Presurgical fMRI and DTI for the Prediction of Perioperative Motor and Language Deficits in Primary or Metastatic Brain Lesions

被引:35
作者
Bailey, Paul D. [1 ,2 ]
Zaca, Domenico [3 ]
Basha, Mahmud Mossa [4 ]
Agarwal, Shruti [1 ,2 ]
Gujar, Sachin K. [1 ,2 ]
Sair, Haris I. [1 ,2 ]
Eng, John [2 ,5 ]
Pillai, Jay J. [1 ,2 ]
机构
[1] Johns Hopkins Univ Hosp, Russell H Morgan Dept Radiol & Radiol Sci, Div Neuroradiol, Baltimore, MD 21287 USA
[2] Johns Hopkins Univ, Sch Med, Baltimore, MD USA
[3] Univ Trento, Ctr Mind Brain Sci, Trento, Italy
[4] Univ Washington, Dept Radiol, Seattle, WA 98195 USA
[5] Johns Hopkins Univ Hosp, Russell H Morgan Dept Radiol & Radiol Sci, Div Gen & Diagnost Radiol, Baltimore, MD 21287 USA
关键词
Functional magnetic resonance imaging (fMRI); diffusion tensor imaging (DTI); brain tumor; neurological deficits; lesion to activation distance (LAD); white matter tract involvement; FUNCTIONAL MRI; CORTICOSPINAL TRACT; TRACTOGRAPHY; STIMULATION; GLIOMAS; NEURONAVIGATION; LOCALIZATION; ACTIVATION; MORBIDITY; MORTALITY;
D O I
10.1111/jon.12273
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
BACKGROUND AND PURPOSETo 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. METHODSWe 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. RESULTSIn 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). CONCLUSIONPresurgical 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.
引用
收藏
页码:776 / 784
页数:9
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