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KMID : 0880420230240060553
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Korean Journal of Radiology
2023 Volume.24 No. 6 p.553 ~ p.563
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Functional Magnetic Resonance Imaging and Diffusion Tensor Imaging for Language Mapping in Brain Tumor Surgery: Validation With Direct Cortical Stimulation and Cortico?Cortical Evoked Potential
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Kang Koung-Mi
Kim Kyung-Min
Kim In-Seong
Kim Joo-Hyun
Kang Ho
Ji So-Young
Dho Yun-Sik
Oh Hyong-Min
Park Hee-Pyoung
Seo Han-Gil
Kim Sung-Min
Choi Seung-Hong
Park Chul-Kee
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Abstract
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Objective : Functional magnetic resonance imaging (fMRI) and diffusion tensor imaging-derived tractography (DTI-t) contribute to the localization of language areas, but their accuracy remains controversial. This study aimed to investigate the diagnostic performance of preoperative fMRI and DTI-t obtained with a simultaneous multi-slice technique using intraoperative direct cortical stimulation (DCS) or corticocortical evoked potential (CCEP) as reference standards.
Materials and Methods : This prospective study included 26 patients (23?74 years; male:female, 13:13) with tumors in the vicinity of Broca’s area who underwent preoperative fMRI and DTI-t. A site-by-site comparison between preoperative (fMRI and DTI-t) and intraoperative language mapping (DCS or CCEP) was performed for 226 cortical sites to calculate the sensitivity and specificity of fMRI and DTI-t for mapping Broca’s areas. For sites with positive signals on fMRI or DTI-t, the true-positive rate (TPR) was calculated based on the concordance and discordance between fMRI and DTI-t.
Results : Among 226 cortical sites, DCS was performed in 100 sites and CCEP was performed in 166 sites. The specificities of fMRI and DTI-t ranged from 72.4% (63/87) to 96.8% (122/126), respectively. The sensitivities of fMRI (except for verb generation) and DTI-t were 69.2% (9/13) to 92.3% (12/13) with DCS as the reference standard, and 40.0% (16/40) or lower with CCEP as the reference standard. For sites with preoperative fMRI or DTI-t positivity (n = 82), the TPR was high when fMRI and DTI-t were concordant (81.2% and 100% using DCS and CCEP, respectively, as the reference standards) and low when fMRI and DTI-t were discordant (≤ 24.2%).
Conclusion : fMRI and DTI-t are sensitive and specific for mapping Broca’s area compared with DCS and specific but insensitive compared with CCEP. A site with a positive signal on both fMRI and DTI-t represents a high probability of being an essential language area.
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KEYWORD
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Functional MRI, Broca′s area, Diffusion tensor imaging, Direct cortical stimulation, Cortico?cortical evoked potential
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