Henning U Voss1, Kyung K Peck2, Nicole M Petrovich Brennan3, Eduard L Pogosbekyan4, Natalia E Zakharova4, Artyom I Batalov4, Igor N Pronin4, Alexander A Potapov4, Andrei I Holodny5. 1. Department of Radiology, Weill Cornell Medicine, New York, NY, USA. Electronic address: hev2006@med.cornell.edu. 2. Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Functional MRI Laboratory, Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. 3. The New School, New York, NY, USA. 4. Department of Radiology, Burdenko Neurosurgery Center, Moscow, Russia. 5. Department of Radiology, Weill Cornell Medicine, New York, NY, USA; Functional MRI Laboratory, Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Brain Tumor Center, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Department of Neuroscience, Weill-Cornell Graduate School of the Medical Sciences, New York, NY, USA.
Abstract
PURPOSE: Preoperative functional MRI (fMRI) is limited by a muted BOLD response caused by abnormal vasoreactivity and resultant neurovascular uncoupling adjacent to malignant brain tumors. We propose to overcome this limitation and more accurately identify eloquent areas adjacent to brain tumors by independently assessing vasoreactivity using breath-holding and incorporating these data into the fMRI analysis. METHODS: Local vasoreactivity using a breath-holding paradigm with the same timing as the functional motor and language tasks was determined in 16 patients (9 glioblastomas, 1 anaplastic astrocytoma, 5 low grade astrocytomas, and 1 metastasis) and 6 healthy control subjects. We derived an fMRI model based on an observed vaso-task response dependency that takes into account the altered hemodynamics adjacent to brain tumors. RESULTS: In both healthy controls and brain tumor subjects, we found a statistical dependency between breath-hold and task BOLD response. In tumor subjects, activation maps that take into account this vaso-task dependency demonstrated clinically meaningful areas of activation that were not seen using the task-only analysis in about half of the cases studied. This included localization of language areas adjacent to brain tumors. CONCLUSIONS: The present preliminary results demonstrate that neurovascular uncoupling known to affect the accuracy of BOLD fMRI adjacent to brain tumors may be, at least partially, overcome by incorporating an observed vaso-task dependency in the BOLD signal analysis.
PURPOSE: Preoperative functional MRI (fMRI) is limited by a muted BOLD response caused by abnormal vasoreactivity and resultant neurovascular uncoupling adjacent to malignant brain tumors. We propose to overcome this limitation and more accurately identify eloquent areas adjacent to brain tumors by independently assessing vasoreactivity using breath-holding and incorporating these data into the fMRI analysis. METHODS: Local vasoreactivity using a breath-holding paradigm with the same timing as the functional motor and language tasks was determined in 16 patients (9 glioblastomas, 1 anaplastic astrocytoma, 5 low grade astrocytomas, and 1 metastasis) and 6 healthy control subjects. We derived an fMRI model based on an observed vaso-task response dependency that takes into account the altered hemodynamics adjacent to brain tumors. RESULTS: In both healthy controls and brain tumor subjects, we found a statistical dependency between breath-hold and task BOLD response. In tumor subjects, activation maps that take into account this vaso-task dependency demonstrated clinically meaningful areas of activation that were not seen using the task-only analysis in about half of the cases studied. This included localization of language areas adjacent to brain tumors. CONCLUSIONS: The present preliminary results demonstrate that neurovascular uncoupling known to affect the accuracy of BOLD fMRI adjacent to brain tumors may be, at least partially, overcome by incorporating an observed vaso-task dependency in the BOLD signal analysis.
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