Delineating gray and white matter involvement in brain lesions: three-dimensional alignment of functional magnetic resonance imaging and diffusion-tensor imaging

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Object. The role of functional magnetic resonance (fMR) imaging has become increasingly important in the presurgical mapping of gray matter. Neurosurgical interventions often involve fiber bundles that connect critical functional areas. Recently, diffusion-tensor (DT) imaging has enabled the visualization of fiber bundle direction and integrity, thus providing the ability to delineate clearly white matter from gray matter tissue. The main objective of this study was to improve the presurgical assessment of critical functionality in the vicinity of brain lesions by combining DT and fMR imaging methodologies.

Methods. Twenty patients with various space-occupying brain lesions underwent imaging for presurgical evaluation of motor and/or somatosensory functions. The authors focus on five patients with diverse space-occupying brain lesions. Diffusion tensor—based fiber tracking and fMR imaging activation maps were superimposed in three dimensions to visualize pyramidal tracts corresponding to motor and somatosensory regional activation.

Conclusions. The combination of DT and fMR imaging for presurgical functional brain mapping provides valuable information that cannot be extracted using either method alone. The validity and sensitivity of noninvasive functional mapping for surgical guidance could be improved by considering results obtained with both methods. Furthermore, the use of three-dimensional visualization seems crucial and unique for viewing and understanding the complicated spatial relationship among the lesion, gray matter activation, and white matter fiber bundles.

Article Information

Address reprint requests to: Yaniv Assaf, Ph.D., Department of Radiology, Functional Brain Imaging Unit, The Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center, 6 Weizman Street, Tel-Aviv 64239, Israel. email: assafyan@post.tau.ac.il.

© AANS, except where prohibited by US copyright law.

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Figures

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    Case 1. A: A T2-weighted MR image of a brain slice obtained in a patient, demonstrating the tumor as a hyperintense area. B and C: Three-dimensional reconstructions of the brain showing the tumor in yellow; the thalamus, caudate, and putamen nuclei in different shades of green; right leg activation in orange; hand motor activation in magenta; and the pyramidal motor fibers in dark blue. Front (B) and top (C) views of the brain. D: An enlargement of the section of the tumor and the pyramidal tract motor fibers that pass through it, medial view.

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    Case 2. A: A T2-weighted MR image of a brain slice obtained in a patient, exhibiting the tumor as a hyperintense area in the left anteromedial region. B and C: Three-dimensional reconstructions of the brain showing the tumor in yellow; the thalamus, caudate and putamen nuclei in different shades of green; right and left leg activation areas in orange; right leg sensory activation area in purple; and pyramidal motor and sensory fibers in dark and light blue, respectively. Side (B) and top (C) views of the brain. D: An enlargement of the section of the tumor and the pyramidal tract motor fibers that pass through it, top view.

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    Case 3. A: A T1-weighted (post—Gd injection) and a T2-weighted image revealing the edematous region surrounding the rim of Gd enhancement. B and C: Three-dimensional reconstructions of the brain showing the Gd-enhanced region of the lesion in yellow; the entire lesion in off-white; the thalamus, caudate, and putamen nuclei in different shades of green; right leg activation area in orange; right hand activation area in magenta; tongue activation area in violet; and pyramidal motor fibers in dark blue. Front (B) and rear (C) views of the brain. D: Enlargement of the section of the tumor and pyramidal tract motor fibers that pass through it, rear view. E and F: Front and rear views of the brain, respectively, the tumor (yellow), edema region (off-white), and motor fibers (blue) measured 3 months postsurgery.

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    Case 4. A: A T1-weighted MR image showing the cavernoma at the frontoparietal region. B and C: Threedimensional reconstructions of the brain showing the tumor in yellow; the thalamus, caudate, and putamen nuclei in different shades of green; the left hand motor activation area in magenta; the sensory activation area in red; and the pyramidal motor and sensory fibers in dark and light blue, respectively. Rear (B) and top (C) views of the brain. D: Side view of the brain showing only the pyramidal tract fibers with respect to a section of the tumor.

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    Case 5. A: A T1-weighted MR image (post—Gd injection) revealing the meningioma in the right posterior parafalcine region. B and C: Three-dimensional reconstructions of the brain showing the tumor in yellow; the thalamus, caudate, and putamen nulei in different shades of green; the left leg motor and sensory activation areas in orange and purple, respectively; and the pyramidal motor and sensory fibers in dark and light blue, respectively. Rear (B) and side (C) views of the brain. D: Enlargement of a rear view of the tumor with respect to the sensory and motor fibers as well as activation areas.

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