Imaging
nordic fMRI Solution – Products for Enhancing the Development of a Functional Imaging Clinical Practice
Catherine Elsinger,1 Attila Schwarcz2 and Tamás Dóczi3
1. Chief Science Officer, NordicNeuroLab; 2. Neurosurgeon, and Assistant Professor of Neurosurgery, Department of Neurosurgery, Pecs University Medical School; 3. Neurosurgeon, Professor of Neurosurgery, and Chairman, Department of Neurosurgery, Pecs University Medical School
Abstract
In the last few years we have witnessed increased adoption of functional magnetic resonance imaging (fMRI) technology in clinical settings. fMRI is rapidly gaining acceptance as a pre-operative planning tool. Functional imaging data provide critical information to the neurosurgeon for considering therapeutic approaches that might not be considered due to procedural risk. The goal is to accurately delineate tissue pathology from surrounding eloquent cortex and examine vital connections between brain regions, aiding decision-making and maintaining a balance between a more aggressive resection approach and reducing post-operative deficits. In this article we describe the solution NordicNeuroLab has developed to support this technology and illustrate the method employed in the Department of Neurosurgery at Pecs University Medical School in Hungary to assess pre-operative risk and plan surgery for patients with brain tumours.
Keywords
Functional brain imaging, functional magnetic resonance imaging (fMRI), pre-surgical mapping, blood-oxygen-level-dependent (BOLD), diffusion tensor imaging (DTI), neuronavigation, magnetic resonance imaging (MRI)
Disclosure: Catherine Elsinger is an employee of NordicNeuroLab. The remaining authors have no conflicts of interest to declare. Received: 4 May 2010 Accepted: 9 June 2010 Citation: European Neurological Review, 2010;5(1):100–2 Correspondence: Catherine Elsinger, NordicNeuroLab Inc., 234 W Florida St, Suite 210, Milwaukee, WI 53204, US. E:
cathy@nordicneurolab.com
Support: The publication of this article was funded by NordicNeuroLab.
Recent advances in functional neuroimaging techniques have revolutionised the approach to neurosurgical planning. Functional magnetic resonance imaging (fMRI) techniques include blood-oxygen- level-dependent (BOLD) and diffusion tensor imaging (DTI) methodologies for non-invasively imaging brain activation and white matter fibres, respectively. In the last decade these techniques have evolved from purely research imaging tools used in cognitive neuroscience studies to clinically viable tools recognised by the medical community and regulatory bodies. These techniques hold considerable potential in the field of neurosurgical treatment planning.1,2
The goal of pre-operative treatment planning for tumour resection or seizure disorders is to differentiate eloquent cortex from structural brain lesions in close proximity, and to establish language lateralisation pre-operatively, in order to minimise surgical risk and post-operative neurological deficits. In addition to providing influential information regarding pre-operative risk assessment, the information provided by BOLD and DTI techniques is also critical to the neurosurgeon for developing intraoperative strategies and/or therapeutic approaches that otherwise might not be considered.
Procedures historically used as surgical mapping tools include the Wada test and direct electrical stimulation.3–6
techniques are invasive and can impose some risk to the patients.
In the last few years, several prospective studies have been conducted with the goal of quantifying relative costs and benefits
100 However, these
of using fMRI as an alternative pre-operative planning procedure, and evaluating concordance with currently used assessment tools. Studies directly comparing fMRI with Wada testing have demonstrated that fMRI imaging results significantly influence diagnostic and therapeutic decision-making, increase the confidence with which critical brain regions are identified and alter the surgical approach.7,8
Likewise, studies evaluating the effect of pre-operative fMRI localisation of language and motor areas on therapeutic decision- making show that treatment plans for nearly half of patients differ after fMRI assessment, surgical times are shortened, the spatial extent of resection is increased and craniotomy size is decreased, resulting in better outcomes and reduced risk of post-operative deficits.9
In addition, a recently published paper by Bizzi et al.10 compared fMRI with the current gold standard, intraoperative electrocortical mapping, and concluded that fMRI is a sensitive and specific method for mapping language and motor function.
Understanding the Application
Regardless of the application, using fMRI for pre-surgical mapping requires the evaluation of alternative imaging protocols to collect sufficient information to determine an optimal surgical approach. Imaging protocols differ in terms of their target brain region and functional complexity. All imaging protocols should include overt, measurable variables of behavioural performance in order to make unambiguous claims about associated neural activity.
© TOUCH BRIEFINGS 2010
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92 |
Page 93 |
Page 94 |
Page 95 |
Page 96 |
Page 97 |
Page 98 |
Page 99 |
Page 100 |
Page 101 |
Page 102 |
Page 103 |
Page 104 |
Page 105 |
Page 106 |
Page 107 |
Page 108 |
Page 109 |
Page 110 |
Page 111 |
Page 112 |
Page 113 |
Page 114 |
Page 115 |
Page 116