Siarhei Vysotski, Presenter: Nothing to Disclose

Casey Madura MD, Abstract Co-Author: Nothing to Disclose

Ryan L Holdsworth MD, Abstract Co-Author: Nothing to Disclose

Alejandro Munoz Del Rio PhD, Abstract Co-Author: Nothing to Disclose

Joel Wood, Abstract Co-Author: Nothing to Disclose

Bornali Kundu, Abstract Co-Author: Nothing to Disclose

Amy Utter BS, MS, Abstract Co-Author: Nothing to Disclose

Jed Kenneth Voss, Abstract Co-Author: Nothing to Disclose

Thomas Anthony Gallagher MD, Abstract Co-Author: Nothing to Disclose

Veena Nair MS, Abstract Co-Author: Nothing to Disclose

Aaron Scott Field MD, PhD, Abstract Co-Author: Nothing to Disclose

Chad H. Moritz RT, Abstract Co-Author: Nothing to Disclose

M. Elizabeth Meyerand PhD, Abstract Co-Author: Nothing to Disclose

John S Kuo MD, PhD, Abstract Co-Author: Nothing to Disclose

Vivek Prabhakaran MD, PhD, Abstract Co-Author: Nothing to Disclose

Studies have shown that functional magnetic resonance imaging (fMRI) activation patterns are consistent with the cortical responses seen during intraoperative brain mapping. However, more research is needed to better characterize the true clinical utility of preoperative fMRI, especially as an adjunct to preoperative risk assessment and surgical planning. This is particularly important in determining the extent to which fMRI can be used as a predictive model of surgical morbidity and mortality.

1727 adult patients undergoing resection of an intracranial mass between 2001 and 2009 at the University of Wisconsin were identified via retrospective review of neurosurgical case logs. 278 patients were included in the study with the following inclusion criteria: pathological diagnosis of glial or metastatic tumor, supratentorial cortical location, and first-time diagnosis of intracranial mass. Exclusion criteria included all tumors not of glial or metastatic origin, extra-axial lesions, and/or recurrent tumor. In addition to all pertinent demographic data, information regarding patient morbidity (motor and language deficits) and mortality was reviewed. Out of 278 patients,118 patients received a preoperative fMRI and 160 patients did not receive a preoperative fMRI.

Preliminary analysis of patients in both groups showed improved survival in the fMRI group (p=7.06*e-11) (see figure). This trend persisted after controlling for age, tumor volume, and tumor grade (p=0.0171). In patients with a pre-existing preoperative motor or language deficit, patients in the fMRI group had an increased incidence of postoperative motor deficits (p=0.012) and language deficits (p=0.039). Additional analysis of patients in both groups is in progress to further characterize these relationships.

1. Patients who received a preoperative fMRI had improved survival compared to patients who did not receive a preoperative fMRI (p=7.06*e-11). 2. This difference persisted even after controlling for age, tumor volume and tumor grade (p=0.017). 3. In the subset of patients with preoperative deficits, patients who did not receive a preoperative fMRI had a decreased incidence of speech (p=0.039) and motor (p=0.012) deficits compared to patients who did receive a preoperative fMRI.  

This research will better characterize the true clinical utility of preoperative fMRI.

Vysotski, S, Madura, C, Holdsworth, R, Munoz Del Rio, A, Wood, J, Kundu, B, Utter, A, Voss, J, Gallagher, T, Nair, V, Field, A, Moritz, C, Meyerand, M, Kuo, J, Prabhakaran, V, Clinical Utility of fMRI in Surgical Planning for Patients with Intracranial Tumors.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11013059.html