG is feasible and, within minutes, produces results that are qualitatively concordant to those achieved by extraoperative mapping modalities. They also suggest that functional language mapping of expressive language areas with ECoG may prove useful in many intraoperative conditions given its time efficiency and safety. Finally, they demonstrate that integration of results from multiple functional mapping techniques, both intraoperative and extraoperative, may serve to improve the confidence in or precision of functional localization when pathology encroaches upon eloquent language cortex.
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Affiliation(s)
- AmiLyn M Taplin
- Department of Neurosurgery, Albany Medical College, Albany, NY, USA
| | - Adriana de Pesters
- National Center for Adaptive Neurotechnologies, Wadsworth Center, New York State Department of Health, Albany, NY, USA; Department of Biomedical Sciences, State University of New York at Albany, Albany, NY, USA
| | - Peter Brunner
- National Center for Adaptive Neurotechnologies, Wadsworth Center, New York State Department of Health, Albany, NY, USA; Department of Neurology, Albany Medical College, Albany, NY, USA
| | - Dora Hermes
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - John C Dalfino
- Department of Neurosurgery, Albany Medical College, Albany, NY, USA
| | - Matthew A Adamo
- Department of Neurosurgery, Albany Medical College, Albany, NY, USA
| | | | - Gerwin Schalk
- National Center for Adaptive Neurotechnologies, Wadsworth Center, New York State Department of Health, Albany, NY, USA; Department of Biomedical Sciences, State University of New York at Albany, Albany, NY, USA; Department of Neurology, Albany Medical College, Albany, NY, USA
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18
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Bailey PD, Zacà D, Basha MM, Agarwal S, Gujar SK, Sair HI, Eng J, Pillai JJ. Presurgical fMRI and DTI for the Prediction of Perioperative Motor and Language Deficits in Primary or Metastatic Brain Lesions. J Neuroimaging 2015; 25:776-784. [DOI: 10.1111/jon.12273] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Affiliation(s)
- Paul D. Bailey
- 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
| | - Domenico Zacà
- Center for Mind/Brain Sciences; University of Trento; Trento Italy
| | | | - Shruti Agarwal
- 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
| | - Sachin K. Gujar
- 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
| | - Haris I. Sair
- 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
| | - John Eng
- 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
| | - Jay J. Pillai
- 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
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19
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Kalpathy-Cramer J, Gerstner ER, Emblem KE, Andronesi O, Rosen B. Advanced magnetic resonance imaging of the physical processes in human glioblastoma. Cancer Res 2015; 74:4622-4637. [PMID: 25183787 DOI: 10.1158/0008-5472.can-14-0383] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The most common malignant primary brain tumor, glioblastoma multiforme (GBM) is a devastating disease with a grim prognosis. Patient survival is typically less than two years and fewer than 10% of patients survive more than five years. Magnetic resonance imaging (MRI) can have great utility in the diagnosis, grading, and management of patients with GBM as many of the physical manifestations of the pathologic processes in GBM can be visualized and quantified using MRI. Newer MRI techniques such as dynamic contrast enhanced and dynamic susceptibility contrast MRI provide functional information about the tumor hemodynamic status. Diffusion MRI can shed light on tumor cellularity and the disruption of white matter tracts in the proximity of tumors. MR spectroscopy can be used to study new tumor tissue markers such as IDH mutations. MRI is helping to noninvasively explore the link between the molecular basis of gliomas and the imaging characteristics of their physical processes. We, here, review several approaches to MR-based imaging and discuss the potential for these techniques to quantify the physical processes in glioblastoma, including tumor cellularity and vascularity, metabolite expression, and patterns of tumor growth and recurrence. We conclude with challenges and opportunities for further research in applying physical principles to better understand the biologic process in this deadly disease. See all articles in this Cancer Research section, "Physics in Cancer Research."
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Affiliation(s)
- Jayashree Kalpathy-Cramer
- Athinoula A. Martinos Center for Biomedical Imaging, Departments of Radiology, Oslo University Hospital, Oslo, Norway
| | - Elizabeth R Gerstner
- Neurology, Massachusetts General Hospital and Harvard Medical School, Oslo University Hospital, Oslo, Norway
| | - Kyrre E Emblem
- Athinoula A. Martinos Center for Biomedical Imaging, Departments of Radiology, Oslo University Hospital, Oslo, Norway.,The Intervention Centre, Oslo University Hospital, Oslo, Norway
| | - Ovidiu Andronesi
- Athinoula A. Martinos Center for Biomedical Imaging, Departments of Radiology, Oslo University Hospital, Oslo, Norway
| | - Bruce Rosen
- Athinoula A. Martinos Center for Biomedical Imaging, Departments of Radiology, Oslo University Hospital, Oslo, Norway
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20
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Abstract
Real-time functional magnetic resonance imaging (rtfMRI) is a recently emerged technique that demands fast data processing within a single repetition time (TR), such as a TR of 2 seconds. Data preprocessing in rtfMRI has rarely involved spatial normalization, which can not be accomplished in a short time period. However, spatial normalization may be critical for accurate functional localization in a stereotactic space and is an essential procedure for some emerging applications of rtfMRI. In this study, we introduced an online spatial normalization method that adopts a novel affine registration (AFR) procedure based on principal axes registration (PA) and Gauss-Newton optimization (GN) using the self-adaptive β parameter, termed PA-GN(β) AFR and nonlinear registration (NLR) based on discrete cosine transform (DCT). In AFR, PA provides an appropriate initial estimate of GN to induce the rapid convergence of GN. In addition, the β parameter, which relies on the change rate of cost function, is employed to self-adaptively adjust the iteration step of GN. The accuracy and performance of PA-GN(β) AFR were confirmed using both simulation and real data and compared with the traditional AFR. The appropriate cutoff frequency of the DCT basis function in NLR was determined to balance the accuracy and calculation load of the online spatial normalization. Finally, the validity of the online spatial normalization method was further demonstrated by brain activation in the rtfMRI data.
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21
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Kronenburg A, van Doormaal T, van Eijsden P, van der Zwan A, Leijten F, Han KS. Surgery for a giant arteriovenous malformation without motor deterioration: preoperative transcranial magnetic stimulation in a non-cooperative patient. J Neurosurg Pediatr 2014; 14:38-42. [PMID: 24866824 DOI: 10.3171/2014.4.peds13592] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Transcranial magnetic stimulation (TMS) is a noninvasive activation method that is increasingly used for motor mapping. Preoperative functional mapping in vascular surgery is not routinely performed; however, in cases of high-grade arteriovenous malformations (AVMs), it could play a role in preoperative decision making. A 16-year-old male was suffering from a giant, right-sided insular, Spetzler-Martin Grade V AVM. This patient's history included 3 hemorrhagic strokes in the past 3 years, resulting in Medical Research Council Grade 2-3 (proximal) and 2-4 (distal) paresis of the left side of the body and hydrocephalus requiring a ventriculoperitoneal shunt. Preoperative TMS showed absent contralateral innervation of the remaining left-sided motor functions. Subsequently, the AVM was completely resected without any postoperative increase of the left-sided paresis. This case shows that TMS can support decision making in AVM treatment by mapping motor functions.
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22
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Rosazza C, Aquino D, D’Incerti L, Cordella R, Andronache A, Zacà D, Bruzzone MG, Tringali G, Minati L. Preoperative mapping of the sensorimotor cortex: comparative assessment of task-based and resting-state FMRI. PLoS One 2014; 9:e98860. [PMID: 24914775 PMCID: PMC4051640 DOI: 10.1371/journal.pone.0098860] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 05/08/2014] [Indexed: 11/18/2022] Open
Abstract
Resting state fMRI (rs-fMRI) has recently been considered as a possible complement or alternative to task-based fMRI (tb-fMRI) for presurgical mapping. However, evidence of its usefulness remains scant, because existing studies have investigated relatively small samples and focused primarily on qualitative evaluation. The aim of this study is to investigate the clinical usefulness of rs-fMRI in the context of presurgical mapping of motor functions, and in particular to determine the degree of correspondence with tb-fMRI which, while not a gold-standard, is commonly used in preoperative setting. A group of 13 patients with lesions close to the sensorimotor cortex underwent rs-fMRI and tb-fMRI to localize the hand, foot and mouth motor areas. We assessed quantitatively the degree of correspondence between multiple rs-fMRI analyses (independent-component and seed-based analyses) and tb-fMRI, with reference to sensitivity and specificity of rs-fMRI with respect to tb-fMRI, and centre-of-mass distances. Agreement with electro-cortical stimulation (ECS) was also investigated, and a traditional map thresholding approach based on agreement between two experienced operators was compared to an automatic threshold determination method. Rs-fMRI can localize the sensorimotor cortex successfully, providing anatomical specificity for hand, foot and mouth motor subregions, in particular with seed-based analyses. Agreement with tb-fMRI was only partial and rs-fMRI tended to provide larger patterns of correlated activity. With respect to the ECS data available, rs-fMRI and tb-fMRI performed comparably, even though the shortest distance to stimulation points was observed for the latter. Notably, the results of both were on the whole robust to thresholding procedure. Localization performed by rs-fMRI is not equivalent to tb-fMRI, hence rs-fMRI cannot be considered as an outright replacement for tb-fMRI. Nevertheless, since there is significant agreement between the two techniques, rs-fMRI can be considered with caution as a potential alternative to tb-fMRI when patients are unable to perform the task.
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Affiliation(s)
- Cristina Rosazza
- Neuroradiology Department, Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milano, Italy
- Scientific Department, Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milano, Italy
- * E-mail:
| | - Domenico Aquino
- Neuroradiology Department, Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milano, Italy
| | - Ludovico D’Incerti
- Neuroradiology Department, Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milano, Italy
| | - Roberto Cordella
- Neurosurgery Department, Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milano, Italy
| | - Adrian Andronache
- Neuroradiology Department, Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milano, Italy
| | - Domenico Zacà
- Center for Mind/Brain Sciences (CIMeC), University of Trento, Trento, Italy
| | - Maria Grazia Bruzzone
- Neuroradiology Department, Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milano, Italy
| | - Giovanni Tringali
- Neurosurgery Department, Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milano, Italy
| | - Ludovico Minati
- Scientific Department, Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milano, Italy
- Center for Mind/Brain Sciences (CIMeC), University of Trento, Trento, Italy
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23
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Sanjuán A, Price CJ, Mancini L, Josse G, Grogan A, Yamamoto AK, Geva S, Leff AP, Yousry TA, Seghier ML. Automated identification of brain tumors from single MR images based on segmentation with refined patient-specific priors. Front Neurosci 2013; 7:241. [PMID: 24381535 PMCID: PMC3865426 DOI: 10.3389/fnins.2013.00241] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 11/27/2013] [Indexed: 11/20/2022] Open
Abstract
Brain tumors can have different shapes or locations, making their identification very challenging. In functional MRI, it is not unusual that patients have only one anatomical image due to time and financial constraints. Here, we provide a modified automatic lesion identification (ALI) procedure which enables brain tumor identification from single MR images. Our method rests on (A) a modified segmentation-normalization procedure with an explicit “extra prior” for the tumor and (B) an outlier detection procedure for abnormal voxel (i.e., tumor) classification. To minimize tissue misclassification, the segmentation-normalization procedure requires prior information of the tumor location and extent. We therefore propose that ALI is run iteratively so that the output of Step B is used as a patient-specific prior in Step A. We test this procedure on real T1-weighted images from 18 patients, and the results were validated in comparison to two independent observers' manual tracings. The automated procedure identified the tumors successfully with an excellent agreement with the manual segmentation (area under the ROC curve = 0.97 ± 0.03). The proposed procedure increases the flexibility and robustness of the ALI tool and will be particularly useful for lesion-behavior mapping studies, or when lesion identification and/or spatial normalization are problematic.
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Affiliation(s)
- Ana Sanjuán
- Wellcome Trust Centre for Neuroimaging, University College of London London, UK ; Departamento de Psicología Básica, Clínica y Psicobiología, Universitat Jaume I Castellón, Spain
| | - Cathy J Price
- Wellcome Trust Centre for Neuroimaging, University College of London London, UK
| | - Laura Mancini
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery London, UK
| | - Goulven Josse
- Hôpital de la Pitié-Salpêtrière, Institut du Cerveau et de la Moëlle épinière Paris, France
| | - Alice Grogan
- Wellcome Trust Centre for Neuroimaging, University College of London London, UK
| | - Adam K Yamamoto
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery London, UK
| | - Sharon Geva
- Developmental Cognitive Neuroscience Unit, Institute of Child Health, University College of London London, UK
| | - Alex P Leff
- Wellcome Trust Centre for Neuroimaging, University College of London London, UK ; Institute of Cognitive Neuroscience, University College of London London, UK
| | - Tarek A Yousry
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery London, UK
| | - Mohamed L Seghier
- Wellcome Trust Centre for Neuroimaging, University College of London London, UK
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24
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Castellanos FX, Di Martino A, Craddock RC, Mehta AD, Milham MP. Clinical applications of the functional connectome. Neuroimage 2013; 80:527-40. [PMID: 23631991 PMCID: PMC3809093 DOI: 10.1016/j.neuroimage.2013.04.083] [Citation(s) in RCA: 249] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 04/18/2013] [Accepted: 04/20/2013] [Indexed: 12/26/2022] Open
Abstract
Central to the development of clinical applications of functional connectomics for neurology and psychiatry is the discovery and validation of biomarkers. Resting state fMRI (R-fMRI) is emerging as a mainstream approach for imaging-based biomarker identification, detecting variations in the functional connectome that can be attributed to clinical variables (e.g., diagnostic status). Despite growing enthusiasm, many challenges remain. Here, we assess evidence of the readiness of R-fMRI based functional connectomics to lead to clinically meaningful biomarker identification through the lens of the criteria used to evaluate clinical tests (i.e., validity, reliability, sensitivity, specificity, and applicability). We focus on current R-fMRI-based prediction efforts, and survey R-fMRI used for neurosurgical planning. We identify gaps and needs for R-fMRI-based biomarker identification, highlighting the potential of emerging conceptual, analytical and cultural innovations (e.g., the Research Domain Criteria Project (RDoC), open science initiatives, and Big Data) to address them. Additionally, we note the need to expand future efforts beyond identification of biomarkers for disease status alone to include clinical variables related to risk, expected treatment response and prognosis.
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Affiliation(s)
- F. Xavier Castellanos
- Phyllis Green and Randolph Cowen Institute for Pediatric Neuroscience, New York University Child Study Center, New York, NY 10016, USA
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY 10962, USA
| | - Adriana Di Martino
- Phyllis Green and Randolph Cowen Institute for Pediatric Neuroscience, New York University Child Study Center, New York, NY 10016, USA
| | - R. Cameron Craddock
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY 10962, USA
- Center for the Developing Brain, Child Mind Institute, New York, NY 10022, USA
| | - Ashesh D. Mehta
- Department of Neurosurgery, Hofstra North Shore LIJ School of Medicine and Feinstein Institute for Medical Research, Manhasset, NY 11030, USA, (F.X. Castellanos)
| | - Michael P. Milham
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY 10962, USA
- Center for the Developing Brain, Child Mind Institute, New York, NY 10022, USA
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"Awake" intraoperative functional MRI (ai-fMRI) for mapping the eloquent cortex: Is it possible in awake craniotomy? NEUROIMAGE-CLINICAL 2012; 2:132-42. [PMID: 24179766 PMCID: PMC3777788 DOI: 10.1016/j.nicl.2012.12.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 11/30/2012] [Accepted: 12/01/2012] [Indexed: 12/04/2022]
Abstract
As a promising noninvasive imaging technique, functional MRI (fMRI) has been extensively adopted as a functional localization procedure for surgical planning. However, the information provided by preoperative fMRI (pre-fMRI) is hampered by the brain deformation that is secondary to surgical procedures. Therefore, intraoperative fMRI (i-fMRI) becomes a potential alternative that can compensate for brain shifts by updating the functional localization information during craniotomy. However, previous i-fMRI studies required that patients be under general anesthesia, preventing the wider application of such a technique as the patients cannot perform tasks unless they are awake. In this study, we propose a new technique that combines awake surgery and i-fMRI, named “awake” i-fMRI (ai-fMRI). We introduced ai-fMRI to the real-time localization of sensorimotor areas during awake craniotomy in seven patients. The results showed that ai-fMRI could successfully detect activations in the bilateral primary sensorimotor areas and supplementary motor areas for all patients, indicating the feasibility of this technique in eloquent area localization. The reliability of ai-fMRI was further validated using intraoperative stimulation mapping (ISM) in two of the seven patients. Comparisons between the pre-fMRI-derived localization result and the ai-fMRI derived result showed that the former was subject to a heavy brain shift and led to incorrect localization, while the latter solved that problem. Additionally, the approaches for the acquisition and processing of the ai-fMRI data were fully illustrated and described. Some practical issues on employing ai-fMRI in awake craniotomy were systemically discussed, and guidelines were provided.
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Structural hemispheric asymmetries in the human precentral gyrus hand representation. Neuroscience 2012; 210:211-21. [DOI: 10.1016/j.neuroscience.2012.02.044] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Revised: 02/21/2012] [Accepted: 02/23/2012] [Indexed: 12/13/2022]
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