RT Journal Article
SR Electronic
T1 Multimodal Imaging in Malignant Brain Tumors: Enhancing the Preoperative Risk Evaluation for Motor Deficits with a Combined Hybrid MRI-PET and Navigated Transcranial Magnetic Stimulation Approach
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 266
OP 273
DO 10.3174/ajnr.A4536
VO 37
IS 2
A1 V. Neuschmelting
A1 C. Weiss Lucas
A1 G. Stoffels
A1 A.-M. Oros-Peusquens
A1 H. Lockau
A1 N.J. Shah
A1 K.-J. Langen
A1 R. Goldbrunner
A1 C. Grefkes
YR 2016
UL http://www.ajnr.org/content/37/2/266.abstract
AB BACKGROUND AND PURPOSE: Motor deficits in patients with brain tumors are caused mainly by irreversible infiltration of the motor network or by indirect mass effects; these deficits are potentially reversible on tumor removal. Here we used a novel multimodal imaging approach consisting of structural, functional, and metabolic neuroimaging to better distinguish these underlying causes in a preoperative setting and determine the predictive value of this approach.MATERIALS AND METHODS: Thirty patients with malignant brain tumors involving the central region underwent a hybrid O-(2-[18F]fluoroethyl)-L-tyrosine–PET-MR imaging and motor mapping by neuronavigated transcranial magnetic stimulation. The functional maps served as localizers for DTI tractography of the corticospinal tract. The spatial relationship between functional tissue (motor cortex and corticospinal tract) and lesion volumes as depicted by structural and metabolic imaging was analyzed.RESULTS: Motor impairment was found in nearly all patients in whom the contrast-enhanced T1WI or PET lesion overlapped functional tissue. All patients who functionally deteriorated after the operation showed such overlap on presurgical maps, while the absence of overlap predicted a favorable motor outcome. PET was superior to contrast-enhanced T1WI for revealing a motor deficit before the operation. However, the best correlation with clinical impairment was found for T2WI lesion overlap with functional tissue maps, but the prognostic value for motor recovery was not significant.CONCLUSIONS: Overlapping contrast-enhanced T1WI or PET-positive signals with motor functional tissue were highly indicative of motor impairment and predictive for surgery-associated functional outcome. Such a multimodal diagnostic approach may contribute to the risk evaluation of operation-associated motor deficits in patients with brain tumors.CEcontrast-enhancedCSTcorticospinal tractFAfractional anisotropyFETO-(2-[18F]fluoroethyl)-L-tyrosineKPSKarnofsky Performance ScaleM1primary motor areanTMSnavigated transcranial magnetic stimulationSPACET2-weighted sampling perfection with application-optimized contrasts using different flip angle evolution