Shengyu Fang1,2, Harrison X Bai3, Xing Fan2, Shaowu Li4, Zhong Zhang1, Tao Jiang1,2,5, Yinyan Wang1,2. 1. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. 2. Beijing Neurosurgical Institute, Capital Medical University, Beijing, China. 3. Department of Diagnostic Imaging, Rhode Island Hospital and Warren Alpert Medical School of Brown University, Providence, Rhode Island. 4. Functional Neuroradiology Center, Beijing Neurosurgical Institute, Beijing, China. 5. Beijing Institute for Brain Disorders Brain Tumor Center, Beijing, China.
Abstract
BACKGROUND: Use of conventional blood oxygen level-dependent functional magnetic resonance imaging (conventional-BOLD-fMRI) presents challenges in accurately identifying the hand-motor cortex when a glioma involves the ipsilateral hand-knob. Zoomed imaging technique with parallel transmission (ZOOMit)-BOLD is a novel sequence allowing high spatial resolution with a relatively small field of view that may solve this problem. OBJECTIVE: To compare the accuracy of ZOOMit-BOLD and conventional-BOLD in hand-motor cortex identification. METHODS: A total of 20 patients with gliomas involving the sensorimotor cortex were recruited to identify the hand-motor cortex by both ZOOMit-BOLD and conventional-BOLD. Based on whether the entire or partial glioma directly invaded (was located within) the hand-knob or indirectly affected it by proximity, patients were placed into the involved or uninvolved groups, respectively. Direct cortical stimulation was applied intraoperatively to verify the location of the hand-motor cortex. Overlap indices were used to evaluate the accuracy of the hand-motor cortex identification. An overlap index equal to 0, indicating lack of overlap, was classified as inaccurate classification. RESULTS: The accuracy of motor-cortex identification with ZOOMit-BOLD was 100% compared to only 65% with conventional-BOLD. The average overlap index yielded by ZOOMit-BOLD was higher than that of conventional-BOLD, regardless of whether gliomas directly invaded the hand-knob (P = .008) or not (P = .004). The overlap index in the involved group was significantly lower than that in the uninvolved group with both ZOOMit-BOLD (P = .002) and conventional-BOLD (P < .001). CONCLUSION: ZOOMit-BOLD may potentially replace conventional-BOLD to identify the hand-motor cortex, particularly in cases in which gliomas directly invade the hand-knob.
BACKGROUND: Use of conventional blood oxygen level-dependent functional magnetic resonance imaging (conventional-BOLD-fMRI) presents challenges in accurately identifying the hand-motor cortex when a glioma involves the ipsilateral hand-knob. Zoomed imaging technique with parallel transmission (ZOOMit)-BOLD is a novel sequence allowing high spatial resolution with a relatively small field of view that may solve this problem. OBJECTIVE: To compare the accuracy of ZOOMit-BOLD and conventional-BOLD in hand-motor cortex identification. METHODS: A total of 20 patients with gliomas involving the sensorimotor cortex were recruited to identify the hand-motor cortex by both ZOOMit-BOLD and conventional-BOLD. Based on whether the entire or partial glioma directly invaded (was located within) the hand-knob or indirectly affected it by proximity, patients were placed into the involved or uninvolved groups, respectively. Direct cortical stimulation was applied intraoperatively to verify the location of the hand-motor cortex. Overlap indices were used to evaluate the accuracy of the hand-motor cortex identification. An overlap index equal to 0, indicating lack of overlap, was classified as inaccurate classification. RESULTS: The accuracy of motor-cortex identification with ZOOMit-BOLD was 100% compared to only 65% with conventional-BOLD. The average overlap index yielded by ZOOMit-BOLD was higher than that of conventional-BOLD, regardless of whether gliomas directly invaded the hand-knob (P = .008) or not (P = .004). The overlap index in the involved group was significantly lower than that in the uninvolved group with both ZOOMit-BOLD (P = .002) and conventional-BOLD (P < .001). CONCLUSION: ZOOMit-BOLD may potentially replace conventional-BOLD to identify the hand-motor cortex, particularly in cases in which gliomas directly invade the hand-knob.