Abstract
BOLD fMRI has, during the past decade, made a major transition from a purely research imaging technique to a viable clinical technique used primarily for presurgical planning in patients with brain tumors and other resectable brain lesions. This review article briefly examines the history and evolution of clinical functional imaging, with particular emphasis on how the use of BOLD fMRI for neurosurgical planning has changed during the past 2 decades. Even more important, this article describes the many published studies during that same period that have examined the overall clinical impact that BOLD and DTI have made on surgical planning.
Highlights
ABBREVIATIONS: AF ϭ arcuate fasciculus; ASFNR ϭ American Society of Functional Neuroradiology; BOLD ϭ blood oxygen levelϪdependent; CPT ϭ current procedural terminology; CPU ϭ central processing unit; CSM ϭ intraoperative cortical stimulation mapping; DTI ϭ diffusion tensor imaging; DTT ϭ diffusion tensor tractography; EPI ϭ echo-planar imaging; FA ϭ fractional anisotropy; FDA ϭ US Food and Drug Administration; fMRI ϭ functional MR imaging; GLM ϭ general linear model; MEG ϭ magnetoencephalography; PACS ϭ picture archiving and communication system; QC ϭ quality control; relatively low memory (RAM) ϭ random access memory; SPM ϭ Statistical Parametric Mapping; TL ϭ temporal lobe; TLE ϭ temporal lobe epilepsy; with those of the intracarotid sodium amobarbital (Wada) ϭ intracarotid sodium amobarbital test
Roessler et al[34] studied 22 patients with gliomas near the motor cortex who underwent both preoperative fMRI on a 3T MR imaging system and CSM. fMRI detected the primary motor cortex in all patients, but CSM was possible in only 17 of 22 patients (77.3%)
Some technical pitfalls of clinical BOLD imaging have been highlighted as a result of the growing use of this technique. Foremost among these is the phenomenon of neurovascular uncoupling, which refers to the uncoupling of the regional microvascular blood flow changes from adjacent neuronal activity often seen in high-grade brain tumors with tumor angiogenesis or in arteriovenous malformations that alter local cerebral hemodynamics; many biochemical mediators of the neurovascular coupling have been implicated, such as nitrous oxide, certain neurotransmitters, etc.[42,43,44]
Summary
ABBREVIATIONS: AF ϭ arcuate fasciculus; ASFNR ϭ American Society of Functional Neuroradiology; BOLD ϭ blood oxygen levelϪdependent; CPT ϭ current procedural terminology; CPU ϭ central processing unit; CSM ϭ intraoperative cortical stimulation mapping; DTI ϭ diffusion tensor imaging; DTT ϭ diffusion tensor tractography; EPI ϭ echo-planar imaging; FA ϭ fractional anisotropy; FDA ϭ US Food and Drug Administration; fMRI ϭ functional MR imaging; GLM ϭ general linear model; MEG ϭ magnetoencephalography; PACS ϭ picture archiving and communication system; QC ϭ quality control; RAM ϭ random access memory; SPM ϭ Statistical Parametric Mapping; TL ϭ temporal lobe; TLE ϭ temporal lobe epilepsy; Wada ϭ intracarotid sodium amobarbital test.
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