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a Department of
Neuroradiology, University Hospital of the Technical University,
Pauwelsstrasse 30, 52057 Aachen, Germany, b Department of Nuclear Medicine, c Department of Neurosurgery, d Department
of Neurology and Interdisciplinary Center for Clinical Research-Central
Nervous System
Correspondence to: Dr T Krings tkrings{at}izkf.rwth-aachen.de
Received 31 May 2001;
Accepted 27 July 2001
OBJECTIVES
Although
functional MRI is widely used for preoperative planning and
intraoperative neuronavigation, its accuracy to depict the site of
neuronal activity is not exactly known. Experience with methods that
may validate fMRI data and the results obtained when coregistering fMRI
with different preoperative and intraoperative mapping modalities
including metabolically based 18F-fluorodeoxyglucose PET,
electrophysiologcally based transcranial magnetic stimulation
(TMS), and direct electrical cortical stimulation (DECS) are described.
METHODSFifty patients
were included. PET was performed in 30, TMS in 10, and DECS in 41 patients. After coregistration using a frameless stereotactic system,
results were grouped into overlapping (<1 cm distance), neighbouring
(<2 cm), or contradictory (>2 cm).
RESULTSComparing fMRI
with PET, 18 overlapping, seven neighbouring, and one contradictory
result were obtained. In four patients no comparison was possible
(because of motion artefacts, low signal to noise ratio, and unusual
high tumour metabolism in PET). The comparison of TMS and fMRI showed
seven overlapping and three neighbouring results. In three patients no
DECS results could be obtained. Of the remaining 38 patients, fMRI hand
motor tasks were compared with DECS results of the upper limb muscles
in 36 patients, and fMRI foot motor tasks were compared with DECS
results of the lower limb on 13 occasions. Of those 49 studies,
overlapping results were obtained in 31 patients, and neighbouring in
14. On four occasions fMRI did not show functional information (because of motion artefacts and low signal to noise).
CONCLUSIONSAll
validation techniques have intrinsic limitations that restrict their
spatial resolution. However, of 50 investigated patients, there was
only one in whom results contradictory to fMRI were obtained. Although
it is not thought that fMRI can replace the intraoperatively updated
functional information (DECS), it is concluded that fMRI is an
important adjunct in the preoperative assessment of patients with
tumours in the vicinity of the central region.
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