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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 26:1980-1985, September 2005
© 2005 American Society of Neuroradiology

BRAIN

The Effect of Prior Surgery on Blood Oxygen Level–Dependent Functional MR Imaging in the Preoperative Assessment of Brain Tumors

Michael J.J. Kim^a, Andrei I. Holodny^a, Bob L. Hou^a, Kyung K. Peck^a, Chaya S. Moskowitz^b, Dmitry L. Bogomolny^a and Philip H. Gutin^c

^a Department of Radiology, Functional MRI Laboratory, Memorial Sloan-Kettering Cancer Center, New York, NY
^b Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY
^c Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, NY

Address correspondence to Andrei I. Holodny, MD, Department of Radiology, Functional MRI Laboratory, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021

BACKGROUND AND PURPOSE: Blood oxygen level–dependent functional MR imaging (BOLD fMRI) is a clinically useful technique for preoperative mapping of eloquent cortices in patients with brain tumors. The purpose of this study was to determine the effect on BOLD fMRI accuracy of susceptibility artifacts caused by prior surgery by comparing volumes of activation in the primary motor cortex (PMC) of patients with and without prior brain surgery.

METHODS: The volumes of fMRI activation of the PMC were measured for the tumor and nontumor sides in patients with (n = 13) and without (n = 30) prior neurosurgery. Statistical comparisons of the volumes were performed by using paired t tests and linear regression analysis. The location and degree of susceptibility artifact were subjectively assessed.

RESULTS: No significant difference was found between the mean tumor and nontumor volumes of fMRI activations in patients without prior surgery (P = .51). In patients who had prior surgery, the volume of activation was significantly smaller on the side of the prior operation when compared with the contralateral side (P = .001). The volume of activation on the side of the tumor was also significantly smaller in the patients with prior surgery compared with those without prior surgery (P < .001). Nevertheless, the PMC was identified in all cases, and its location was confirmed intraoperatively.

CONCLUSION: Prior surgery is associated with a decrease in the volume of fMRI activation in patients with prior surgery; however, by examining the T2 images, an astute radiologist can recognize this phenomenon, draw the appropriate conclusions, and correctly identify the PMC.

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