Universität zu Köln

Neuschmelting, V., Lucas, C. Weiss, Stoffels, G., Oros-Peusquens, A. -M., Lockau, H., Shah, N. J., Langen, K. -J., Goldbrunner, R. and Grefkes, C. (2016). 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. Am. J. Neuroradiol., 37 (2). S. 266 - 274. DENVILLE: AMER SOC NEURORADIOLOGY. ISSN 1936-959X

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Abstract

Patients with malignant brain tumors involving the central region underwent a hybrid O-(2-[F-18]fluoroethyl)-L-tyrosine-PET-MR imaging and motor mapping by neuronavigated transcranial magnetic stimulation. The spatial relationship between functional tissue and lesion volumes as depicted by structural and metabolic imaging was analyzed. Tumor infiltration of the M1 region or the corticospinal tract as depicted by FET-PET is highly indicative of motor impairment, better than contrast-enhanced T1WI alone, and is of predictive value for operative-risk evaluation. 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-[F-18]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.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Neuschmelting, V. UNSPECIFIED UNSPECIFIED UNSPECIFIED Lucas, C. Weiss UNSPECIFIED UNSPECIFIED UNSPECIFIED Stoffels, G. UNSPECIFIED UNSPECIFIED UNSPECIFIED Oros-Peusquens, A. -M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Lockau, H. UNSPECIFIED UNSPECIFIED UNSPECIFIED Shah, N. J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Langen, K. -J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Goldbrunner, R. UNSPECIFIED UNSPECIFIED UNSPECIFIED Grefkes, C. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-286066
DOI:	10.3174/ajnr.A4536
Journal or Publication Title:	Am. J. Neuroradiol.
Volume:	37
Number:	2
Page Range:	S. 266 - 274
Date:	2016
Publisher:	AMER SOC NEURORADIOLOGY
Place of Publication:	DENVILLE
ISSN:	1936-959X
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language CORTICOSPINAL TRACT; INFILTRATION INDEX; PYRAMIDAL TRACT; FIBER TRACKING; DIFFUSION; GLIOMAS; LESIONS; GLIOBLASTOMA; RELIABILITY; METASTASES Multiple languages Clinical Neurology; Neuroimaging; Radiology, Nuclear Medicine & Medical Imaging Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/28606